Rabies Vaccine Booster Protocol for Previously Vaccinated Individuals with Dog Bite Reexposure

Definition and Booster Protocol

• The American College of Physicians and other medical guidelines recommend that previously vaccinated individuals who are reexposed to a dog bite should receive two doses of rabies vaccine (HDCV or PCECV), one immediately and the second dose 3 days later, without rabies immunoglobulin 1
• A previously vaccinated person is defined as someone who has received a complete pre-exposure or post-exposure prophylaxis regimen of HDCV, PCECV, or RVA, or has a documented rabies virus neutralizing antibody titer from previous vaccination 1, 2

Wound Management and Special Considerations

• The Centers for Disease Control and Prevention recommends that all post-exposure treatment should begin with immediate thorough cleansing of all wounds with soap and water, and consider tetanus prophylaxis as appropriate 4
• Immunosuppressed individuals may have suboptimal response to vaccination, and consultation with public health officials is recommended when treating immunosuppressed previously vaccinated individuals 1, 3
• Antibody titers should be checked after vaccination in immunosuppressed individuals 2, 3

Important Considerations

• Rabies immunoglobulin (RIG) should NOT be administered to previously vaccinated individuals, as it may inhibit the strength or rapidity of the expected anamnestic immune response 1, 3
• Previously vaccinated individuals develop a rapid anamnestic antibody response following booster vaccination 1