Rabies Pre-Exposure Prophylaxis Regimen
Animal Bites and Rabies Risk:A Guide for Health Professionals

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Rabies Pre-Exposure Prophylaxis Regimen
Who should receive rabies pre-exposure prophylaxis?
Pre-exposure rabies vaccination series
Antibody titers and booster vaccination
Laboratories offering RFFIT rabies antibody titer testing

Rabies Pre-Exposure Prophylaxis Regimen

Pre-exposure vaccination against rabies simplifies the rabies post-exposure treatment, and it may protect in cases of unrecognized rabies exposure or when post-exposure treatment is delayed. It does not eliminate the need for appropriate treatment following a known rabies virus exposure.

Who should receive rabies pre-exposure prophylaxis?

  • Veterinarians, veterinary technicians, animal control officers, wildlife rehabilitators, zoo employees, certain laboratory workers, and others who have regular contact with potentially rabid animal species.
  • International travelers to areas with endemic canine rabies who are likely to come into contact with dogs or wild animals and where access to medical care and appropriate biologics may be limited.

Pre-exposure rabies vaccination series

  • Three 1.0 mL doses of rabies vaccine are given IM, one injection per day, on days 0, 7, and 21 or 28, in the deltoid area of adults or in the anterolateral thigh of young children.
  • Human diploid cell vaccine (HDVC) or purified chick embryo cell vaccine (PCEC) may be used, although it is recommended that the vaccine series be initiated and completed with the same vaccine product.
  • No HRIG should be given.

Antibody titers and booster vaccination

    • Following their initial rabies vaccination series, persons in high-risk occupations should have their virus neutralizing rabies antibody titers checked periodically (Table 5).
      • Every 6 months in persons in the continuous-risk category.
      • Every 2 years for persons in the frequent-risk category.  
    • The RFFIT (Reference 7) is the only recommended test for determining virus neutralizing antibody levels against the rabies virus. Other available titer tests (including the ELISA test) are not recommended for this purpose.
    • There are currently two working guidelines (or recommended “cut-offs”) for antibody titer levels below which a rabies-vaccinated person should receive a booster vaccination.
      • The ACIP (Reference 1, pg. 19) recommends that a single booster rabies vaccination be given when the titer falls below that corresponding to complete neutralization at a serum dilution ≥ 1:5 by the rapid fluorescent focus inhibition test (RFFIT), a virus neutralization test. Complete viral neutralization at a 1:5 dilution is approximately equal to a titer of 0.1-0.2 IU/mL, depending on the reporting laboratory.
        • MDH generally recommends that the ACIP guideline be used.
        • WHO recommends that a single booster rabies vaccination be given when the titer drops below 0.5 IU/mL by the RFFIT.
        • Healthcare providers should take into consideration their patient’s risk of exposure, time until the next titer test, previous rabies titer results, health status, and accessibility to healthcare should a potential exposure occur, when determining when to administer a rabies vaccine booster to a patient.

Laboratories offering RFFIT rabies antibody titer testing

Both require 2.0 mL serum.

Rabies Laboratory
Kansas State University
2005 Research Park Circle
Manhattan, KS 66502 
785-532-4483
www.vet.k-state.edu/depts/dmp/service/rabies/rffit.htm
Attention: Non-MDH link.
Testing at KSU may also be requested through Quest Labs
 as Rabies Vaccine Response End Point Titer (order # 5789)

Atlanta Health Associates
309 Pirkle Rd, Suite D-300      
Cummings, GA 30040
1-800-717-5612
www.atlantahealth.net
Attention: Non-MDH link.

 

Updated Tuesday, August 12, 2014 at 04:10PM