Rabies Vaccination Guidelines

Post-Exposure Prophylaxis (PEP) for Previously Unvaccinated Persons

The American College of Emergency Physicians recommends administering 4 doses of rabies vaccine intramuscularly on days 0, 3, 7, and 14, combined with rabies immune globulin (RIG) at 20 IU/kg on day 0 for previously unvaccinated individuals exposed to rabies 1, 2
The Centers for Disease Control and Prevention (CDC) suggests that immediate wound care, including thorough washing with soap and water for 15 minutes, is crucial in preventing rabies 2
The World Health Organization (WHO) recommends infiltrating the full dose of RIG around and into the wound(s) if anatomically feasible, with any remaining volume administered intramuscularly at a site distant from vaccine administration 2, 4

The CDC recommends that previously vaccinated individuals require only 2 doses of vaccine on days 0 and 3, with no RIG administration 5, 2
The Advisory Committee on Immunization Practices (ACIP) states that RIG should not be administered to previously vaccinated persons, as it can inhibit the anamnestic antibody response 5, 2

The CDC recommends administering 3 doses of HDCV or PCECV, 1.0 mL intramuscularly, on days 0, 7, and 21 or 28 for pre-exposure prophylaxis 5, 1
The WHO suggests that individuals at high risk of exposure, such as rabies researchers and laboratory workers, should receive pre-exposure prophylaxis 5

The CDC recommends that immunocompromised individuals receive the full 5-dose vaccine regimen on days 0, 3, 7, 14, and 28, plus RIG at 20 IU/kg, even if previously vaccinated 2, 3
The ACIP states that children receive the same vaccine dose volume (1.0 mL) and RIG dose (20 IU/kg) as adults 2, 3

The CDC recommends initiating PEP as soon as possible after exposure, ideally within 24 hours, with no absolute cutoff beyond which PEP should be withheld 2
The WHO suggests that delays of even a few hours matter significantly, as rabies is nearly 100% fatal once clinical symptoms develop 2

The CDC states that when administered promptly and appropriately, rabies PEP combining wound care, RIG infiltration, and the vaccine series is nearly 100% effective in preventing human rabies 2, 3
The ACIP reports that post-vaccination serologic testing is not necessary in immunocompetent individuals, as all healthy persons demonstrate adequate antibody response when prophylaxis is administered according to guidelines 5