Pre-Exposure Prophylaxis for Rabies

Primary Vaccination Series

The Centers for Disease Control and Prevention recommends a primary vaccination series consisting of three 1.0-mL injections of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) administered intramuscularly in the deltoid area on days 0, 7, and 21 or 28 for individuals at high risk of exposure to rabies 1, 2, 3, 4
The primary vaccination series establishes adequate immunity against rabies virus and creates immunologic memory for future exposures, with a specific timeline for administration: first dose on day 0, second dose on day 7, and third dose on either day 21 or day 28 1, 3, 6

The Centers for Disease Control and Prevention recommends pre-exposure vaccination for persons in high-risk groups, including veterinarians and their staff, animal handlers, rabies researchers, and certain laboratory workers 1, 5
Individuals who frequently handle bats should receive pre-exposure prophylaxis regardless of their location, as lyssaviruses exist on all continents except Antarctica 1, 5

For individuals with continuous risk, such as laboratory workers, serum should be tested for rabies virus neutralizing antibody every 6 months, and a booster dose is required if serum titer falls below complete neutralization at a 1:5 serum dilution by RFFIT 1, 5, 7
For individuals with frequent risk, such as diagnostic lab workers, cavers, veterinarians, and animal control officers in enzootic areas, serum should be tested for rabies virus neutralizing antibody every 2 years, and a booster dose is required if titer is less than complete neutralization at a 1:5 serum dilution by RFFIT 1, 5, 7

Pre-exposure prophylaxis eliminates the need for rabies immunoglobulin (RIG) if exposed to rabies, and reduces the number of vaccine doses needed for post-exposure prophylaxis from 4 to 2 doses 1, 3, 4, 7
Pre-exposure prophylaxis may provide partial immunity if post-exposure prophylaxis is delayed, and provides protection against unrecognized exposures to rabies 1

Immunosuppressed individuals should postpone pre-exposure vaccinations when possible, and if vaccination cannot be postponed, antibody response should be checked after completing the pre-exposure series 5, 8

For previously vaccinated persons who are subsequently exposed to rabies, only 2 IM doses of vaccine are required (on days 0 and 3), without RIG 1, 5, 7