Rabies Vaccines for Postexposure Prophylaxis
The two rabies vaccines used in the United States for postexposure prophylaxis after a potentially rabid animal bite are Human Diploid Cell Vaccine (HDCV, marketed as Imovax Rabies) and Purified Chick Embryo Cell Vaccine (PCECV, marketed as RabAvert). 1
Available Vaccine Products
Both vaccines are FDA-approved and equally effective for rabies postexposure prophylaxis:
- HDCV (Human Diploid Cell Vaccine) - Brand name: Imovax Rabies (Sanofi Pasteur)
- PCECV (Purified Chick Embryo Cell Vaccine) - Brand name: RabAvert 2
Administration Protocol
For previously unvaccinated persons exposed to a potentially rabid animal, the current ACIP guidelines recommend:
- 4-dose vaccine regimen: 1.0 mL intramuscularly on days 0,3,7, and 14 1
- Plus Human Rabies Immune Globulin (HRIG): 20 IU/kg body weight, infiltrated around the wound site 1
- Site of injection: Deltoid muscle in adults and older children; anterolateral thigh in younger children
- Never inject in the gluteal area (results in diminished immune response) 1
Key Clinical Points
The 4-dose schedule replaced the previous 5-dose regimen in 2010 based on evidence showing equivalent protection with cost savings of approximately $16.6 million to the U.S. healthcare system 1. Both HDCV and PCECV achieve protective antibody titers (≥0.5 IU/mL) in 100% of patients within 14 days when combined with HRIG 2.
Important caveat: Immunocompromised patients still require a 5-dose regimen (days 0,3,7,14, and 28) 1.