Rabies
Rabies Postexposure Prophylaxis (PEP) Schedule (1)
Adapted from: Centers for Disease Control and Prevention. Use of a
Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to
Prevent Human Rabies: Recommendations of the Advisory Committee on
Immunization Practices (ACIP) MMWR
2010;59(No. RR-2)
I. FOR PERSONS NOT PREVIOUSLY VACCINATED:
Wound cleansing
All PEP should begin with immediate thorough
cleansing of all wounds with soap and water. If available, a virucidal
agent (e.g., povidine-iodine solution) should be used to irrigate the
wounds.
Human rabies immune globulin (HRIG)
Administer 20 IU/kg body weight.
If anatomically feasible, the full dose should be infiltrated around and
into the wounds(s), and any remaining volume should be administered at
an anatomical site (intramuscular [IM]) distant from vaccine
administration. Also, HRIG should not be administered in the same
syringe as vaccine. Because HRIG might partially suppress active
production of rabies virus antibody, no more than the recommended dose
should be administered.
Vaccine
Human diploid cell vaccine (HDCV) or purified chick embryo
cell vaccine (PCECV) 1.0 mL, IM (deltoid area (2)), 1 each on days 0
(3),
3, 7, and 14. (4)
Both HRIG and vaccine should be used, regardless of how long ago the
exposure occurred. There is no approved regimen in the USA that omits
the use of HRIG for persons who were not previously vaccinated. Note
also that the number of vaccine doses recommended for the PEP of immune
competent persons has decreased from 5 to 4 doses.
II. FOR PERSONS WHO WERE PREVIOUSLY VACCINATED: (5)
Wound cleansing
All PEP should begin with immediate thorough
cleansing of all wounds with soap and water. If available, a virucidal
agent such as povidine-iodine solution should be used to irrigate the
wounds.
Vaccine
HDCV or PCECV 1.0 mL, IM (deltoid area (2)), 1 each on days 0
(3),
and 3.
HRIG should NOT be administered.
(1) These regimens are applicable for all age groups, including
children.
(2) The deltoid area is the only acceptable site of vaccination for
adults and older children. For younger children, the outer aspect of the
thigh may be used. Never administer the vaccine in the gluteal area.
(3) Day 0 is the day dose 1 of vaccine is administered
(4) For persons with immunosuppression, rabies PEP should be administered
using 5 doses of vaccine on days 0, 3, 7, 14, and 28.
(5) "Previously vaccinated" is defined as any person with a history of pre-exposure vaccination with HDCV,
PCECV, or rabies vaccine adsorbed (RVA); prior PEP with HDCV, PCECV, or
RVA; or previous vaccination with any other type of rabies vaccine and a
documented history of antibody response to the prior vaccination.
Last Revised:
June 12, 2012 |
