~100%
PEP effectiveness when started before symptoms appear
Bats
primary endemic rabies reservoir in LA County; all bat and wildlife contact requires evaluation
No time limit
PEP can be started anytime while the patient is asymptomatic; begin ASAP if indicated
Rabies rising
2026 has surpassed 2025, the previous record, for rabid bats in LA County
This page is intended for physicians. Looking for something else?
Reporting & Consultation
Clinical Questions from Providers
- Weekdays 8:00 AM to 5:00 PM:
- (213) 240-7941
- After-hours provider line:
- (213) 974-1234 (ask for physician on call)
Reporting Animal Bites & Assessment of Rabies Risk
All mammal bites must be reported to Public Health. Bites from small rodents (e.g., rats, mice, and squirrels) and rabbits are not reportable for rabies exposure purposes. Public Health is also available for consultation with members of the public on rabies exposure risk assessment.
- Phone: (213) 288-7060 (weekdays 8:00 AM to 5:00 PM)
- Email: vet@ph.lacounty.gov
- Send Animal Bite Reporting Form for Medical Facilities by secure email to vet@ph.lacounty.gov
- Fax Animal Bite Reporting Form for Medical Facilities to 213-481-2375
- Report online via the Animal Bite Reporting Portal
Clinical Guidance
PEP Checklist & Admin TipsDetermine Need for PEP
Step 1 Collect information about the exposure
Promptly obtain detailed information about the exposure and animal involved, including where the animal is now. Every effort should be made to safely locate and detain the biting animal; capture enables testing or quarantine to determine if the animal actually has rabies, and therefore may eliminate the need for PEP.
Collect and document:
- Animal species, breed, ownership, vaccination status, and availability of rabies records
- Date, location, and description of the incident (e.g. animal behavior before, during, and after the incident, precipitating factors)
- Current location of the animal and any details that may help determine whether it can be safely confined, observed, or tested
- If the animal is available, the patient should contact their local Animal Control agency for capture, quarantine, and/or testing
- Type of exposure: bite, scratch from a tooth, saliva contact with mucous membranes or broken skin, or bat encounter where an unrecognized bite may have occurred
Step 2 Report the animal bite to Public Health
Do not delay consultation with public health while awaiting vaccination records or animal capture if the exposure is high risk. Report the bite.
Step 3 Evaluate need for PEP
With the information collected and in consultation with Public Health as needed, determine whether PEP is appropriate. If PEP will be pursued, determine whether the person was previously vaccinated and follow the appropriate administration schedule.
Local Risk Assessment by Exposure
Rabies Post-Exposure Prophylaxis Algorithm
Post-Exposure Prophylaxis (PEP)
Step 1 Wound Care: Do this immediately
Thoroughly cleanse all wounds with soap and water. If available, irrigate with a virucidal agent (e.g., povidone-iodine solution). Wound cleansing alone markedly reduces the risk of rabies infection. Consider antibiotic therapy, tetanus prophylaxis, and other wound care needs as clinically indicated.
Step 2 Human Rabies Immune Globulin (HRIG)
- Do NOT give HRIG to previously rabies-vaccinated patients.
- Administer HRIG once only at the start of PEP to provide immediate passive immunity while the vaccine series takes effect.
- If HRIG is unavailable on Day 0, it can and should still be given up to Day 7 of the vaccine series.
- Dose: 20 IU/kg. Infiltrate as much as possible into and around the wound(s). Administer any remaining volume IM at a site anatomically distant from the vaccine injection.
- If PEP is indicated but no wound is identifiable, administer the full HRIG dose IM. Do not withhold HRIG solely because a bite cannot be found.
- HRIG must NEVER be given in the same syringe or anatomical site as the first vaccine dose. Do not exceed the recommended dose.
- Avoid the gluteal muscle for HRIG unless the bite wound is located there (risk of sciatic nerve injury).
Step 3 Rabies Vaccine
Administer rabies vaccine 1.0 mL IM. Use the deltoid area for adults; anterolateral thigh is also acceptable for young children. Do not administer in the gluteal area; any dose administered in the gluteal region must be repeated.
