Rabies PEP Decision Tree
Rabies PEP Decision Tree - a deterministic tool in Sophie Well's Immunization & Infectious Disease group.
Open the Rabies PEP Decision Tree → Runs in your browser. No signup, no tracking.
What this is
Walk the CDC ACIP rabies post-exposure prophylaxis decision tree. Sophie Well asks about the exposure type (bite, scratch, mucous-membrane contact, or bat in the sleeping area), the animal species and its observation or testing status, the patient's prior rabies vaccination history, and any local public-health guidance, and returns the recommended PEP regimen: wound care, human rabies immune globulin dosing and infiltration around the wound, and the four-dose rabies vaccine series on days 0, 3, 7, and 14 (with a fifth dose on day 28 for immunocompromised patients). Source: CDC ACIP rabies PEP recommendations (current edition).
When to use it
Use this in the ED, urgent care, or primary care when a patient presents after a potential rabies exposure - dog or cat bite in an area without reliable observation, any bat exposure including a found bat in a bedroom, or contact with a wild carnivore. PEP is time-sensitive but not an emergency in the resuscitation sense; the right speed is hours-to-days, not minutes. Coordinate with the state or local health department before declining PEP for any wild-mammal exposure, because the rabies fatality rate once symptoms begin is effectively 100% and the cost-benefit math always favors prophylaxis when the exposure cannot be ruled out.
References
CDC/ACIP rabies post-exposure prophylaxis. Rupprecht CE, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: ACIP recommendations. MMWR Recomm Rep. 2010;59(RR-2):1-9.
Source: CDC rabies post-exposure prophylaxis decision aid
Sophie Well is a reference and educational tool. Not medical, legal, or financial advice. Does not replace clinician judgment, professional billing review, or legal counsel.