First Aid for Cat Bites and the Risk of Rabies

Expert Pediatrics Q&A

A stray cat hidding under a house.
Teach your kids to not play with stray or ferel cats. J. MacNeill-Traylor/Getty Images

Q. My preschooler was bitten by a stray cat in the neighborhood this afternoon. What should I do?

A. In addition to basic first aid, which includes stopping the bleeding, cleaning the wound with soap and water, and applying an antibiotic ointment and bandage to the bite, you should call your local animal control agent, health department, and/or pediatrician to see if your child is at risk for:

  • a bacterial infection - many cats, although they don't have symptoms, have the Pasteurella multocida bacteria in their mouth, which can cause wound infections in children
  • tetanus - especially if it has been more than 5 years since your child's last tetanus shot and the cat bite is very deep or is contaminated with dirt, etc.
  • rabies - surprisingly, more reported rabies cases in the United States involve cats than dogs, although those cases are still much lower than the incidence of rabies in wild animals.

Antibiotics for Cat Bites

Cat bite wounds are susceptible to infection, especially with the P. multocida bacteria, so it is usually recommended that kids be treated with an antibiotic, such as Augmentin, after getting bitten by a cat.

If a child is allergic to penicillin, then he will likely be treated with a combination of clindamycin with either Bactrim or an extended spectrum cephalosporin.

Rabies and Cat Bites

The risk of getting rabies from a cat is fairly low, with most cases of rabies now occurring in wild animals, such as raccoons, skunks, bats, and foxes.

Still, about 7 percent of rabies cases occur in domestic animals, including cats and dogs.

Although not common, affecting only 1 to 3 people in the United States each year, since rabies is almost always fatal, most experts recommend erring on the side of caution if you think your child could have been exposed to rabies.

That means having the animal quarantined and observed for 10 days if possible, or if you really think the animal could have had rabies and they can't find the cat to see if it has rabies, getting your child human rabies immune globulin (HRIG) and beginning the first, in a series of four, rabies shots as soon as possible. After the first dose of vaccine, it is repeated 3, 7, and 14 days later.

Your local animal control agent, health department, and pediatrician can help determine if your child needs rabies shots after getting bitten by a stray cat.

In addition to the incidence of rabies in wild animals in your area (if a lot wild animals have rabies, then it is more likely that one of them could have infected this stray cat...), the experts you consult will likely consider whether or not the cat was provoked to bite your child. An unprovoked attack is more suspicious to be from a rabid animal. On the other hand, if your child was trying to pet or pick up the cat and then got bit, that would be considered a provoked attack and would be less suspicious, although it wouldn't prove that the cat didn't have rabies.

Cat Scratch Fever

Children with cat scratch fever develop a brownish-red bump or sore about 7 to 12 days after being scratched, bitten, or licked by a cat, or more commonly a kitten, at the same site as the initial wound. A few weeks later, they will develop a slowly enlarging lymph node or gland in the same area. For example, if they were scratched on the arm, they may have an enlarged gland in their armpit.

Although children are more likely to get cat scratch fever from stray cats versus their own pet cat, at this point you should just watch and remind your pediatrician about the cat bite if your child develops any symptoms of cat scratch fever in the next few weeks.

What To Know About Cat Bites

Other things to know if your child gets bitten by a cat include that:

  • If your child is bitten by a friend's or neighbor's cat, be sure to check and make sure the cat had its rabies shots.
     
  • A child with a cat bite may need a tetanus shot.
     
  • Kids usually develop symptoms of rabies 1 to 3 months after they are exposed to the bite of a rabid animal, although it is important to keep in mind that the incubation period can range from a few days to several years later.
     
  • To prevent rabies, tell your kids not to play, feed, or touch wild animals, especially raccoons, skunks, bats, coyotes, and foxes, or stray domestic animals, including dogs and cats. There were reports of almost 6,000 rabid animals in the US in 2013.
     
  • Although very few people develop rabies in the US, there are at least 40,000 to 50,000 rabies postexposure treatments (human rabies immune globulin plus a set of four rabies shots) given each year.
     
  • Small rodents, such as squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice, and rabbits, usually don't have rabies.
     

Most importantly, after a cat bite or scratch, call or see your pediatrician to see if your child needs antibiotics, a tetanus shot, and to see if they are at risk for rabies.

Sources:

CDC. National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Rabies. Accessed May 2016.

Dyer et al. Rabies surveillance in the United States during 2013. JAVMA, Vol 245, No. 10, November 15, 2014

Human Rabies Prevention - United States, 1999 Recommendations of the Immunization Practices Advisory Committee (ACIP).

Long: Principles and Practice of Pediatric Infectious Diseases, 2nd ed.

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