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).
- Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies
MMWR: March 19, 2010 / 59(02);1-9
- ACIP Provisional Recommendations for the Prevention of Human Rabies (PDF: 28KB/1 page)
The full 2009 ACIP provisional rabies PEP recommendations.
- Rabies Vaccine VIS (PDF: 155KB/2 pages)
The new rabies VIS.
- Please contact Dr. Joni Scheftel, Dr. Stacy Holzbauer or Carrie Klumb at 651-201-5414 if you have any questions and for more information.
- There is no longer a passcode required to obtain Imovax rabies vaccine from Sanofi Pasteur. However, consultation about potential rabies exposures and the need for post-exposure prophylaxis (PEP) continues to be available to healthcare providers 24/7 and to the public during business hours, at 651-201-5414 or 1-877-676-5414.
- Animal Bites and Rabies Risk
Animal bites and rabies risk information, including information about bat exposures.
- Animal Bites and Rabies Risk
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 |
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, |
|
Immunocompromised,
|
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 |
