Rabies Post-Exposure Prophylaxis Protocol After Animal Bite
Rabies post-exposure prophylaxis (PEP) consists of wound care, human rabies immune globulin (HRIG), and rabies vaccine for individuals not previously vaccinated. [1] PEP should be initiated at the first medical visit (day 0) with vaccine plus HRIG when indicated. [1]
Immediate Wound Management
Immediate and thorough cleansing of all wounds with soap and water is recommended. [1] If available, a virucidal agent such as povidone-iodine should be used to irrigate the wounds. [1]
Immune Globulin Indications and Administration
HRIG is indicated only for people who have not previously received ACIP-recommended rabies pre-exposure prophylaxis or rabies post-exposure prophylaxis. [1] The recommended HRIG dose is 20 IU/kg for all age groups. [2] HRIG should be infiltrated into and around any wound(s) to the extent anatomically feasible. [1] Any remaining HRIG volume should be administered intramuscularly at an anatomical site distant from vaccine administration. [1] HRIG should not be administered in the same syringe as the vaccine. [1]
Rabies Vaccine Schedule
For individuals who have never been vaccinated against rabies, rabies vaccine should be administered as a 4-dose series on days 0, 3, 7, and 14. [1] Each dose should be 1.0 mL of human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) given intramuscularly. [1] For adults, vaccine should be given intramuscularly in the deltoid area. [1] For children, vaccine can be given intramuscularly in the deltoid area or the anterolateral aspect of the thigh. [1] Rabies vaccine should not be administered in the gluteal area. [1]
Immunocompromised Patient Modification
Immunocompromised individuals should receive a 5-dose vaccine regimen that adds an additional vaccine dose on day 28. [1]
Previously Vaccinated Patient Protocol
For individuals with previously documented rabies vaccination, HRIG should not be administered. [1] Previously vaccinated individuals should receive two rabies vaccine doses on days 0 and 3. [1]
Key Administration Precautions and Timing
The first vaccine dose should be given at a different anatomical site than HRIG. [1] HRIG should be given at the beginning of the PEP course. [1] If HRIG was not administered on day 0 when vaccination was begun, HRIG can be administered up to and including day 7 of the PEP series. [2] Delays of a few days for individual vaccine doses are considered unimportant, but longer lapses (weeks or more) may have unpredictable consequences. [2]
Clinical Urgency
Rabies PEP should be initiated for indicated exposures at the first medical visit because it prevents progression from infection to disease. [1] Public health input should be sought for exposure risk assessment and regimen details. [1]