What is the recommended schedule for Rabivax (rabies vaccine) administration?

Rabivax (Rabies Vaccine) Administration Schedule

The recommended schedule for Rabivax administration for post-exposure prophylaxis in previously unvaccinated persons consists of 4 doses of 1.0 mL given intramuscularly in the deltoid area on days 0,3,7, and 14, along with human rabies immune globulin (HRIG) administration at the time of the first vaccine dose. 1, 2

Post-Exposure Prophylaxis (PEP) Schedule

For Previously Unvaccinated Persons:

• Immediate thorough wound cleansing with soap and water, and if available, irrigation with a virucidal agent such as povidone-iodine solution 1
• Administration of human rabies immune globulin (HRIG) at 20 IU/kg body weight, with the full dose infiltrated around and into the wound(s) if anatomically feasible, and any remaining volume administered intramuscularly at a site distant from vaccine administration 1, 3
• Rabies vaccine (Rabivax) administration: 1.0 mL given intramuscularly in the deltoid area on days 0,3,7, and 14 1, 2

For Previously Vaccinated Persons:

• Immediate thorough wound cleansing with soap and water, and if available, irrigation with a virucidal agent 1
• No HRIG administration is necessary 1, 2
• Rabies vaccine (Rabivax) administration: 1.0 mL given intramuscularly in the deltoid area on days 0 and 3 only 1, 2

For Immunocompromised Persons:

• The same wound cleansing and HRIG administration as for unvaccinated persons 1
• Rabies vaccine (Rabivax) administration: 5 doses given on days 0,3,7,14, and 28 1, 2

Important Administration Considerations

• The deltoid area is the only acceptable site of vaccination for adults and older children; for younger children, the anterolateral aspect of the thigh may be used 1, 2
• Vaccine should never be administered in the gluteal area as this may result in diminished immune response 1, 3
• HRIG should not be administered in the same syringe or at the same anatomic site as the first vaccine dose 1, 3
• If HRIG was not administered when vaccination began on day 0, it can be administered up to and including day 7 of the PEP series 1, 4
• Day 0 is considered the day the first dose of vaccine is administered 1, 2

Pre-Exposure Prophylaxis Schedule

• For individuals at high risk of rabies exposure (veterinarians, animal handlers, rabies researchers, etc.), a primary vaccination series of three 1.0 mL injections administered intramuscularly in the deltoid area on days 0,7, and 21 or 28 is recommended 5, 6
• Booster doses may be required based on risk category and antibody titer levels 5

Managing Missed Doses

• For minor schedule deviations, administer the missed dose when the patient presents and resume the schedule from that point, maintaining the same intervals between remaining doses 4
• For substantial deviations from the schedule, immune status should be assessed by performing serologic testing 7-14 days after administration of the final dose 4

Efficacy and Safety

• When administered according to the recommended schedule with proper wound care and HRIG, the 4-dose vaccine regimen induces an adequate, long-lasting antibody response that effectively neutralizes rabies virus and prevents disease in exposed patients 7
• Rabivax-S has demonstrated an excellent safety profile with primarily mild adverse events that resolve without sequelae 8

Pitfalls to Avoid

• Never delay initiation of PEP as rabies is nearly 100% fatal once clinical symptoms develop 2, 7
• Never administer rabies vaccine in the gluteal area 1, 3
• Never administer HRIG and vaccine in the same syringe or at the same anatomical site 1, 3
• Never exceed the recommended HRIG dose as it might partially suppress active production of rabies virus antibody 1, 3
• Never use the abbreviated 2-1-1 schedule for severely exposed patients who also need to receive rabies immune globulin 9