Rabies Post-Exposure Prophylaxis Schedule After Dog Bite

Initial Assessment and Wound Management

The Centers for Disease Control and Prevention recommends immediate and thorough cleansing of all wounds with soap and water, and if available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds 1
Tetanus prophylaxis and measures to control bacterial infection should be administered as indicated, according to the Centers for Disease Control and Prevention 1
The decision to suture large wounds should consider cosmetic factors and potential for bacterial infections; suturing should be avoided when possible, as recommended by the Centers for Disease Control and Prevention 3

The Centers for Disease Control and Prevention recommends administering 20 IU/kg body weight of HRIG on day 0 1
The World Health Organization suggests that if anatomically feasible, the full dose of HRIG should be infiltrated around and into the wound(s) 1
The Centers for Disease Control and Prevention advises that any remaining volume of HRIG should be administered intramuscularly at a site distant from vaccine administration 1
HRIG can be administered up to and including day 7 of the PEP series if not given on day 0, according to the Centers for Disease Control and Prevention 1
The Centers for Disease Control and Prevention recommends administering Human Diploid Cell Vaccine (HDCV) or Purified Chick Embryo Cell Vaccine (PCECV) 1
The dosage of the vaccine should be 1.0 mL, intramuscularly in the deltoid area (for adults and older children) or anterolateral thigh (for younger children), as recommended by the Centers for Disease Control and Prevention 1
The vaccine schedule should consist of 4 doses on days 0, 3, 7, and 14, according to the Centers for Disease Control and Prevention 1, 2
For immunosuppressed individuals, the Centers for Disease Control and Prevention recommends a 5-dose schedule (days 0, 3, 7, 14, and 28) 1

The Centers for Disease Control and Prevention recommends wound cleansing as described above 1
HRIG should NOT be administered to previously vaccinated individuals, according to the Centers for Disease Control and Prevention 1
The Centers for Disease Control and Prevention advises administering 2 doses of vaccine (1.0 mL each, IM in deltoid area) on days 0 and 3 1

The Centers for Disease Control and Prevention recommends that PEP should be initiated as soon as possible after exposure, but can be started regardless of the time interval since exposure if clinical signs of rabies are not present 4
The animal's vaccination status and circumstances of the bite should be considered when determining the need for PEP, according to the Centers for Disease Control and Prevention 4
A healthy domestic dog that bites a person may be confined and observed for 10 days; PEP can be delayed unless the animal develops signs of rabies, as recommended by the Centers for Disease Control and Prevention 4
For stray or unwanted dogs, immediate euthanasia and testing or immediate initiation of PEP is recommended, according to the Centers for Disease Control and Prevention 5
In areas where dog rabies is endemic (parts of Asia, Africa, Central and South America), immediate initiation of PEP may be warranted, as recommended by the Centers for Disease Control and Prevention 5

Delaying wound cleansing, which is crucial for reducing rabies virus transmission, should be avoided, according to the Centers for Disease Control and Prevention 3
Administering vaccine in the gluteal area, which can result in diminished immune response, should be avoided, as recommended by the Centers for Disease Control and Prevention 1
Using more than the recommended dose of HRIG, which can suppress active antibody production, should be avoided, according to the Centers for Disease Control and Prevention 1
Failing to infiltrate HRIG around the wound when anatomically feasible should be avoided, as recommended by the Centers for Disease Control and Prevention 1
The 4-dose vaccine schedule has been shown to be effective and provides cost savings while maintaining safety, according to the Centers for Disease Control and Prevention 2
This recommendation is based on evidence that most rabies PEP failures occurred before day 28 when the fifth dose would have been administered, as reported by the Centers for Disease Control and Prevention 6