Rabies Prevention and Management

Immediate Wound Management

The Centers for Disease Control and Prevention recommends that all dog bite victims immediately wash wounds thoroughly with soap and water for at least 15 minutes, as this single intervention markedly reduces rabies transmission risk more than any vaccine or immunoglobulin 1, 2

The World Health Organization recommends that any bite that penetrates skin or contamination of mucous membranes with saliva requires both rabies immunoglobulin (RIG) and vaccine, regardless of delay in presentation 1

The Centers for Disease Control and Prevention recommends administering RIG at 20 IU/kg body weight on day 0, infiltrating the full dose around and into the wound(s) if anatomically feasible, with any remaining volume given intramuscularly at a site distant from vaccine administration 1
RIG must be given within 7 days of starting vaccine; beyond day 7, it is contraindicated as antibody response to vaccine is presumed to have occurred 1
RIG should NEVER be administered in the same syringe or anatomical site as vaccine 1

The Centers for Disease Control and Prevention recommends that previously unvaccinated persons should receive a 4-dose intramuscular vaccine regimen on days 0, 3, 7, and 14 in the deltoid muscle (or anterolateral thigh in children), never in the gluteal area 1, 3
The 4-dose schedule (days 0, 3, 7, 14) is now recommended over the older 5-dose schedule (which included day 28), as no rabies failures have been documented with the reduced schedule and it saves costs without compromising safety 3
Tissue culture vaccines (HDCV, RVA, PCEC) are the standard of care globally 1

The Centers for Disease Control and Prevention recommends that individuals with documented prior complete rabies vaccination (pre- or post-exposure) should receive vaccine ONLY on days 0 and 3, without RIG 1
RIG is contraindicated in previously vaccinated persons as it may suppress the anamnestic antibody response 1

Post-exposure prophylaxis should be initiated regardless of time elapsed since exposure, as incubation periods >1 year have been documented 1