- The first day of rabies PEP is called Day 0
- For patients not previously vaccinated, give doses on Days 0, 3, 7, and 14.
- For patients not previously vaccinated who are immunocompromised, give 5 doses on Days 0, 3, 7, 14, and 28.
- For patients previously vaccinated, give doses on Days 0 and 3 only; HRIG is not given.
PEP Schedules
• HRIG
• Vaccine #1
(immunocompromised patients)
• Vaccine #1
A patient qualifies for the simplified 2-dose regimen (no HRIG) if they have completed any one of the following:
- Completed full prior PEP series (4+ doses)
- Completed 3-dose PrEP (days 0, 7, plus one dose between day 28 and 3 years)
- Completed 2-dose PrEP (days 0 & 7) within the past 3 years
- Completed 2-dose PrEP (days 0 & 7) plus confirmed titer ≥ 0.5 IU/mL
If none apply, treat as unvaccinated. If uncertain, call ACDC: (213) 240-7941. Source: ACIP Rabies PrEP Recommendations, MMWR 2022
Obtaining Rabies Biologics
Any physician can order rabies vaccine and HRIG directly for their patient – there is no minimum order requirement. For ordering information, see the VPH PEP Checklist and CDC: Rabies Biologics.
Do not refer insured patients to public health for treatment. Any physician can quickly receive and administer rabies biologics. Please actively help your patient access and complete the full vaccine series.
Patients often initiate PEP in an emergency department, particularly when a bite occurs after hours or when rapid access to HRIG is needed. However, patients who receive Day 0 treatment in an emergency department may be able to complete the remaining vaccine doses (Days 3, 7, and 14) with their primary care provider or at an urgent care, which may significantly reduce out-of-pocket costs. Advise patients to bring documentation of Day 0 treatment to any follow-up appointment.
Special Populations & Clinical Considerations
- Give a 5-dose vaccine series (Days 0, 3, 7, 14, and 28).
- Counsel patients that their immune response may be inadequate.
- Test for rabies virus neutralizing antibody after completing the series.
- Avoid immunosuppressive agents during PEP unless essential.
Pre-Exposure Prophylaxis (PrEP)
PrEP is recommended for people at elevated occupational or recreational risk of rabies exposure. While PrEP does not provide 100% protection against rabies infection, it significantly simplifies post-exposure management for patients who are later exposed. Previously vaccinated individuals do not require HRIG following a rabies exposure and need only two vaccine doses for PEP.
Who Should Receive PrEP
- Individuals who work directly with animals that could have rabies, such as veterinary staff, animal control officers, wildlife researchers
- International travelers who work with animals in parts of the world where rabies is common and access to medical care is limited
Note: Rabies PrEP is not recommended for the general U.S. population. Individuals should not approach, try to feed, or interact with unknown animals.
CDC: PrEP Guidance & Previously Vaccinated CriteriaLA County Resources
PEP Ordering Information & Bite Reporting Checklist
Animal Bites & Rabies Risk Reference Poster
Rabies: Which Patients Need PEP?
Bats in the Home: Clinical Decision Flowchart
Online Animal Bite Reporting Portal
What to do if you find a bat: poster
News & Updates
- News Release: On World Rabies Day, Public Health Warns of Record Rabid Bat Detections in Los Angeles County (9-28-26)
- Significant Increase in Rabid Bats in LA County: What Providers Need to Know about Rabies Post Exposure Prophylaxis (9-4-26)
- Public Health Reports Second-Highest Number of Rabid Bats Ever Recorded in LA County (11-5-25)
- Rabid Bats More Common During Summer and Fall (7-25-23)
- Potential Rabies Exposure at Malibu Cafe/Calamigos Ranch (6-10-22)
- Health Advisory: Avoid Contact with Bats (7-22-11)
- Human Rabies Death in L.A. County: First Human Case in 30 Years (PDF, 2005 Special Study)
- Canine Rabies Importation into L.A. County (PDF, 2004 Special Study)