Rabies postexposure prophylaxis should be given after which exposure?

• A. Only after a bite
• B. Only after contact with saliva
• C. Only after symptoms appear
• D. When there has been close mucous membrane exposure

Answer: (D)

Rabies prophylaxis is given whenever there is a possible exposure to rabies virus, which is primarily transmitted through saliva reaching the body's tissues. The best answer recognizes that not only bites but any contact where saliva touches mucous membranes or broken skin can transmit the virus. Close mucous membrane exposure—such as saliva contact with the eyes, nose, or mouth—constitutes a potential exposure and warrants prompt postexposure prophylaxis. Starting PEP promptly after such exposures is crucial, because once symptoms appear, rabies is almost always fatal. Limiting the criterion to bites misses other important routes, and waiting for symptoms delays lifesaving treatment.