Rabies Vaccine Dosing and Administration

Female medical professional preparing a syringe for injection.

How to Effectively Administer Rabies Vaccine

Dosing1

  • When treating a previously unvaccinated person, a regimen of four 1-mL vaccine doses of HDCV or PCECV should be administered intramuscularly
  • Children should receive the same vaccine dose volume as recommended for adults

Regimen1-3

  • The first dose should be administered as soon as possible after rabies exposure
  • The first dose marks the start of postexposure prophylaxis
  • The date of the first dose is considered day 0 of the series
  • Subsequent doses are administered on days 3, 7, and 14 after the first vaccination
  • In cases where a person has a weak or compromised immune system, there may be a 5th shot on day 28

All shots are required

Day

Day 0
Protocol

Administer HRIG and the FIRST rabies vaccine dose (1 mL)

Day 3
Protocol

Administer rabies vaccine (1 mL IM)

Day 7
Protocol

Administer rabies vaccine (1 mL IM). Antibody production begins

Day 14
Protocol

Administer rabies vaccine (1 mL IM)

Day Protocol

Day 0

Administer HRIG and the FIRST rabies vaccine dose (1 mL)

Day 3

Administer rabies vaccine (1 mL IM)

Day 7

Administer rabies vaccine (1 mL IM). Antibody production begins

Day 14

Administer rabies vaccine (1 mL IM)

Injection1

  • For adults and older children, the deltoid area is the only acceptable site for vaccine injections
  • Young children may receive vaccine injections in the anterolateral aspect of the thigh
  • The gluteal area should not be used for the administration of vaccine

Find Out if a Tetanus Vaccine Should Also Be Considered When Administering Rabies Postexposure Prophylaxis

Tetanus Vaccine

Important Safety Information for HyperRAB® (rabies immune globulin [human])

Indication and Usage
HYPERRAB® (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.

Limitations of Use
Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis. Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

Important Safety Information

For infiltration and intramuscular use only.

Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reactions in >5% of subjects during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.

Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.

Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio, or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.

Please see full Prescribing Information for HYPERRAB.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088

References

  1. Rupprecht CE, Briggs D, Brown CM, et al; Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010;59(RR-2):1-9.
  2. Baxter D. Active and passive immunity, vaccine types, excipients and licensing. Occup Med. 2007;57:552–556.
  3. Siegrist CA. Vaccine immunology. In: Orenstein W, Offit PA, Edwards KM, Plotkin SA. Plotkin’s Vaccines. 7th ed. Elsevier; 2018:16-34.e7.