Rabies Post-Exposure Prophylaxis Protocol

Components of Rabies PEP

The Centers for Disease Control and Prevention recommends thorough wound cleansing, administration of rabies immune globulin (RIG) at 20 IU/kg body weight, and a 4-dose vaccination regimen administered on days 0, 3, 7, and 14 for previously unvaccinated persons 1, 2
The World Health Organization suggests using a virucidal agent such as povidone-iodine solution to irrigate the wounds when available 1, 2
Administer 20 IU/kg body weight of human rabies immune globulin (HRIG) 1, 2
HRIG should never be administered in the same syringe or at the same anatomic site as the first vaccine dose 3, 4
The American Academy of Pediatrics recommends administering 4 doses of 1 mL of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) intramuscularly 1, 2
For immunocompromised persons, administer 5 doses on days 0, 3, 7, 14, and 28 1, 2

The Centers for Disease Control and Prevention advises consulting public health officials for guidance on exposures to other domestic animals 6
Delaying PEP: Rabies PEP should be initiated as soon as possible after exposure, though it is still indicated regardless of the time interval between exposure and treatment initiation 3
Insufficient wound infiltration: Failure to thoroughly infiltrate HRIG around all wounds has been associated with rare PEP failures 3, 5
The World Health Organization notes that administering vaccine in the gluteal area results in lower antibody titers 5
Incorrect HRIG dose: Using more than the recommended dose of HRIG may suppress active antibody production 3, 1
Incomplete vaccination: Every effort should be made to complete the full vaccination schedule, though minor delays in individual doses are not critical 5
The current 4-dose vaccine regimen has been shown to be safe and effective while providing cost savings to the healthcare system 1, 7