Yes, Give the Second Rabies Vaccine Dose on Schedule
A child with febrile tonsillitis should receive the second dose of rabies vaccine as scheduled on day 3 after a dog bite. Fever from concurrent illness like tonsillitis is not a contraindication to continuing rabies post-exposure prophylaxis (PEP).
Why Fever Does Not Stop Rabies Vaccination
Rabies is 100% fatal once symptoms develop, making timely completion of the vaccine series absolutely critical for survival. The ACIP guidelines explicitly state that rabies PEP regimens are applicable for "persons in all age groups, including children" without mentioning fever as a contraindication 1.
The rabies vaccine schedule must be maintained because:
- For previously unvaccinated children, doses are given on days 0,3,7, and 14 (4-dose regimen) 1
- Delays of a few days are acceptable, but the effect of longer delays is unknown 2
- Every attempt should be made to adhere to the recommended schedule 2
Managing the Concurrent Illness
The febrile tonsillitis should be treated appropriately with:
- Antibiotics if bacterial (streptococcal) tonsillitis is suspected
- Antipyretics for fever control
- Supportive care
However, none of these treatments should delay the rabies vaccine. The vaccine can be safely administered while the child is being treated for tonsillitis.
Critical Timing Considerations
The second dose is due on day 3 after the initial dose (day 0). If you miss this window:
- Resume the schedule as soon as possible 2
- Continue with remaining doses maintaining the same intervals
- For example, if day 3 dose is given on day 5, subsequent doses would be on days 9 and 16
Important Caveats
Do not confuse minor illness with true contraindications. The only scenario where you might modify the schedule is severe immunosuppression, which requires a 5-dose regimen (days 0,3,7,14, and 28) rather than the standard 4-dose regimen 1.
Ensure the child also received:
- Rabies immune globulin (HRIG) at 20 IU/kg on day 0 if previously unvaccinated 1
- Proper wound cleaning with soap and water, ideally with povidone-iodine 1, 2
- Tetanus prophylaxis if indicated 2
The mortality risk from rabies far outweighs any theoretical concern about vaccinating during a minor febrile illness. Proceed with the day 3 dose while managing the tonsillitis concurrently.