What is the recommended administration site for the rabies vaccine (Rabies Immunoglobulin)?

Rabies Vaccine and Immunoglobulin Administration Sites

Rabies immunoglobulin (RIG) should be thoroughly infiltrated in and around the wound(s) if anatomically feasible, with any remaining volume injected intramuscularly at a site distant from vaccine administration, while the rabies vaccine should be administered intramuscularly in the deltoid muscle (never in the gluteal area). 1, 2

Rabies Immunoglobulin (RIG) Administration

Primary Site: Wound Infiltration

• RIG dose: 20 IU/kg body weight for all age groups 1, 2
• Timing: At the time of first vaccine dose (day 0) or up to day 7 after first vaccine dose 1
• Administration technique:
  • If anatomically feasible, up to the full dose should be thoroughly infiltrated in and around all wounds 1, 2
  • This local wound infiltration is the primary mechanism of protection 3

Secondary Site: Distant Intramuscular Injection

• Any remaining RIG volume that cannot be infiltrated into wounds should be administered intramuscularly at a site distant from vaccine administration 1, 2
• Typically in the deltoid muscle of the upper arm or lateral thigh muscle 2

Critical Cautions for RIG Administration

• Never administer RIG in the same syringe or at the same anatomical site as the vaccine 1, 2
• Never administer RIG in the gluteal region due to risk of sciatic nerve injury 2
• Do not exceed the recommended dose as RIG might partially suppress active antibody production 2

Rabies Vaccine Administration

Recommended Site

• Adults and older children: Deltoid muscle only 1, 2
• Younger children: Outer aspect of the thigh may be used 2

Sites to Avoid

• The gluteal area should never be used for vaccine injections as this results in lower neutralizing antibody titers 1, 2

Dosing Schedule

• Previously unvaccinated individuals: 1.0 mL IM on days 0,3,7,14, and 28 1, 2
• Immunocompromised individuals: 5-dose regimen on days 0,3,7,14, and 28 1
• Previously vaccinated individuals: Only 2 doses (1.0 mL each) on days 0 and 3, with no RIG needed 1, 2

Wound Care

• Immediate and thorough wound cleansing with soap and water for at least 15 minutes is essential 1
• If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds 1, 2
• Proper wound cleansing significantly reduces rabies risk 1

Common Pitfalls to Avoid

1. Using the gluteal area for vaccine administration (reduces effectiveness)
2. Administering RIG and vaccine at the same anatomical site
3. Using the same syringe for RIG and vaccine
4. Neglecting thorough wound cleansing
5. Exceeding the recommended RIG dose
6. Failing to infiltrate wounds with RIG when anatomically feasible

By following these evidence-based guidelines for rabies post-exposure prophylaxis administration, healthcare providers can ensure optimal protection against this nearly 100% fatal disease when untreated.