What is the schedule for completing the rabies vaccine series after receiving rabies immunoglobulin (antibody) and the first dose of rabies vaccine?

Rabies Vaccine Schedule After Initial Dose and Immunoglobulin

Complete the 4-Dose Series Without Restarting

You should complete the remaining doses of your rabies vaccine series on days 3,7, and 14 from when you received your first dose (day 0), without restarting the series. 1, 2

Standard Schedule for Previously Unvaccinated Persons

Since you received rabies immunoglobulin (RIG) and your first vaccine dose, you are following the standard post-exposure prophylaxis regimen for previously unvaccinated individuals:

• Day 0: First vaccine dose + RIG (already completed)
• Day 3: Second vaccine dose
• Day 7: Third vaccine dose
• Day 14: Fourth vaccine dose 1, 2, 3

This 4-dose schedule is the current CDC/ACIP recommendation for immunocompetent individuals and has been proven safe and effective when combined with RIG. 2, 4, 5

Critical Timing Considerations

• Minor delays of a few days for individual doses are acceptable and do not require restarting the entire series. 1, 2
• Do not restart the series if you miss a dose—simply resume where you left off, giving the next dose as soon as possible while maintaining the same intervals between remaining doses. 1
• Continue from where you left off even if longer interruptions occur (weeks or months), though antibody testing 7-14 days after the final dose may be warranted for substantial delays. 1, 2

Administration Details

• Vaccines must be given intramuscularly in the deltoid muscle (or anterolateral thigh in young children)—never in the gluteal area, as this produces inadequate antibody response. 2, 3
• Each dose is 1.0 mL administered at a site distant from where RIG was given. 2, 3

Special Circumstances Requiring Modified Schedule

You would need a 5-dose regimen (adding day 28) ONLY if you are immunocompromised, including conditions such as:

• HIV/AIDS
• Corticosteroid or immunosuppressive medication use
• Other immunosuppressive illnesses 1, 2, 6

For immunocompromised patients, serologic testing 7-14 days after the final dose is mandatory to confirm adequate antibody response (≥1:5 dilution by RFFIT). 1, 2

Common Pitfalls to Avoid

• Do not accept RIG after day 7 of your vaccine series, as it may suppress active antibody production. 1, 2
• Do not get routine antibody testing if you are healthy and immunocompetent—it is unnecessary after completing all 4 doses properly. 1, 2
• Do not delay seeking remaining doses even if significant time has passed since your first dose, as no case of human rabies in the U.S. has been attributed to completing a delayed vaccine series. 1