Rabies Post-Exposure Prophylaxis Guidelines

Standard Post-Exposure Prophylaxis Regimen

The Centers for Disease Control and Prevention recommends administering 4 doses of Rabipur, 1.0 mL each, intramuscularly on days 0, 3, 7, and 14, for previously unvaccinated individuals, combined with human rabies immune globulin (HRIG) 20 IU/kg on day 0 1, 2
The American Academy of Pediatrics and the Centers for Disease Control and Prevention suggest injecting the vaccine in the deltoid muscle for adults and older children, and in the anterolateral thigh for young children 1, 2
The World Health Organization advises against administering the vaccine in the gluteal area, as this produces inadequate antibody response and is associated with vaccine failure 1, 2

The Centers for Disease Control and Prevention recommends administering HRIG at exactly 20 IU/kg body weight on day 0, ideally simultaneously with the first vaccine dose, and infiltrating the full calculated dose around and into the wound(s) if anatomically feasible 1, 2
The World Health Organization suggests that HRIG should never be administered in the same syringe or at the same anatomical site as the vaccine 1, 2

The Centers for Disease Control and Prevention advises administering only 2 doses of Rabipur (1.0 mL each) on days 0 and 3 for previously vaccinated persons, and not administering HRIG to previously vaccinated persons, as it will inhibit the anamnestic antibody response 1, 2, 3

The American College of Infectious Diseases recommends administering 5 doses of Rabipur on days 0, 3, 7, 14, and 28, plus HRIG at 20 IU/kg on day 0, for immunocompromised patients, and performing serologic testing 1-2 weeks after the final dose to confirm adequate antibody response 1, 2

The American Academy of Pediatrics suggests that children receive the same vaccine dose volume (1.0 mL) and HRIG dose (20 IU/kg) as adults, and using the anterolateral thigh for vaccine administration in young children 1, 2, 3

The World Health Organization recommends immediately washing all wounds thoroughly with soap and water for 15 minutes before administering any biologicals, and following with irrigation using a virucidal agent such as povidone-iodine solution if available 1, 2

The Centers for Disease Control and Prevention advises initiating post-exposure prophylaxis as soon as possible after exposure, ideally within 24 hours, and treating even if weeks or months have elapsed since exposure, as rabies incubation periods can exceed one year 2

The American College of Infectious Diseases warns against using the gluteal area for vaccine administration, giving HRIG to previously vaccinated persons, administering HRIG and vaccine in the same syringe or anatomical location, and exceeding 20 IU/kg of HRIG 1, 2, 3, 4