If a person has previously received a full rabies vaccination series (Rabies Vaccine) and rabies human immunoglobulin (RIG), is RIG required again after a subsequent bite?

No, Rabies Immunoglobulin Should NOT Be Repeated for Previously Vaccinated Persons

If you have previously received a complete rabies vaccination series (either pre-exposure or post-exposure prophylaxis with a cell-culture vaccine), you should receive only vaccine doses after a subsequent bite—HRIG must not be administered. 1

Key Principle: Previously Vaccinated Persons Require Only Vaccine

The ACIP guidelines are unequivocal on this point:

• Previously vaccinated persons should receive 2 vaccine doses only (1.0 mL each in the deltoid), administered on day 0 and day 3 after the new exposure 1
• HRIG is unnecessary and should NOT be administered to previously vaccinated persons 1, 2
• The rationale is critical: HRIG can inhibit the anamnestic (memory) antibody response that your immune system will mount rapidly after re-exposure 1

Who Qualifies as "Previously Vaccinated"?

You are considered previously vaccinated if you have received:

• Any ACIP-recommended pre-exposure prophylaxis regimen with cell-culture vaccines 1
• Any complete post-exposure prophylaxis regimen with cell-culture vaccines (HDCV, PCECV, or RVA) 1, 3
• Any other vaccine regimen with documented adequate rabies virus-neutralizing antibody response 1

The Science Behind This Recommendation

Your immune system retains immunologic memory after complete vaccination:

• Previously vaccinated persons mount a rapid anamnestic response upon re-exposure, producing neutralizing antibodies quickly without needing passive immunization 1
• HRIG can partially suppress active antibody production, which is counterproductive when your body is capable of generating its own protective antibodies rapidly 1, 4
• The 2-dose vaccine booster (days 0 and 3) is sufficient to trigger this memory response 1, 2

Critical Exception: Immunocompromised Patients

If you are immunocompromised, the rules change completely:

• Immunocompromised patients may require HRIG even if previously vaccinated, along with an extended 5-dose vaccine schedule (days 0,3,7,14, and 28) 2, 5
• This includes patients on corticosteroids, other immunosuppressive agents, or those with immunosuppressive illnesses 1
• Consult with public health officials for immunocompromised patients with prior vaccination history 1

What About Timing of HRIG in Unvaccinated Persons?

For context (though not your situation), unvaccinated persons receiving their first post-exposure prophylaxis:

• HRIG is given only once, ideally on day 0 with the first vaccine dose 1, 6, 4
• If not given on day 0, HRIG can still be administered up to and including day 7 of the vaccine series 1, 6, 4
• Beyond day 7, HRIG is not indicated because vaccine-induced antibodies are presumed to have developed 1, 6

Common Pitfalls to Avoid

Never administer HRIG to previously vaccinated persons 1, 2:

• This is the single most important pitfall—HRIG will interfere with the rapid immune response your body is capable of mounting
• The only exception is documented immunocompromise 2, 5

Always verify vaccination history carefully 1:

• "Previously vaccinated" requires documentation of a complete series with cell-culture vaccines
• If vaccination history is uncertain or incomplete, treat as unvaccinated (full 4-dose vaccine series plus HRIG) 3

Don't forget wound care 1, 2, 5:

• Thorough wound cleansing with soap and water for 15 minutes remains essential regardless of vaccination status 2, 5
• Apply virucidal agent (povidone-iodine) if available 2, 5