Do I need to administer Equine Rabies Immunoglobulin (Erig) after reexposure to rabies if I have completed the primary rabies vaccination series?

No, Do Not Give Rabies Immunoglobulin (RIG/ERIG) After Reexposure in Previously Vaccinated Individuals

If you completed a primary rabies vaccination series (either pre-exposure or post-exposure), you should NOT receive rabies immunoglobulin upon reexposure—only vaccine boosters are needed. 1, 2

Post-Exposure Management for Previously Vaccinated Persons

Vaccine-Only Protocol

• Administer 2 doses of rabies vaccine (1.0 mL IM each): 1, 2
  • First dose: immediately upon reexposure
  • Second dose: 3 days later (day 3)
• Location: Deltoid muscle for adults; anterolateral thigh for children 1

Why No Immunoglobulin?

• RIG/HRIG/ERIG is unnecessary and should NOT be given to previously vaccinated persons 1, 2, 3
• Rationale: An anamnestic (memory) antibody response occurs rapidly after booster vaccination, regardless of pre-booster antibody titer 1
• RIG can actually suppress or inhibit the expected rapid immune response in previously vaccinated individuals 1, 2

Definition of "Previously Vaccinated"

You qualify as previously vaccinated if you have received: 1, 2

• A complete pre-exposure prophylaxis series (3 doses), OR
• A complete post-exposure prophylaxis series (4-5 doses with or without RIG), OR
• Any other vaccine regimen with documented rabies virus neutralizing antibody titer

The time interval since your original vaccination does not change this recommendation—even if years have passed, you still receive only the 2-dose booster without immunoglobulin. 1

Essential Wound Care

• Immediately cleanse all wounds thoroughly with soap and water or dilute povidone-iodine solution 1
• This step is critical—wound cleansing alone markedly reduces rabies risk in animal studies 1
• Consider tetanus prophylaxis as appropriate 1, 2
• Avoid suturing when possible 1

Special Considerations

Immunosuppressed Patients

• If you are immunocompromised, the protocol differs significantly: 4
  • May require a full 5-dose series even if previously vaccinated
  • Mandatory antibody titer testing 7-14 days after completion 4, 3
  • Consult public health officials for management 1, 3

Timing of RIG (If Mistakenly Considered)

• Even in never-vaccinated persons, RIG can only be given up to and including day 7 of the vaccine series 1, 4
• After day 7, RIG is contraindicated as vaccine-induced antibody production is presumed to have occurred 1, 4

Common Pitfalls to Avoid

1. Do not administer RIG to previously vaccinated persons—this is the most critical error to avoid, as it may impair the anamnestic response 1, 2
2. Do not restart the entire vaccine series—only 2 doses are needed 1, 2
3. Do not delay treatment to obtain antibody titers—proceed with the 2-dose protocol immediately 1
4. Do not administer vaccine in the gluteal area—use deltoid only (failures have occurred with gluteal administration) 1

Evidence Quality Note

This recommendation is consistent across multiple CDC/ACIP guidelines spanning decades (1991-2025), with the most recent guidance reaffirming that previously vaccinated individuals develop rapid anamnestic responses and do not require passive immunization. 1, 4, 2, 3 No postexposure vaccine failures have occurred in the United States when this protocol has been followed properly. 1