From the Guidelines
The recommended booster dose for rabies vaccination in previously vaccinated individuals is two IM doses (1.0 mL each) of vaccine, one immediately and one 3 days later, without the need for rabies immunoglobulin. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1.
Key Points
- The booster dose is crucial for previously vaccinated individuals exposed to rabies, as it stimulates an anamnestic response that is faster and stronger than the primary immune response.
- The standard booster regimen consists of two doses of rabies vaccine, administered intramuscularly in the deltoid, one immediately and one 3 days later.
- Rabies immunoglobulin (RIG) is unnecessary and should not be administered to previously vaccinated individuals, as an anamnestic response will follow the administration of a booster regardless of the prebooster antibody titer 1.
Booster Dose Considerations
- For pre-exposure prophylaxis, a single booster dose is recommended every 2-5 years for individuals with continuous or frequent risk of exposure.
- For those with infrequent exposure, antibody testing is preferred before administering a booster.
- The booster dose is essential for maintaining adequate protection against rabies, given its nearly 100% fatality rate once symptoms develop.
From the Research
Booster Dose of Rabies Vaccination
The World Health Organization recommends a booster dose of rabies vaccination as part of pre-exposure prophylaxis for individuals at risk of exposure to the rabies virus.
- The booster dose is typically given 2-3 weeks after the initial two doses, which are administered 1 week apart 2.
- A systematic booster dose after primary vaccination has been shown to confer a high and long-term immune response in nearly all individuals, except for rare low responders 3.
- The booster dose can be administered intradermally, with a dose of 0.1 ml of cell-culture rabies vaccine, and has been shown to be safe and immunogenic 2, 4.
Administration of Booster Dose
- The booster dose can be administered as a single dose, with studies showing that a one-dose intradermal rabies booster enhances rabies antibody production and avidity maturation 4.
- The World Health Organization has recommended a 1-site intradermal injection of 0.1 mL on days 0 and 3 as postexposure prophylaxis for individuals who have already been immunized against rabies 4.
- Changing the route of administration from intramuscular to intradermal during a single course of postexposure prophylaxis has been shown to be effective and safe 5.
Timing of Booster Dose
- The timing of the booster dose can vary, with some studies showing that a booster dose given 1 year after primary vaccination can provide long-term immune protection 2.
- Other studies have shown that a booster dose given 2-3 weeks after the initial two doses can provide adequate immune protection 2.
- The need for a booster dose should be determined based on individual risk factors and immune response, with adequate antibody levels monitored before the booster is administered 4.