RABIES POSTEXPOSURE PROPHYLAXIS SCHEDULE ¹

Adapted from: Centers for Disease Control and Prevention. Human rabies prevention — United States, 2008: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2008;57(No. RR-3):[page 15] http://www.cdc.gov/mmwr/pdf/rr/rr5703.pdf .

I. FOR PERSONS NOT PREVIOUSLY VACCINATED:

1. Wound cleansing - All postexposure treatment should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as a povidone-iodine solution should be used to irrigate the wounds.
2. Rabies Immune Globulin - Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around the wounds(s) and any remaining volume should be administered IM at an anatomical site distant from vaccine administration. Also, RIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of antibody, no more than the recommended dose should be given.
   RIG is administered only once (i.e., at the beginning of antirabies prophylaxis) to provide immediate antibodies until the patient responds to the vaccine by actively producing antibodies.
3. Vaccine - HDCV² or PCEC³ 1.0 mL, intramuscular (deltoid area⁴ ), one each on days 0⁵, 3, 7, 14, and 28.

Both RIG and vaccine should be used, regardless of how long ago the exposure occurred. There is no approved regimen in the USA that omits the use of RIG for persons who were not previously vaccinated.

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II. FOR PERSONS WHO WERE PREVIOUSLY VACCINATED: ⁶

1. Wound cleansing - All postexposure treatment should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as a povidone-iodine solution should be used to irrigate the wounds.
2. Rabies Immune Globulin - RIG should NOT be administered.
3. Vaccine - HDCV² or PCEC³ 1.0 mL, intramuscular (deltoid area⁴ ), one each on days 0⁵ and 3.

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¹ These regimens are applicable for all age groups, including children.
² HDCV = human diploid cell vaccine
³ PCEC = purified chick embryo cell vaccine
⁴ The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children, the outer aspect of the thigh may be used. Vaccine should never be administered in the gluteal area.
⁵ Day 0 is the day the first dose of vaccine is administered.
^{6 "}Previously vaccinated" is defined as any person with a history of preexposure vaccination with HDCV, RVA or PCEC; prior postexposure prophylaxis with HDCV, RVA, or PCEC; or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination.