Rabies Concerns After Cat Scratch: What You Need to Know

Q: Rabies Concerns After Cat Scratch: What You Need to Know

Dear Mr. <br>Wang：<br>1. <br>The risk of rabies in Taiwan is currently limited to wild animals in the central, southern, and eastern mountainous regions, with the main infected species being the ferret badger, along with a few cases involving the white-nosed coati. <br>According

Rabies Consultation

Hello Doctor: About a week ago, while I was feeding stray cats near my home (in the Taoyuan District), I was scratched on the back of my hand near the webbing between my thumb and index finger.
At the time, there were only superficial scratch marks and no bleeding.
Another wound seemed to be slightly punctured by a claw, with a little bit of bleeding.
About a day after being scratched, the wounds completely healed.
However, starting yesterday, I began to experience a slight throbbing pain under my thumb nail, and I am worried that this could be a sign of rabies.
I have been observing that cat for a week, and it has not shown any unusual behavior.
I also checked and found that there are currently no rabies outbreaks in the northern region, including among wildlife, which gives me some relief.
However, I would like to ask you, Doctor, if there is a possibility of infection in this situation? Should I continue to monitor it, or as some sources online suggest, if the cat does not show symptoms within 10 days, I can consider it safe? Thank you again for taking the time to respond.

Mr. Wang, 20~29 year old female. Ask Date: 2020/10/31

Dr. Xiao Yongxun reply Family Medicine

Dear Mr.
Wang:
1.
The risk of rabies in Taiwan is currently limited to wild animals in the central, southern, and eastern mountainous regions, with the main infected species being the ferret badger, along with a few cases involving the white-nosed coati.
According to the rabies surveillance data for stray dogs and cats from the Council of Agriculture from 1999 to 2017, all results were negative.
Furthermore, the country continues to promote rabies vaccination for dogs and cats, resulting in an extremely low risk of rabies virus infection in domestic pets.
For "stray dog or cat bite victims," rabies vaccination is not administered as it is for domestic dog or cat bite victims.
If the animal is observed for 10 days and shows suspected rabies symptoms, and if there is a high suspicion from the animal inspection authority, then vaccination will be given.
2.
Post-exposure wound management primarily involves immediate and thorough washing of the wound with soap and plenty of water for at least 15 minutes, followed by disinfection with povidone-iodine or 70% alcohol.
If possible, avoid suturing the wound; if suturing is necessary, it should be done as loosely as possible to avoid impeding blood flow and the drainage of other secretions.
If immunoglobulin infiltration injection is administered to the wound, it is recommended to wait a few hours (no less than 2 hours) before suturing, allowing antibodies to adequately diffuse within the tissue before closure.
The administration of antibiotics, tetanus vaccine, or tetanus immunoglobulin should be treated similarly to other bite wound management.
3.
You have sustained a cat scratch; it is recommended to observe or capture the cat for 10 days.
If the cat dies or shows signs of illness, consideration should be given to administering the rabies vaccine.
Of course, if you are very concerned, you may consider self-paying for the rabies vaccine series of four doses (totaling approximately several thousand New Taiwan Dollars).
4.
Additionally, it is advisable for you to seek treatment for the wound at a surgical outpatient department of a regional hospital or higher.
Apart from the risk of rabies, animal bites are more commonly associated with aerobic or anaerobic bacterial infections, which may sometimes require antibiotic treatment.
If you still have questions, it is recommended to discuss them with your family physician.
5.
Feeding or approaching stray or wild animals is not recommended, as highlighted by various research reports.
Clinically, we often encounter cases where patients have been bitten or scratched due to feeding or approaching stray animals.

Reply Date: 2020/10/31

More Info

When it comes to concerns about rabies after being scratched by a cat, it's essential to understand the risks and the necessary precautions. Rabies is a viral disease that affects the central nervous system and is almost always fatal once symptoms appear. The virus is typically transmitted through the saliva of an infected animal, most commonly through bites. Scratches can also pose a risk, especially if the cat is infected and has saliva on its claws.

In your case, you were scratched by a stray cat, and while the scratch did not draw significant blood, there are still considerations to keep in mind. The fact that you observed the cat for a week without any signs of illness is reassuring, as rabies symptoms in cats typically manifest within 10 days of infection. If the cat remains healthy and shows no signs of rabies, such as aggression, excessive drooling, or neurological symptoms, the risk of transmission is significantly reduced.

However, it is important to note that rabies can have an incubation period that varies widely, and symptoms may not appear immediately. The general guideline is to monitor the animal for 10 days. If the cat remains healthy during this period, it is unlikely that it was shedding the rabies virus at the time of the scratch.
Regarding your symptoms, the pain under your thumbnail could be due to a variety of reasons, including inflammation or irritation from the scratch itself, rather than an indication of rabies. It’s not uncommon for minor injuries to cause discomfort as they heal. However, if you experience worsening symptoms, such as swelling, redness, or fever, it would be prudent to seek medical attention.

In terms of preventive measures, if you have not already done so, it is advisable to consult with a healthcare professional about post-exposure prophylaxis (PEP) for rabies. This is particularly important if the cat's rabies vaccination status is unknown. PEP typically involves a series of rabies vaccinations and, in some cases, rabies immune globulin, which can be critical in preventing the onset of the disease if there is a risk of exposure.

In summary, while your immediate observation of the cat and the lack of severe symptoms are positive signs, it is essential to remain vigilant. Continue to monitor your health and the cat's behavior. If there are any changes or if you have concerns about rabies exposure, do not hesitate to contact a healthcare provider for further evaluation and potential rabies vaccination. It is always better to err on the side of caution when it comes to rabies, given the severity of the disease.

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