From the Guidelines
Rabies vaccination is indicated for both pre-exposure prophylaxis in high-risk individuals and post-exposure prophylaxis after potential rabies exposure. For pre-exposure prophylaxis, three doses of rabies vaccine are given intramuscularly on days 0,7, and 21 or 28, as recommended by 1. This is indicated for:
- Veterinarians
- Animal handlers
- Laboratory workers handling rabies virus
- Travelers to rabies-endemic regions with limited medical access
- Persons whose vocations or avocations bring them into contact with potentially rabid animals, including skunks, raccoons, and bats, as stated in 1
For post-exposure prophylaxis, the recommended regimen is:
- Four doses of rabies vaccine given on days 0,3,7, and 14 for unvaccinated individuals, along with rabies immune globulin (20 IU/kg) infiltrated into the wound area, as recommended by 1
- Two booster doses on days 0 and 3 without immune globulin for previously vaccinated individuals
Immediate post-exposure treatment is critical as rabies is nearly 100% fatal once symptoms develop. Thorough wound cleansing with soap and water is also essential immediately after any potential rabies exposure to reduce viral load. Persons with continuing risk of exposure should receive a booster dose every 2 years, or they should have their serum tested for rabies antibody every 2 years and, if the titer is inadequate, receive a booster dose, as stated in 1.
From the FDA Drug Label
INDICATIONS AND USAGE Rabies vaccine and HyperRAB S/D should be given to all persons suspected of exposure to rabies with one exception: persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine
- The rabies vaccine is indicated for:
- Persons suspected of exposure to rabies
- Persons who have not been previously immunized with rabies vaccine
- Persons who have been previously immunized with rabies vaccine but do not have a confirmed adequate rabies antibody titer
- The rabies vaccine is not indicated for:
- Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer, as they should receive only HyperRAB S/D 2
From the Research
Rabies Vaccine Indication
- The rabies vaccine is indicated for post-exposure prophylaxis (PEP) in individuals who have been exposed to a rabid animal, as well as for pre-exposure prophylaxis (PrEP) in individuals who are at high risk of exposure [(3,4,5)].
- The vaccine can be administered intradermally (ID) or intramuscularly (IM), and the choice of route depends on the individual's needs and the availability of the vaccine [(4,5)].
- The WHO recommends a series of vaccinations, typically 2-5 doses, over a period of several weeks or months, depending on the schedule and the individual's risk of exposure 4.
- Abridged schedules with fewer doses have been shown to be effective and may improve patient compliance and access to care 4.
- The vaccine is safe and effective in pediatric patients, as well as in special populations such as pregnant women and immunocompromised individuals [(3,4,5)].
- Older individuals may require special attention due to lower antibody response to the vaccine 5.
- Rabies immunoglobulin (HRIG) is also recommended as part of PEP in individuals who have been exposed to a rabid animal, particularly in those who have not been previously vaccinated 3.