From the Guidelines
The recommended dosage and schedule for a post-exposure rabies vaccination series is four doses of rabies vaccine administered over a 14-day period, with the first dose given as soon as possible after exposure (day 0), followed by additional doses on days 3,7, and 14, in combination with Rabies Immune Globulin (RIG) for previously unvaccinated individuals. The most commonly used vaccines in the United States are HDCV (Human Diploid Cell Vaccine) or PCECV (Purified Chick Embryo Cell Vaccine), administered as a 1.0 mL dose intramuscularly in the deltoid area for adults or the anterolateral thigh for young children 1. For previously unvaccinated individuals, RIG should also be administered at the time of the first vaccine dose, at 20 IU/kg body weight, with as much as possible infiltrated around the wound and any remaining volume given intramuscularly at a site distant from the vaccine 1.
Key points to consider when administering the rabies vaccination series include:
- The importance of prompt administration of the first dose after exposure
- The use of RIG in combination with the vaccine for previously unvaccinated individuals
- The administration of the vaccine in the deltoid area for adults or the anterolateral thigh for young children
- The schedule of additional doses on days 3,7, and 14 after the first vaccination
For individuals who have previously received a complete rabies vaccination series, only two booster doses are needed on days 0 and 3, with no RIG required 1. This vaccination schedule is critical because rabies is nearly always fatal once symptoms develop, but proper post-exposure prophylaxis is nearly 100% effective in preventing the disease when administered promptly and correctly.
From the FDA Drug Label
A. Pre-exposure dosage ... B. Post-exposure dosage 1 Post-exposure dosage for previously unimmunized persons Dose Previously unvaccinated persons should receive 5 intramuscular doses (1 mL each) of Imovax Rabies vaccine, one dose immediately after exposure (Day 0) and one dose 3,7,14, and 28 days later.
2 Post-exposure dosage for previously immunized persons When an immunized person who was vaccinated using the recommended pre-exposure regimen or a prior post-exposure regimen with a cell culture vaccine or who had previously demonstrated rabies antibody is exposed to rabies, that person should receive two intramuscular doses (1. 0 mL each) of Imovax Rabies vaccine, one dose immediately after the exposure and one dose 3 days later.
The recommended dosage and schedule for a post-exposure rabies vaccination series is as follows:
- Previously unvaccinated persons: 5 intramuscular doses (1 mL each) of Imovax Rabies vaccine, administered on Day 0,3,7,14, and 28.
- Previously immunized persons: 2 intramuscular doses (1.0 mL each) of Imovax Rabies vaccine, administered immediately after exposure and 3 days later 2.
From the Research
Post-Exposure Rabies Vaccination Series
The recommended dosage and schedule for a post-exposure rabies vaccination series vary depending on the individual's previous vaccination status.
- For previously unvaccinated persons, the Advisory Committee on Immunization Practices, United States recommends a 4-dose vaccine schedule on days 0,3,7, and 14, as supported by studies 3, 4.
- Alternatively, a 5-dose schedule on days 0,3,7,14, and 28 may also be used, as suggested by earlier research 5, 6.
Administration and Additional Measures
- The vaccine should be administered intramuscularly in the deltoid muscle 5, 6.
- Human rabies immune globulin (20 IU/kg) should be given on day 0, with administration into and around the wounds, and the remaining volume given intramuscularly at a site distant from the vaccine site 5, 6.
- Local wound cleansing is an essential part of postexposure rabies prophylaxis 5, 7.