Rabies Vaccine Preparation and Administration Protocol
The rabies vaccine (HDCV or PCECV) must be reconstituted with the accompanying sterile diluent to a final volume of 1.0 mL in the original vial just before administration and given as an intramuscular injection in the deltoid area. 1
Vaccine Types Available in the United States
Human Diploid Cell Vaccine (HDCV, Imovax® Rabies):
- Prepared from the Pitman-Moore strain of rabies virus grown on MRC-5 human diploid cell culture 1
- Concentrated by ultrafiltration and inactivated with beta-propiolactone 1
- Supplied as a single-dose vial containing lyophilized vaccine 1
- Contains <150 µg neomycin sulfate, <100 mg albumin, and 20 µg of phenol red indicator 1
- Contains no preservative or stabilizer 1
Purified Chick Embryo Cell Vaccine (PCECV, RabAvert®):
- Prepared from the fixed rabies virus strain Flury LEP grown in primary cultures of chicken fibroblasts 1
- Inactivated with betapropiolactone and processed by zonal centrifugation in a sucrose density gradient 1
- Supplied as a single-dose vial containing lyophilized vaccine 1
- Contains <12 mg polygeline, <0.3 mg human serum albumin, 1 mg potassium glutamate, and 0.3 mg sodium EDTA 1
- Contains no preservatives 1
Preparation Protocol
- Inspect the vaccine vial for particulate matter and discoloration prior to reconstitution 2
- Use only the diluent supplied with the vaccine 1
- Reconstitute the lyophilized vaccine in its original vial with the accompanying sterile diluent to a final volume of 1.0 mL just before administration 1
- Do not mix different vaccine products in the same series 1
Administration Protocol
Pre-exposure Prophylaxis
- Administer a full 1.0 mL dose intramuscularly in the deltoid area 1
- Schedule: Three 1.0 mL injections on days 0,7, and 21 or 28 1
- For persons at continuous risk (e.g., lab workers), check antibody titers every 6 months 1
- For persons at frequent risk (e.g., veterinarians in endemic areas), check antibody titers every 2 years 1
Post-exposure Prophylaxis (for previously unvaccinated persons)
- Administer a full 1.0 mL dose intramuscularly in the deltoid area 1, 2
- Schedule: Four 1.0 mL injections on days 0,3,7, and 14 1
- Rabies Immune Globulin (RIG) should be administered concurrently with the first dose of vaccine at a dose of 20 IU/kg body weight 1, 2
- If anatomically feasible, infiltrate the full RIG dose around the wound(s) and administer any remaining volume intramuscularly at a site distant from vaccine administration 2
Post-exposure Prophylaxis (for previously vaccinated persons)
- Administer a full 1.0 mL dose intramuscularly in the deltoid area 1
- Schedule: Two 1.0 mL injections on days 0 and 3 1, 2
- RIG is not needed for previously vaccinated persons 1, 2
Important Administration Considerations
- The deltoid area is the only acceptable site for vaccination in adults and older children 2
- For young children, the outer aspect of the thigh may be used 2
- Never administer the vaccine in the gluteal area due to potentially lower antibody response 2
- Never administer RIG and vaccine in the same syringe or at the same anatomical site 2
- The potency of one dose is ≥2.5 international units (IU) per 1.0 mL of vaccine 1
- Vaccine should be stored according to manufacturer's recommendations 1
Common Pitfalls to Avoid
- Avoid administering the vaccine in the gluteal region, which can lead to suboptimal immune response 2
- Do not delay administration of post-exposure prophylaxis, as rabies is almost always fatal once clinical symptoms appear 1
- Do not mix different vaccine products during a vaccination series if possible 1
- Never administer the vaccine intradermally unless specifically using the HDCV formulation approved for this route (not currently available in the US) 1
- Do not exceed the recommended dose of RIG as it may suppress active antibody production 2
- Do not store reconstituted vaccine; use immediately after reconstitution 1