How is the rabies vaccine administered?

Updated: Jun 21, 2019
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

If the patient has had no prior rabies vaccination, if he or she is of unknown status, or if more than 5 years have passed since his or her last vaccination, rabies vaccine and immunoglobulin should be administered as follows (these dosages being applicable to products available in the United States):

  • Rabies vaccine IM (deltoid) - 1 mL on days on days 0, 3, 7, and 14 (if immunocompromised, add an additional dose: 1 mL IM deltoid on days 0, 3, 7, 14, and 28)
  • Rabies immunoglobulin - 20 IU/kg infiltrated as much as feasible around and under the bite wound; if any left over, give IM (gluteus)
  • The pediatric dose of HRIG, calculated by body weight, may be of insufficient volume to infiltrate all of the wounds. The immunoglobulin may be diluted with sterile saline so that more volume can be used without exceeding the total recommended dose. [40]

If the patient has had prior rabies vaccination, rabies vaccine should be administered IM (deltoid) 1 mL on days 0 and 3 (this dosage again being applicable to US vaccine).

The World Health Organization (WHO) has revised PEP guidance for previously unimmunized individuals in order to reduce cost and spare vaccine doses without reducing effectiveness. Currently recommended guidance for rabies PEP outside the United States, in order of preference, includes the following: [19]

  • Two-site intradermal (ID) vaccine administration on days 0, 3, and 7
  • One-site IM vaccine administration on days 0, 3, 7 and the fourth dose between days 14 and 28 (same as in the United States)
  • Two-site IM vaccine administration on day 0 and one-site IM administration on days 7 and 21

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