Rabies Vaccine

A regimen of four 1-mL doses of HDCV or PCEC vaccines should be administered intramuscularly to previously unvaccinated persons.

The first dose of the four-dose course should be administered as soon as possible after exposure. Additional doses should be administered on days 3, 7, and 14 after the first vaccination. For adults, the vaccination should always be administered intramuscularly in the deltoid area (arm). For children, the anterolateral aspect of the thigh is also acceptable. The gluteal area should never be used for rabies vaccine injections because observations suggest administration in this area results in lower neutralizing antibody titers.

Postexposure Prophylaxis for Non-immunized Individuals
Treatment	Regimen
Wound cleansing	All postexposure prophylaxis should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds.
RIG	If possible, the full dose should be infiltrated around any wound(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.
Vaccine	HDCV or PCECV 1.0 mL, IM (deltoid area ), one each on days 0 , 3, 7, and 14.

Postexposure Prophylaxis for Previously Immunized Individuals
Treatment	Regimen
Wound cleansing	All postexposure prophylaxis should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidine-iodine solution should be used to irrigate the wounds.
RIG	RIG should not be administered.
Vaccine	HDCV or PCECV 1.0 mL, IM (deltoid area), one each on days 0 and 3.

If exposed to rabies, previously vaccinated persons should receive two IM doses (1.0 mL each) of vaccine, one immediately and one three days later. Previously vaccinated persons are those who have received one of the recommended preexposure or postexposure regimens of HDCV, RVA, or PCECV, or those who received another vaccine and had a documented rabies antibody titer. RIG is unnecessary and should not be administered to these persons because an anamnestic response will follow the administration of a booster regardless of the pre-booster antibody titer.