Animal bite in Puerto Rico: what to do today, and why mongooses matter

According to the CDC and Puerto Rico’s Department of Health:

Mongooses were brought to Puerto Rico in the 19th century for pest control. According to a CDC report, they are now the principal reservoir of rabies on the island, accounting for nearly 75% of all animal rabies cases.

In 2015, a 54-year-old man in Puerto Rico died of rabies after a mongoose bit him in early October. The Department of Health explains that a mongoose that approaches or makes contact with a person is behaving erratically, which is a sign it may have rabies.

According to the CDC, dogs with rabies are not commonly found in Puerto Rico, but rabies is found in some wildlife and in bats. Even so, the Department of Health says anyone bitten by an animal should wash the wound and go to a health center or a doctor to decide what to do.

Post-exposure prophylaxis (PEP) is the treatment that prevents rabies after an exposure. According to the CDC, it includes wound washing, rabies immune globulin and rabies vaccine; for someone never vaccinated before, that is 4 vaccine doses on days 0, 3, 7 and 14. The CDC says it is highly effective if you get it as soon as possible, and that people who need it and don’t get it before symptoms start will most likely die.

PEP is given in person, at an emergency room or wherever you are referred; we do not give it or decide it by video. The clinician who treats you reports the bite to the Department of Health, which runs a surveillance system for animal bites and possible rabies exposure.

Bites are among the wounds with a higher risk of infection, according to MedlinePlus. A dog or cat bite that broke the skin needs to be cleaned and checked in person, especially if it is deep or on the face, hands, feet or a joint.

Tetanus: according to the CDC, after a dirty wound or a bite you get a booster if your last tetanus shot was 5 or more years ago. The shot is given in person, so ask about it at that visit.

Over the next days, watch for signs of infection: warmth and redness, throbbing pain, swelling, a red streak from the wound, pus or fever. Read about skin infection (cellulitis) and cuts and wounds.

We do not treat a fresh bite by video: cleaning, the rabies assessment and tetanus happen in person, the same day. Not sure where to go? Read ER vs urgent care in San Juan. The same applies if you are visiting: go to an ER today.

After you have been seen in person, Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, can see you by video to check how the wound is healing, look for signs of infection and answer your questions in an online doctor visit. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.

A doctor visit costs US$79, the same price for every age, with no membership; your card is charged when you request it, with a full refund if the visit can’t take place. Request a visit online 24/7 — we confirm your time by email or text. We send you a secure video link that works on your phone, tablet or computer. For patients under 21, a parent or legal guardian stays on camera with photo ID. Book your visit.

A few simple steps lower the risk:

Go to an emergency room or urgent care center today, or call 911 for severe bleeding. See when to go to the ER.