What is the recommended route of administration for the antirabies (rabies) vaccine in adults, children, and infants?

Rabies Vaccine Route of Administration

Direct Answer

The antirabies vaccine must be administered intramuscularly (IM) in the deltoid muscle for adults and older children, or in the anterolateral thigh for young children and infants—never in the gluteal area. 1, 2, 3

Route of Administration by Age Group

Adults

• Administer 1.0 mL intramuscularly in the deltoid area only 1, 3
• The deltoid is the only acceptable site for adults 3
• Gluteal administration is strictly contraindicated because it produces inadequate neutralizing antibody titers 1, 2

Children and Infants

• For older children: deltoid muscle (same as adults) 1, 3
• For younger children and infants: anterolateral aspect of the thigh is acceptable 1, 3
• The gluteal area must never be used in any pediatric age group due to poor immune response 1, 2

Standard Dosing Schedule

Previously Unvaccinated Persons

• 4-dose regimen: Days 0,3,7, and 14 (current recommendation) 2, 4
• Each dose is 1.0 mL administered intramuscularly 2, 3
• Must be combined with rabies immunoglobulin (RIG) 20 IU/kg on day 0 2, 5, 3
• The older 5-dose regimen (days 0,3,7,14,28) is still used for immunocompromised patients 1, 5

Previously Vaccinated Persons

• 2-dose regimen only: Days 0 and 3 2, 3
• No RIG is required 2, 3
• Same intramuscular route applies 3

Critical Administration Pitfalls to Avoid

Anatomical Site Errors

• Never inject in the gluteal region because this results in lower neutralizing antibody titers and inadequate immune response 1, 2, 6
• The gluteal area also carries risk of sciatic nerve injury 3

RIG and Vaccine Separation

• Never administer RIG and vaccine in the same syringe or same anatomical site 1, 5, 3
• RIG should be infiltrated around wounds when anatomically feasible, with remaining volume given IM at a site distant from vaccine administration 5, 3

Timing Considerations

• RIG can be given up to day 7 after the first vaccine dose if not administered initially 1, 5
• Beyond day 7, RIG is not indicated for the same exposure because vaccine-induced antibodies are presumed to have developed 1, 5

Special Populations

Immunocompromised Patients

• Use 5-dose schedule (days 0,3,7,14,28) with RIG 2, 5
• Consider serologic testing 7-14 days after the last dose to confirm seroconversion 2

No Contraindications

• There are no absolute contraindications to rabies vaccination when exposure has occurred 6
• Concurrent medical conditions (including severe hypertension, pregnancy, etc.) do not preclude vaccination 6
• Rabies is universally fatal without treatment, making immediate vaccination imperative regardless of other health conditions 6, 7

Evidence Quality Note

The 4-dose regimen has been validated in recent high-quality studies showing 100% seroprotection when combined with proper wound care and RIG administration 4. The intramuscular deltoid route remains the gold standard based on decades of evidence demonstrating superior immunogenicity compared to alternative sites 1, 2.