DOSAGE AND ADMINISTRATION
PRIMARY OR PREEXPOSURE VACCINATION
Pre exposure vaccination should be offered to persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers. Pre exposure vaccination also should be considered for other persons whose activities bring them into frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other species at risk for having rabies.
Pre-exposure prophylaxis is administered for several reasons. First, although pre-exposure vaccination does not eliminate the need for additional therapy after a rabies exposure, it simplifies therapy by eliminating the need for RIG and decreasing the number of doses of vaccine needed — a point of particular importance for persons at high risk for being exposed to rabies in areas where immunizing products might not be available or where they might be at high risk for adverse reactions. Second, pre-exposure prophylaxis might protect persons whose post-exposure therapy is delayed. Finally, it might provide protection to persons at risk for inapparent exposures to rabies.
The vaccine should be given by intramuscular injection into the deltoid muscle, or into the anterolateral region of the thigh in small children.
It must not be given by intra-gluteal injection.
Do not administer by intravascular injection
Treatment of Wounds and Immunization
The essential components of rabies post-exposure prophylaxis are wound treatment and, for previously unvaccinated persons, the administration of both RIG and vaccine. Persons who have been bitten by animals suspected or proven to be rabid should begin post-exposure prophylaxis immediately. Incubation periods of >1 year have been reported in humans. Thus, when a documented or likely exposure has occurred, post-exposure prophylaxis is indicated regardless of the length of the delay, provided the clinical signs of rabies are not present.
Immediate and thorough washing of all bite wounds and scratches with soap and water and a virucidal agent such as a povidone-iodine solution ( Betadine ) irrigation are important measures for preventing rabies. In studies of animals, thorough wound cleansing alone without other post-exposure prophylaxis has been shown to reduce markedly the likelihood of rabies.
Tetanus prophylaxis and measures to control bacterial infection also should be administered as indicated. The decision to suture large wounds should take into account cosmetic factors and the potential for bacterial infections.
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.