What are the administration guidelines for the powder form of the rabies vaccine?

Administration Guidelines for Rabies Vaccine Powder Form

The powder form of rabies vaccine 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

Types of Powder Form Rabies Vaccines

• Human Diploid Cell Vaccine (HDCV) is available as a lyophilized (freeze-dried) powder that must be reconstituted before use 2
• Purified Chick Embryo Cell Vaccine (PCEC) is also available as a lyophilized powder requiring reconstitution 2
• Both vaccine types contain ≥2.5 international units (IU) per 1.0 mL dose, meeting WHO standards 1

Proper Reconstitution Technique

• For HDCV intramuscular administration: Reconstitute the single-dose vial containing lyophilized vaccine with the accompanying diluent to a final volume of 1.0 mL just before administration 2
• For HDCV intradermal administration (where available): Reconstitute the single-dose syringe containing lyophilized vaccine to a volume of 0.1 mL just before administration 2
• For PCEC: Reconstitute the lyophilized vaccine in the vial with the accompanying diluent to a final volume of 1.0 mL just before administration 2
• Never store reconstituted vaccine; use immediately after reconstitution 1

Administration Routes and Dosing

• Intramuscular (IM) route is recommended for both HDCV and PCEC at a full 1.0 mL dose 2
• Only HDCV has been evaluated and approved for intradermal (ID) administration at a 0.1 mL dose 2
• RVA (Rabies Vaccine Adsorbed) should not be used intradermally as it is already in liquid form (not powder) 2

Vaccination Schedules

• For pre-exposure prophylaxis: Administer 1.0 mL IM on days 0,7, and 21 or 28 1, 3
• For post-exposure prophylaxis in previously unvaccinated persons: Administer 1.0 mL IM on days 0,3,7, and 14 1
• For post-exposure prophylaxis in previously vaccinated persons: Administer 1.0 mL IM on days 0 and 3 1

Critical Administration Considerations

• Do not delay administration of post-exposure prophylaxis, as rabies is almost always fatal once clinical symptoms appear 1
• For post-exposure prophylaxis in previously unvaccinated persons, Rabies Immune Globulin (RIG) must be administered concurrently with the first vaccine dose at 20 IU/kg body weight 2, 1
• Do not mix different vaccine products during a vaccination series 2, 1
• The deltoid area is the preferred site for intramuscular injection in adults; the anterolateral thigh is an alternative site for children 1

Storage and Handling

• Store the lyophilized powder according to manufacturer's recommendations (typically 2-8°C/36-46°F) 1
• Protect from light 1
• Discard if not used immediately after reconstitution 1

Efficacy and Safety Considerations

• Studies have shown that properly reconstituted powder vaccines produce adequate antibody responses when administered according to recommended schedules 4, 5
• Local and systemic reactions are generally mild and self-limiting 4
• The potency and efficacy of both HDCV and PCEC powder forms are considered equivalent when properly reconstituted and administered 2