Rabies Vaccine Administration in the Anterolateral Thigh of Adults
Yes, intramuscular rabies vaccine can be given in the anterolateral thigh of adults, though the deltoid muscle is the preferred site for adults and older children according to CDC guidelines. 1
Standard Site Recommendations by Age
The CDC explicitly recommends the following injection sites for rabies vaccination 1, 2, 3:
- Adults and older children: Deltoid muscle (preferred site)
- Young children: Anterolateral thigh
The gluteal area must never be used for rabies vaccine administration, as this produces inadequate antibody response and has been associated with vaccine failure. 1, 2, 3
When the Thigh Site Is Appropriate in Adults
While guidelines specifically designate the anterolateral thigh for young children, the thigh can serve as an acceptable alternative site in adults when:
- The deltoid muscle is not accessible or suitable for injection
- Anatomical considerations prevent deltoid administration
- Multiple simultaneous injections are required at different sites
The middle of the vastus lateralis (anterolateral thigh) has been demonstrated to be anatomically safe with low risk of vascular or nerve damage in adults. 4
Critical Administration Requirements
Regardless of whether you use the deltoid or thigh, the following principles apply 1, 2:
- Dose: 1.0 mL per dose administered intramuscularly
- Schedule: Days 0,3,7, and 14 (4-dose regimen for immunocompetent adults)
- HRIG administration: Must be given at a different anatomical site from the vaccine, never in the same syringe or location 2, 3
- Needle depth: Must penetrate subcutaneous tissue adequately to reach muscle 5, 6
Common Pitfall to Avoid
Never administer rabies vaccine in the gluteal area, as this consistently produces inadequate immune response due to injection into fat rather than muscle tissue. 1, 2, 3 This is the most critical site-selection error to avoid, as it has been directly associated with vaccine failure. 7