RABIES VACCINE – Post Exposure Immunization
Individuals who have been exposed to rabies virus through suspected/infected rabid animal bites/scratches/licks come under this group.
Important facts in management
- Immediate and thorough cleansing of wounds with copious soap and water.
- Preferably, the wound should not be sutured.
- Tetanus vaccine as per prior immunization status.
- Anti Rabies vaccine to be given.
The number of doses required is determined by the previous anti-rabies immunization status of an individual.
Immunized person is one who has:
- received prior complete post-exposure vaccination with HDCV, PCEC
- previously been immunized with any other type of rabies vaccine with a documented blood report of adequate antibody response (0.5 IU/ml or greater)
Unimmunized person is one who has:
- received incomplete or no anti-rabies vaccines in the past.
Grade of Exposure determines the schedule. So, it becomes important that you provide correct information to your health care provider & let him make the decision.
|Exposure Grade||Type of Exposure||Immunisation Schedule|
|1||Touching/feeding animals with no contact with their saliva; with undamaged skin.||No immunisation necessary.|
|If there is risk of further exposure, vaccinate on day 0, 7, 28. But if in doubt, give the complete course on day 0, 3, 7, 14 and 30.|
|2||Animal has nibbled or licked exposed skin||Immediately start immunization. Give the complete course.|
|Contact of broken skin with infected animals saliva||Also give simultaneous prophylaxis with human rabies immune globulin (readymade antibody).|
|Superficial, non- bleeding, scratches made by the animal with the exception of scratches on the head, neck, scapular region, arms, hands||If the animal later is proved to be healthy, it is recommended to continue with schedule on day 0, 7, 28.|
|3||All bites||Immediate administration of immune globulin and start the immunization- complete course as mentioned above.|
|Bleeding scratches and all scratches on the head, neck, scapular region, arms, hands||If the animal later is proved to be healthy, it is recommended to continue with schedule on day 0, 7, 28.|
|Contact of mucus membrane with saliva as in licking|
If one has already taken the full course of vaccines once and is re- exposed, the following schedule is to be followed:
|Interval between full course and re-exposure||Schedule|
|Less than 3 years||One injection on day 0 and 3|
|More than 3 years||Full course|
Post-exposure Immunisation Time Table
|Immunization Status||Vaccine / Product||Dose||Number of Doses||Schedule (Days)||Route|
|Not previously immunized||Human RIG||20 IU/kg body weight||1||0||50% Infiltrated Subcutaneously at the site of bite/scratch (if possible); remainder Intramuscular in the buttocks.|
|HDCV||1ml||5||0, 3, 7, 14, 30||Intramuscular|
|Previously immunized*(Within 3 years)||HDCV||1ml||2||0, 3||Intramuscular|
|Previously immunized (>3 years back)||HDCV||1ml||5||0, 3, 7, 14, 30||Intramuscular|
Abbreviations: RIG – Rabies Immune Globulin; HDCV – Human Diploid Cell
* Prior complete post-exposure vaccination with HDCV, PCEC; or previously immunized with any other type of rabies vaccine with a documented blood report of adequate antibody response.
- The dose of the vaccine remains the same in adultsand children.
- Under no circumstances should the vaccine be given in the buttocks.
- The pre-exposure vaccines can be given intradermally (ID) in case of HDCV or intramuscularly (IM) but the post-exposure vaccines must be given intramuscularly (IM).