Two-Dose Rabies Vaccination for Previously Vaccinated Individuals
Yes, two doses of Rabipur (rabies vaccine) administered intramuscularly on days 0 and 3 is the correct and complete regimen for post-exposure prophylaxis in previously vaccinated individuals, regardless of exposure severity, and no rabies immunoglobulin should be given. 1, 2, 3
Definition of Previously Vaccinated Status
You are considered previously vaccinated if you have completed any of the following 2, 3:
- A recommended pre-exposure vaccination series (3 doses) with a cell culture vaccine (HDCV, PCECV, or RVA)
- A prior post-exposure prophylaxis regimen with a cell culture vaccine
- Documented rabies virus neutralizing antibody titer at any level
The key point: You do NOT need a specific antibody titer level to qualify as "previously vaccinated"—completion of a proper vaccine series is sufficient. 2
The Two-Dose Protocol
For your small scratch exposure, the complete regimen is 1, 2, 3:
- Day 0: 1.0 mL intramuscular injection in the deltoid muscle immediately
- Day 3: 1.0 mL intramuscular injection in the deltoid muscle
- No rabies immunoglobulin (RIG) should be administered, as it will inhibit your rapid anamnestic immune response 2, 4
Why Two Doses Are Sufficient
Previously vaccinated individuals develop a rapid anamnestic (memory) antibody response following booster vaccination, regardless of their pre-booster antibody titer 2. This robust immune memory eliminates the need for:
- The full 4-dose series (days 0,3,7,14) required for unvaccinated persons 1
- Rabies immunoglobulin for passive immunity 2, 4
- Additional doses beyond day 3 1, 2
The two-dose regimen has been validated as safe and effective by the CDC, ACIP, and WHO for all previously vaccinated individuals, including those with minor exposures like scratches. 1, 2
Critical Pitfalls to Avoid
Do not administer rabies immunoglobulin to previously vaccinated persons—this is a critical error that will suppress your memory immune response and is explicitly contraindicated 2, 4. RIG is only for previously unvaccinated individuals 4.
Do not use the gluteal area for injection—this produces inadequate antibody responses and has been associated with vaccine failures 1, 3. Always use the deltoid muscle 1, 3.
Do not delay treatment to check antibody titers—determining your current antibody level before administering boosters is unnecessary and inappropriate, as it delays treatment without clinical benefit 2.
Special Consideration: Immunosuppression
If you are immunosuppressed (corticosteroids, HIV, chemotherapy, other immunosuppressive conditions), the two-dose regimen may be inadequate 1. Immunocompromised individuals require:
- The full 5-dose regimen (days 0,3,7,14,28) 1
- Rabies immunoglobulin at 20 IU/kg on day 0 1
- Mandatory serologic testing 1-2 weeks after the final dose 1
This applies even if you were previously vaccinated, because immunosuppression substantially reduces vaccine response 1.
Wound Care
Regardless of vaccination status, immediately wash the scratch thoroughly with soap and water for 15 minutes, followed by irrigation with a virucidal agent such as povidone-iodine solution if available 5, 1. This single intervention markedly reduces rabies risk and should be done before any other treatment 1.