What is the protocol for Rabies (Rabies) vaccine administration?

From the Guidelines

The rabies vaccine is recommended for individuals at risk of exposure to rabies, and the standard post-exposure prophylaxis consists of four doses of rabies vaccine on days 0,3,7, and 14, along with rabies immunoglobulin (RIG) at the wound site as soon as possible for unvaccinated individuals, while previously vaccinated individuals need only two booster doses on days 0 and 3. The vaccine works by stimulating the immune system to produce antibodies against the rabies virus before it can reach the nervous system 1. Common vaccines include HDCV (Imovax) and PCECV (RabAvert), typically given as 1 mL intramuscular injections in the deltoid for adults or anterolateral thigh for children 1. Some key points to consider when administering the rabies vaccine include:

• Wound cleansing with soap and water, and if available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds 1
• For persons previously unvaccinated with rabies vaccine, the reduced regimen of 4 1-mL doses of HDCV or PCECV should be administered intramuscularly, with the first dose administered as soon as possible after exposure (day 0), and additional doses on days 3,7, and 14 after the first vaccination 1
• For persons who previously received a complete vaccination series with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer following vaccination with noncell-culture vaccine, the recommendation for a 2-dose PEP vaccination series has not changed 1
• The number of doses recommended for persons with altered immunocompetence has not changed, and for such persons, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG 1
• Recommendations for pre-exposure prophylaxis also remain unchanged, with 3 doses of vaccine administered on days 0,7, and 21 or 28 1
• Side effects are generally mild and may include pain at the injection site, headache, or low-grade fever 1

From the FDA Drug Label

The essential components of rabies post-exposure prophylaxis are wound treatment and, for previously unvaccinated persons, the administration of both human rabies immune globulin (RIG) and vaccine.

Post-exposure antirabies vaccination should always include administration of both passive antibody and vaccine, with the exception of persons who have ever previously received complete vaccination regimens (pre-exposure or post-exposure) with a cell culture vaccine or persons who have been vaccinated with other types of vaccines and have previously had a documented rabies virus neutralizing antibody titer.

Rabies Vaccine Administration:

• The vaccine should be administered intramuscularly, using a sterile needle and syringe.
• In adults and older children, the vaccine should be administered in the deltoid muscle.
• In infants and small children, the anterolateral aspect of the thigh may be preferable, depending on age and body mass.
• The recommended dose for post-exposure prophylaxis is 1.0 mL, IM (deltoid area), one each on days 0,3,7,14, and 28 for previously unvaccinated persons.
• For previously vaccinated persons, the recommended dose is 1.0 mL, IM (deltoid area), one each on days 0 and 3. 2 3 3

From the Research

Rabies Vaccine Overview

• The rabies vaccine is a crucial component of post-exposure prophylaxis (PEP) to prevent the development of rabies after exposure to the virus 4, 5, 6.
• The World Health Organization (WHO) recommends a 1-week intradermal vaccination regimen for PEP, which is as safe as other regimens but offers cost-, dose-, and time-sparing benefits 4, 6.

Administration and Dosage

• The administration of rabies immune globulin is generally recommended in conjunction with the first dose of the rabies vaccine 5.
• The number of doses and route of vaccination may differ depending on the region and individual circumstances 5, 6.
• Abridged vaccination schedules with fewer doses have been shown to be effective and may improve patient compliance and access to PEP 6.

Pre-Exposure Prophylaxis

• Pre-exposure prophylaxis is recommended for individuals at high risk of exposure to the rabies virus, such as those working with animals or traveling to areas with high rabies incidence 5, 7.
• Pre-exposure prophylaxis typically consists of 3 doses of an approved rabies vaccine administered on days 0,7, and 21 or 28, with periodic booster doses or titre determination depending on the level of risk 5.

Special Considerations

• Rabies vaccination during pregnancy is considered safe and effective 6.
• There is a need for further research on the safety and immunogenicity of novel PEP schedules in special populations, such as infants and immunocompromised individuals 6.