Post-Exposure Prophylaxis After Recent Booster (Within 6 Months)
If you received a rabies booster and are then exposed to a small scratch within 6 months, you should receive two doses of rabies vaccine (1.0 mL intramuscular in the deltoid) on days 0 and 3, without rabies immunoglobulin. 1, 2
Key Protocol for Previously Vaccinated Individuals
The management is straightforward and does not change based on the timing of your last booster:
Previously vaccinated persons are defined as anyone who has completed a recommended pre-exposure or post-exposure vaccination series with HDCV, PCECV, or RVA, or has documented rabies virus neutralizing antibody titers 1, 2, 3
The standard 2-dose regimen applies regardless of when you last received a booster - whether it was 6 months ago, 2 years ago, or longer 1, 2, 4
The first dose should be administered immediately upon presentation, and the second dose exactly 3 days later 1, 2, 3
Critical Points About This Protocol
Why No Immunoglobulin?
Rabies immunoglobulin (RIG) should NOT be given to previously vaccinated individuals because it may actually inhibit the strength and speed of your anamnestic (memory) immune response 1, 2, 4
Previously vaccinated individuals develop a rapid anamnestic antibody response following booster vaccination, regardless of pre-booster antibody titer 2, 4
Why Only 2 Doses?
The 2-dose regimen for previously vaccinated persons is distinct from the 4-dose series (days 0,3,7,14) required for never-vaccinated individuals 3, 5
Your immune system retains memory from previous vaccination, allowing for this simplified protocol 2, 6
Wound Management
Immediately wash and flush the wound thoroughly with soap and water for approximately 15 minutes if possible 3, 6
Apply an iodine-containing or similarly viricidal topical preparation to the wound where available 3
Consider tetanus prophylaxis and measures to control bacterial infection as indicated 3
Special Considerations
Immunosuppressed Patients
If you are immunosuppressed by disease or medications, you may require special management including consultation with public health officials 2, 3
Immunosuppressed individuals may need antibody titers checked after vaccination to confirm adequate response 4, 3
No Need for Antibody Testing
- Do not delay treatment to check antibody titers - this is inappropriate for previously vaccinated persons exposed to rabies because it delays treatment, no specific "protective" titer is definitively established, and other immune effectors beyond antibodies are operative in disease prevention 1, 2
Common Pitfalls to Avoid
Do not restart the entire 4-dose series - previously vaccinated individuals only need 2 doses 1, 2, 3
Do not administer RIG - this is a common error that can actually impair your immune response 1, 2, 7
Do not administer vaccine in the gluteal area - this produces inadequate antibody responses; use the deltoid muscle for adults 2, 3
Do not delay the second dose - it should be given exactly 3 days after the first dose 1, 3