Three components of PEP are highly effective in preventing human rabies in exposed patients who have not been previously vaccinated against the virus.2
Thoroughly cleanse the wound site with soap and water2
Administer a human rabies immune globulin, such as KEDRAB, as soon as possible after exposure, but no later than 7 days after the first dose of the vaccine2,3
Vaccinate against the rabies virus to stimulate the patient’s immune system (virus neutralizing antibodies will appear approximately 7 to 10 days after initiation of the vaccine series)2
Adapted from Health and Disease Blog 2013.4
PEP for Rabies2
|Not Previously Vaccinated||Wound Cleansing||All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (eg, povidone-iodine solution) should be used to irrigate the wounds|
|Human Rabies Immune Globulin|
|Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because HRIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered|
|Vaccine||Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area†) 1 each on days 0,‡ 3, 7, 14|
|Previously Vaccinated§||Wound Cleansing||All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds|
|HRIG||HRIG should not be administered|
|Vaccine||HDCV or PCECV 1.0 mL, IM (deltoid area†), 1 each on days 0‡ and 3|
Adapted from CDC Advisory Committee on Immunization Practices 2010.2
*These regimens are applicable for persons in all age groups, including children.
†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.
‡Day 0 is the day dose 1 of vaccine is administered.
§Any person with a history of pre-exposure vaccination with HDCV, PCECV, or rabies vaccine adsorbed (RVA); prior PEP with HDCV, PCECV, or RVA; or previous vaccination with any other type of rabies vaccine and a documented history of antibody response to the prior vaccination.
NOTE: For persons with immunosuppression, rabies post-exposure prophylaxis should be administered using all 5 doses of vaccine on days 0, 3, 7, 14, and 28.
It is critical that the volume of your HRIG dose is adequate when treating all rabies exposures.
References: 1. Centers for Disease Control and Prevention. Human rabies prevention—United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2008;57(RR-3):1-28. 2. Centers for Disease Control and Prevention. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2010;59(2):1-9. 3. KEDRAB [package insert]. Fort Lee, NJ: Kedrion Biopharma Inc.; 2021. 4. Health and Disease Blog. Rabies virus: properties, mode of transmission, pathogenesis, types, prevention, vaccination, lab diagnosis. https://www.healthdiseaseblog.com/2013/02/rabies-virus-properties-disease-transmission-pathogenesis-neurotrophicvirus-types-of-rabies-virus-street-virus-fixed-virus-vaccine-lab-diagnosis.html. Accessed October 19, 2020. 5. World Health Organization. WHO Expert Consultation on Rabies, third report. Geneva: World Health Organization; 2018 (WHO Technical Report Series, No. 1012). Licence: CC BY-NC-SA 3.0 IGO. 6. Dimaano EM, Scholand SJ, Alera MTP, Belandres DB. Clinical and epidemiological features of human rabies cases in the Philippines: a review from 1987 to 2006. Int J Infect Dis. 2011;15(7):e495-e499. 7. Wilde H. Failures of post-exposure rabies prophylaxis. Vaccine. 2007;25(4):7605-7609. 8. Wilde H, Sirikawin S, Sabcharoen A, et al. Failure of postexposure treatment of rabies in children. Clin Infect Dis. 1996;22(2):228-232.