From the Guidelines
The recommended dose of rabies vaccination is 1.0 mL given intramuscularly, with the number of doses depending on the individual's vaccination status and exposure history, as outlined in the most recent guidelines from the Advisory Committee on Immunization Practices (ACIP) 1. The vaccination regimen for rabies depends on several factors, including whether the individual is being vaccinated for pre-exposure prophylaxis or post-exposure treatment, and their previous vaccination history.
- For pre-exposure prophylaxis, three doses of rabies vaccine are recommended: on day 0, day 7, and day 21 or 28.
- For post-exposure prophylaxis in previously unvaccinated individuals, four doses of rabies vaccine are recommended: on days 0,3,7, and 14, along with Rabies Immune Globulin (RIG) at 20 IU/kg given once on day 0 1.
- For previously vaccinated individuals who are exposed, only two booster doses are needed on days 0 and 3, with no RIG required 1. The most common vaccines used are HDCV (Human Diploid Cell Vaccine) or PCECV (Purified Chick Embryo Cell Vaccine), both of which have been shown to be effective in preventing rabies when administered promptly after exposure 1. Rabies is nearly 100% fatal once symptoms appear, making proper vaccination crucial to prevent the disease 1. The vaccine works by stimulating the immune system to produce antibodies against the rabies virus before it can reach the central nervous system, thereby preventing the development of symptoms and reducing the risk of mortality 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION The recommended dose for HyperRAB S/D is 20 IU/kg (0.133 mL/kg) of body weight given preferably at the time of the first vaccine dose. VaccineHDCV, RVA, or PCEC 1. 0 mL, IM (deltoid area† ), one each on days 0‡, 3,7,14, and 28. The dose of rabies vaccination recommended is 1.0 mL of vaccine, administered intramuscularly in the deltoid area, on days 0,3,7,14, and 28 2.
- The vaccine can be either HDCV (human diploid cell vaccine), RVA (rabies vaccine adsorbed), or PCEC (purified chick embryo cell vaccine).
- For previously vaccinated individuals, the regimen is 1.0 mL of vaccine, administered intramuscularly in the deltoid area, on days 0 and 3 2.
From the Research
Rabies Vaccination Dose
The recommended dose of rabies vaccination is not explicitly stated in the provided studies. However, the studies discuss various aspects of rabies vaccination, including pre-exposure prophylaxis, immunogenicity, and cost-effectiveness.
Pre-Exposure Prophylaxis
- Pre-exposure rabies prophylaxis is recommended for individuals at high risk of rabies infection, such as those living in areas where rabies is common 3.
- The World Health Organization (WHO) recommends several different regimens for post-exposure prophylaxis, but individual countries decide on protocols for local use 4.
- Pre-exposure prophylaxis can reduce the risk of individual rabies and reduce the cost of post-exposure prophylaxis by establishing an immunologic barrier in advance and the memory immune response after the booster 3.
Immunogenicity and Dose-Response
- Both intradermal (ID) and intramuscular (IM) pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) produce adequate geometric mean titres (GMT) 5.
- Significantly lower GMT levels were achieved in older (>50 years) compared to younger (<50 years) participants 5.
- Short 1-week schedules were as effective as longer schedules that can take between 3 and 12 weeks to complete 5.
Cost-Effectiveness and Recommendations
- The evidence available indicates that shorter regimens and regimens involving fewer doses are safe and immunogenic, and that booster intervals could be extended up to 10 years 6.
- Pre-exposure rabies prophylaxis is safe and immunogenic and should be considered where access to post-exposure prophylaxis is limited or delayed, where the risk of exposure is high and may go unrecognized, and where controlling rabies in the animal reservoir is difficult 6.
- Provision of economical rabies prophylaxis can be improved, and decisions to change recommendations should take account of the immunological, financial, practical, and logistical aspects of dog bite treatment in remote areas 4.