A farmer's son was bitten deeply on the forearm by a stray dog suspected of being rabid. The wound is bleeding and the skin is broken. After thorough washing with soap and water, what additional measures are required?

• A Anti-rabies vaccine series only, since immunoglobulin is reserved for head and neck bites
• B Tetanus prophylaxis alone with observation of the dog for 10 days
• C Anti-rabies vaccine with immunoglobulin withheld until day 7 if antibody titers are low
• D Anti-rabies immunoglobulin infiltrated into and around the wound, followed by a full course of anti-rabies vaccine ✓

Explanation

A transdermal bite constitutes WHO Category III exposure, mandating both passive and active immunization. Equine or human rabies immunoglobulin must be infiltrated into the wound and surrounding tissue on the same visit to neutralize virus locally before it reaches nerves, followed by the full intradermal or intramuscular vaccine schedule. Delaying immunoglobulin sacrifices the window before neutralizing antibodies develop, and observation of the animal never replaces post-exposure prophylaxis for a proven or suspect rabid bite in India.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.