What is the recommended dosage for Rabivac (rabies vaccine)

Rabies Vaccine (Rabivac) Dosage

For previously unvaccinated persons exposed to rabies, administer 4 doses of 1.0 mL intramuscularly on days 0,3,7, and 14, along with rabies immune globulin (RIG) on day 0. 1

Post-Exposure Prophylaxis (PEP) for Previously Unvaccinated Persons

Standard 4-Dose Regimen

• Administer 1.0 mL intramuscularly in the deltoid muscle (or anterolateral thigh in young children) on days 0,3,7, and 14 1, 2
• The first dose should be given as soon as possible after exposure (day 0) 1
• Never inject in the gluteal area, as this results in lower neutralizing antibody titers 2

Rabies Immune Globulin (RIG) Administration

• Give RIG 20 IU/kg on day 0 in conjunction with the first vaccine dose 2
• Infiltrate the full calculated dose into and around the wound(s) if anatomically feasible 1
• Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 1
• If RIG was not given on day 0, it can be administered up to and including day 7 of the series; beyond day 7, RIG is not indicated 1, 3

Special Population: Immunocompromised Patients

• Use a 5-dose regimen (days 0,3,7,14, and 28) for immunosuppressed persons 1, 2
• Perform serologic testing 7-14 days after the final dose to verify adequate antibody response 1

Post-Exposure Prophylaxis for Previously Vaccinated Persons

Previously vaccinated individuals require only 2 doses of 1.0 mL intramuscularly: one immediately (day 0) and one on day 3 1, 4

• Previously vaccinated persons are those who completed a pre- or post-exposure prophylaxis regimen with cell-culture vaccines or have documented adequate rabies virus-neutralizing antibody titers 1, 4
• Do NOT administer RIG to previously vaccinated persons, as it may inhibit the anamnestic immune response 1, 4

Pre-Exposure Prophylaxis

For individuals at high risk of rabies exposure, administer 3 doses of 1.0 mL intramuscularly on days 0,7, and 21 or 28 5, 2

Target Populations

• Veterinarians and staff, animal handlers, rabies researchers, laboratory workers 5
• Bat handlers regardless of location 5
• Certain international travelers to rabies-endemic areas 2

Booster Recommendations by Risk Category

• Continuous risk (laboratory workers with live virus): Check antibody titers every 6 months; give booster if titer falls below 1:5 dilution by RFFIT 5, 2
• Frequent risk (diagnostic lab workers, veterinarians in endemic areas): Check titers every 2 years; give booster if inadequate 5, 2
• Infrequent risk (veterinarians in low-endemic areas): No routine booster or serologic testing required after completing primary series 2

Catch-Up Dosing for Missed Appointments

If a dose is missed, administer it immediately when the patient presents and resume the schedule maintaining the same intervals between remaining doses 3

• Delays of a few days are considered unimportant 3
• Most interruptions do not require restarting the entire series 3
• For substantial deviations, perform serologic testing 7-14 days after the final dose 3

Critical Wound Management

All post-exposure treatment must begin with immediate thorough cleansing of all wounds with soap and water 4

• Consider tetanus prophylaxis as appropriate 4
• Proper wound care combined with RIG infiltration and vaccination is highly effective in preventing rabies 1

Important Clinical Pitfalls

• The reduction from 5 to 4 doses applies only to immunocompetent previously unvaccinated persons; immunocompromised patients still require 5 doses 1
• Rabies is nearly 100% fatal once clinical symptoms develop, making adherence to the vaccination schedule critical 3
• No routine serologic testing is needed for healthy patients completing PEP, as all demonstrate adequate antibody response 1