Rabies Vaccine Booster Protocol for Previously Vaccinated Individuals with Dog Bite Reexposure
For previously vaccinated individuals who are reexposed to a dog bite, two doses of rabies vaccine (HDCV or PCECV) should be administered: one immediately upon presentation and the second dose 3 days later, without rabies immunoglobulin. 1
Definition of Previously Vaccinated Individual
A previously vaccinated person is defined as someone who has:
- Received a complete pre-exposure or post-exposure prophylaxis regimen of HDCV, PCECV, or RVA 1, 2
- Documented rabies virus neutralizing antibody titer from previous vaccination 1
Booster Protocol for Reexposure
Vaccination Schedule
- Administer two 1.0 mL doses of rabies vaccine (HDCV or PCECV) intramuscularly in the deltoid muscle 1, 3
- First dose: Immediately upon presentation (day 0)
- Second dose: 3 days after the first dose (day 3)
Important Considerations
- Rabies immunoglobulin (RIG) should NOT be administered to previously vaccinated individuals 1, 4, 3
- RIG may inhibit the strength or rapidity of the expected anamnestic immune response 1
- Previously vaccinated individuals develop a rapid anamnestic antibody response following booster vaccination 1, 5
Wound Management
- All post-exposure treatment should begin with immediate thorough cleansing of all wounds with soap and water 6, 3
- If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds 3
- Consider tetanus prophylaxis as appropriate 6
Special Considerations
Immunocompromised Patients
- Immunosuppressed individuals may have suboptimal response to vaccination 1, 4
- Consultation with public health officials is recommended when treating immunosuppressed previously vaccinated individuals 1, 4
- Antibody titers should be checked after vaccination in immunosuppressed individuals 4, 2
Antibody Testing
- Determining rabies virus neutralizing antibody titer before administering boosters to previously vaccinated persons is unnecessary and inappropriate 1
- Testing would delay treatment and no specific "protective" titer is definitively established 1
Common Pitfalls to Avoid
- Administering rabies immunoglobulin: Previously vaccinated individuals should NOT receive RIG as it may suppress the anamnestic response 1, 3
- Delaying treatment: Do not delay administration of booster doses for antibody testing 1
- Inadequate wound care: Thorough wound cleansing is essential and markedly reduces the likelihood of rabies 6
- Using the wrong vaccination schedule: Do not use the full 4-5 dose schedule intended for previously unvaccinated individuals 3, 7
- Incorrect administration site: The deltoid area is the only acceptable site of vaccination for adults and older children 3
Effectiveness of Booster Doses
- Studies show that booster doses produce remarkable antibody responses in previously vaccinated individuals 8
- A single intradermal booster dose can effectively stimulate a mature and sustained antibody response 5
- Even when antibody levels have declined below protective levels, booster vaccination rapidly restores immunity 9, 10