Rabies Vaccine Administration in Pediatric Patients
Children should receive the same rabies vaccine dose (i.e., vaccine volume) and follow the same administration schedule as recommended for adults. 1
Dosage for Post-Exposure Prophylaxis
Previously Unvaccinated Individuals (regardless of age)
- A regimen of 4 1-mL vaccine doses of HDCV or PCECV administered intramuscularly on days 0,3,7, and 14 1, 2
- For immunocompromised patients, a 5-dose schedule (days 0,3,7,14, and 28) is still recommended 1, 3
- Human Rabies Immune Globulin (HRIG) should be administered at 20 IU/kg body weight - this formula is applicable for all age groups, including children 1, 4
Previously Vaccinated Individuals (regardless of age)
- Only 2 doses of vaccine (1.0 mL each) administered on days 0 and 3 1, 2
- HRIG should not be administered 1
Administration Site Differences
- Adults and older children: Vaccine should be administered in the deltoid muscle 1, 4
- Infants and younger children: The anterolateral aspect of the thigh is an acceptable alternative 1, 4
- Important: The gluteal area should never be used for vaccine administration in any age group as this may result in lower neutralizing antibody titers 1, 4
Safety and Efficacy in Children
- Studies have demonstrated that rabies vaccines are well-tolerated and effective in pediatric patients 5
- In clinical trials, pediatric patients showed adequate immune responses with protective antibody levels after receiving the standard rabies vaccination schedule 5, 6
- A study of HRIG150 in pediatric patients showed that 93.3% of children had adequate rabies virus neutralizing antibody levels by day 14 5
Special Considerations
- All healthy persons who receive the complete rabies PEP regimen should develop adequate antibody response 1
- Routine post-vaccination serologic testing is not necessary in immunocompetent individuals 2
- For substantial deviations from the vaccination schedule, immune status should be assessed by performing serologic testing 7-14 days after administration of the final dose 3
Common Pitfalls to Avoid
- Never administer vaccine in the gluteal area for any age group as this may result in diminished immune response 1, 4
- Never delay initiation of PEP as rabies is nearly 100% fatal once clinical symptoms develop 2
- Never administer HRIG and vaccine in the same syringe or at the same anatomical site as the first vaccine dose 1
- If HRIG was not given when vaccination began, it can be administered up to and including day 7 of the PEP series; beyond day 7, HRIG is not indicated 1, 3
The evidence clearly shows that pediatric patients follow the same dosing schedule and receive the same volume of vaccine as adults, with the only difference being the potential use of the anterolateral thigh as an injection site for younger children when appropriate 1, 4.