Effective Immediately: Rabies Post-exposure Prophylaxis Vaccine Regimen Changes to 4 Doses

Created 10/30/2009, Updated 3/8/2009

New Advisory Committee on Immunization Practices (ACIP) Recommendations for Rabies Post-exposure Prophylaxis (PEP)

Rabies PEP recommendations for unvaccinated persons:
Vaccine use
A regimen of 4 one-mL vaccine doses of rabies vaccine (HDCV or PCEV) should be administered intramuscularly to previously unvaccinated persons. The first day of treatment is designated day 0. Vaccine is given on days 0, 3, 7, and 14.

Immunosupression
For persons who are immunocompromised, post-exposure prophylaxis should be administered using all 5 doses of vaccine on days 0, 3, 7, 14 and 28.
Note: Pregnant women exposed to rabies may be given the standard 4 dose regimen.

Rabies immune globulin use
The recommendations for human rabies immune globulin (HRIG) use remain unchanged.
See tables below.

Rabies PEP recommendations for previously vaccinated persons:
The recommendations for post-exposure vaccination of previously vaccinated persons remain unchanged.
See tables below.

Post-vaccination serologic testing:
No testing of healthy persons, including pregnant women, completing the vaccine series is necessary to document seroconversion. For immunocompromised persons, a serum sample (2cc) should be tested for antibody by the rapid fluorescent focus inhibition test (RFFIT) to ensure that seroconversion has occurred (complete neutralization of challenge virus at a 1:5 serum dilution).

Table 1. Regimen for Rabies Post-Exposure Prophylaxis for Healthy, Immune Competent Persons, Including Pregnant Women.

Vaccination Status

Treatment

Dosage/Administration Guidelines for All Ages

Day of Regimen

Unvaccinated Persons

Local wound cleansing. Tetanus toxoid booster, if needed.

 

 

Human Rabies Immune Globulin (HRIG)

20 IU/kg body weight, given once. As much as possible of the HRIG should be infiltrated into and around the wound, and the remaining given IM at a site distant from the vaccine.

Day 0

Rabies Vaccine

Four 1-mL doses, given IM. Rabies vaccine must be given in the deltoid area of adults and older children. The vaccine may be given in the anterolateral thigh of young children. Never give rabies vaccine in the gluteals.

Days 0, 3, 7, 14

Previously Vaccinated
Persons
(Those who have completed a pre-exposure or post-exposure regimen of Human Diploid Cell Vaccine (HDCV) or Purified Chick Embryo Cell Vaccine (PCEC), or who have received another vaccine and had a documented rabies antibody titer ≥ 1:5 by the Rapid Fluorescent Focus Inhibition Test (RFFIT)

Local wound cleansing. Tetanus toxoid booster, if needed.

 

 

Rabies Vaccine

Two 1-mL does, given IM. Rabies vaccine must be given in the deltoid area. Never give rabies vaccine in the gluteals.

Do not give HRIG to previously vaccinated persons.

Days 0, 3

Table 2. Regimen for Rabies Post-exposure Prophylaxis (PEP) for Immunocompromised Persons.

Vaccination Status

Treatment/Testing

Dosage/Administration Guidelines for All Ages

Day of Regimen

Immunocompromised, Unvaccinated Persons

Local wound cleansing. Tetanus toxoid booster, if needed.

 

 

Human Rabies Immune Globulin (HRIG)

20 IU/kg body weight, given once. As much as possible of the HRIG should be infiltrated into and around the wound, and the remaining given IM at a site distant from the vaccine.

Day 0

Rabies Vaccine

Five 1-mL doses, given IM. Rabies vaccine must be given in the deltoid area of adults and older children. The vaccine may be given in the anterolateral thigh of young children. Never give rabies vaccine in the gluteals.

Days 0, 3, 7,
14, 28

Immunocompromised,
Previously Vaccinated
Persons

 

Local wound cleansing. Tetanus toxoid booster, if needed.

 

 

Rabies Vaccine

Two 1-mL does, given IM. Rabies vaccine must be given in the deltoid area. Never give rabies vaccine in the gluteals.

Do not give HRIG to previously vaccinated persons.

Days 0, 3

All Immunocompromised Persons Receiving Rabies PEP

Post Vaccination Serologic Testing

To document seroconversion, submit serum (2cc) for a rapid fluorescent focus inhibition test (RFFT). Antibody titer ≥ 1:5 is adequate.

1 to 2 weeks following rabies PEP

 

Updated Wednesday, 23-Oct-2013 12:38:58 CDT