Rabies Post-Exposure Prophylaxis

 

Risk of developing rabies if untreated:

• bite exposure to rabid animal: 5-60%

• scratch or saliva exposure or mucous membrane exposure: 0.1-2%

 

Human rabies immune globulin (HRIG) administration:

(1) Infiltrate as much of the dose as possible into the wound(s) and surrounding tissue.

(2) Administer the remainder intramuscularly at an anatomic site as remote as possible from the site of vaccine administration.

(3) Do not use the same syringe as for the vaccine since these will inactivate each other.

(4) Do not use more than the recommended dose, since HRIG may partially suppress active production of antibody in response to the vaccine.

 

Vaccines:

(1) HDCV: human diploid cell vaccine

(2) RVA: rabies vaccine absorbed

(3) PCEC: purified chick embryo cell culture vaccine

 

Definition of previously vaccinated - one or more of the following:

(1) history of pre-exposure vaccination with HDCV, RVA, PCEC

(2) previous post-exposure prophylaxis with HDCV, RVA, PCEC

(3) previous vaccination with other type of rabies vaccine, with documented antibody response

 

Intramuscular vaccination site:

(1) adults and older children: deltoid area (only acceptable site)

(2) young children: deltoid area or outer aspect of thigh

DO NOTuse the gluteal region.

 

Previously Vaccinated

Intervention	Regimen
local wound cleaning	immediate thorough cleaning of all wounds with soap and water
human rabies immune globulin	not given
vaccine	1.0 mL of HDCV, RVA or PCEC vaccine administered intramuscularly on day 0 and day 3

 

where:

• day 0 = first day of treatment

 

Not Previously Vaccinated

 

Intervention	Regimen
local wound cleaning	immediate thorough cleaning of all wounds with soap and water
human rabies immune globulin	administer 20 IU per kilogram of body weight
vaccine	1.0 mL of HDCV, RVA or PCEC vaccine administered intramuscularly on days 0, 3, 7, 14, and 28

 

where:

• day 0 = first day of treatment