Rabies Vaccine Administration Guidelines
Introduction to Rabies Vaccination
- The Centers for Disease Control and Prevention recommends that the antirabies vaccine must be administered intramuscularly (IM) in the deltoid muscle for adults and older children, or in the anterolateral thigh for young children and infants—never in the gluteal area 1, 2
Route of Administration by Age Group
- The Centers for Disease Control and Prevention recommends administering 1.0 mL intramuscularly in the deltoid area only for adults 1
- For older children, the deltoid muscle is the recommended site, same as adults 1
- For younger children and infants, the anterolateral aspect of the thigh is an acceptable site 1
- The gluteal area must never be used in any pediatric age group due to poor immune response 1, 2
Standard Dosing Schedule
- The American Academy of Pediatrics recommends a 4-dose regimen: Days 0, 3, 7, and 14 for previously unvaccinated persons 2
- Each dose is 1.0 mL administered intramuscularly, and must be combined with rabies immunoglobulin (RIG) 20 IU/kg on day 0 2, 3
- For previously vaccinated persons, a 2-dose regimen only: Days 0 and 3 is recommended, with no RIG required 2
Critical Administration Pitfalls to Avoid
- The World Health Organization recommends never injecting in the gluteal region because this results in lower neutralizing antibody titers and inadequate immune response 1, 2, 4
- RIG and vaccine should never be administered in the same syringe or same anatomical site 1, 3