What is the recommended dosing schedule for the Rabipur (rabies vaccine) injection?

Rabipur (Rabies Vaccine) Injection Dosing Schedule

For post-exposure prophylaxis in previously unvaccinated individuals, Rabipur should be administered as a 4-dose regimen with 1.0 mL intramuscular injections on days 0,3,7, and 14. 1

Post-Exposure Prophylaxis (PEP) Dosing

Previously Unvaccinated Individuals

• Vaccine dosing: 1.0 mL of Rabipur administered intramuscularly on days 0,3,7, and 14 1, 2
• Injection site: Deltoid area for adults and older children; anterolateral thigh for younger children 1
• Important: Never administer in the gluteal area as this may result in lower neutralizing antibody titers 1
• Rabies Immunoglobulin (RIG): 20 IU/kg body weight administered on day 0 2
  • Infiltrate full dose around and into wounds if anatomically feasible
  • Administer any remaining volume intramuscularly at a site distant from vaccine administration
  • Never administer RIG in the same syringe or at the same anatomic site as the vaccine

Previously Vaccinated Individuals

• Vaccine dosing: 1.0 mL of Rabipur administered intramuscularly on days 0 and 3 only 1
• Injection site: Same as for unvaccinated individuals (deltoid area)
• Note: RIG should NOT be administered to previously vaccinated persons 1

Special Populations

• Immunocompromised patients: Should receive a 5-dose vaccination regimen on days 0,3,7,14, and 28, plus RIG 1, 2
• Children: Receive the same vaccine volume (1.0 mL) as adults 1

Pre-Exposure Prophylaxis Dosing

• Standard regimen: 1.0 mL of Rabipur administered intramuscularly on days 0,7, and 21 or 28 2, 3
• Booster doses: Based on risk category and antibody titers 3
  • Continuous risk: Check antibody titers every 6 months
  • Frequent risk: Check antibody titers every 2 years
  • Infrequent risk: No routine boosters required

Important Clinical Considerations

Wound Care

• All post-exposure prophylaxis should begin with immediate thorough cleansing of all wounds with soap and water for at least 15 minutes 2
• If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds 1

Common Pitfalls to Avoid

1. Incorrect injection site: Never administer in the gluteal area as this reduces immunogenicity 1
2. Delayed initiation: PEP should begin as soon as possible after exposure, ideally within 24 hours 2
3. Improper RIG administration: Failure to infiltrate wounds properly with RIG can reduce effectiveness 2
4. Mixing RIG and vaccine: Never administer RIG in the same syringe as the vaccine 1
5. Exceeding recommended RIG dose: This may suppress active antibody production 1

Effectiveness

The 4-dose vaccine regimen replaced the previous 5-dose regimen in 2010 based on evidence that it provides adequate protection while reducing costs and the burden of additional medical visits 2. When administered correctly, post-exposure prophylaxis is nearly 100% effective in preventing rabies 2.