What is the recommended course of action for someone who has completed post-exposure prophylaxis (PEP) for rabies and is exposed to a cat bite again within 6 months?

Re-exposure to Rabies Within 6 Months After Completing PEP

For someone who completed post-exposure prophylaxis (PEP) for rabies and is re-exposed within 6 months, administer only 2 doses of rabies vaccine on days 0 and 3, without rabies immune globulin (RIG). 1, 2

Simplified Protocol for Previously Vaccinated Individuals

The management is straightforward because the person is now considered "previously vaccinated":

• Give 2 intramuscular doses of rabies vaccine only 3, 1, 2

  • First dose on day 0 (as soon as possible after the new exposure)
  • Second dose on day 3

• Do NOT administer rabies immune globulin (RIG) 3, 1, 2

• Administer vaccine in the deltoid muscle (never the gluteal area, which has been associated with PEP failures) 1, 4

Immediate Wound Care

Before any vaccination, perform thorough wound management:

• Wash the wound immediately with soap and water for approximately 15 minutes 1, 2, 4
• Apply a viricidal agent (such as iodine-containing solution) if available 4
• Provide tetanus prophylaxis and bacterial infection control as indicated 4

Immunological Rationale

The simplified 2-dose regimen works because:

• Previously vaccinated individuals develop a rapid anamnestic (memory) immune response upon re-exposure 2
• Studies demonstrate that persons who received primary vaccination maintained adequate antibody titers (>0.5 IU/mL) at 1 year post-vaccination 2
• The immune system "remembers" the previous vaccination series and responds quickly with just 2 booster doses 5

Critical Timing Considerations

• Initiate treatment as soon as possible after the new exposure, regardless of how recent the previous PEP series was completed 1, 2
• The 6-month timeframe mentioned in your question is well within the protective window—even individuals vaccinated 1 year previously respond adequately to the 2-dose booster regimen 2, 5

Important Caveats

Immunocompromised Patients Exception

If the patient is immunosuppressed, do NOT use the simplified 2-dose regimen. Instead:

• Administer a full 5-dose vaccination series (days 0,3,7,14,28) 1, 6
• Include RIG administration 1, 2

Animal Observation Period

While initiating the 2-dose series:

• If the cat is available and healthy, observe it for 10 days 4
• Dogs, cats, and ferrets do not shed rabies virus in saliva more than 10 days before showing clinical signs 1
• Discontinue vaccination if the animal remains healthy after 10 days or if laboratory testing proves negative 4
• If the cat is unavailable, rabid, or suspected rabid, complete the full 2-dose series 4

Common Pitfall to Avoid

Do not give the full 4-dose or 5-dose series to previously vaccinated individuals (unless immunocompromised). This is unnecessary, wasteful, and increases the risk of adverse reactions. The 2-dose regimen is specifically designed for previously vaccinated persons and is highly effective 3, 1, 2.