Vaccination procedure for persons who have not been vaccinated
Days 0,28,56 & once one year later, or Days 0,7,21 & once one yr. later
Post -exposure vaccination
Days 0,3,7,14,30 & 90 (optional)
Post-exposure simultaneous prophylaxis
Vaccination as above, plus Human Rabies Immunoglobulin 20 I.U./ Kg bwt or Rabies immune serum 40 I.U / Kg bwt with the first dose of vaccine or no later than 8 days. Half of total amount of immunoglobulin to be infiltrated in the region of the wound. The remainder is preferably to be injected intragluteally.
Local treatment of the wound should always be carried out. Usually the time interval between the last dose of the vaccine and the date of pre-exposure are taken into consideration.
Previous Vaccinations using a rabies vaccine with a potency of >2.5 I.U./dose, which date back:-
Less than One year
1 vaccination on day 0. For high-degree exposure 2 vaccinations on day 0 & 3.
1 to 5 years
2 vaccinations: day 1 & 3 For high degree exposure: 3 vaccinations day 0, 3 & 7
More than 5 years
A complete course of vaccination including RIG if indicated.
Regimen for post-exposure treatment of a previously vaccinated person
Cases of high degree of exposure, category 11 and III Persons who have previously received pre or post exposure treatment with vaccines of unproven potency, and those who have not demonstrated an acceptable rabies neutralizing antibody titre should receive a complete post-exposure course, including Rabies lmmunoglobulin (RIG) if indicated.
It may be appropriate to double the first dose of the vaccine in the following situations:
In patients with underlying chronic diseases e.g. liver cirrhosis.
In patients who are congenitally immunodeficient or suffering from AIDS.
In patients taking immuno suppressive drugs including corticosteroids and anti malarials.
In severely malnourished.
In patients who come for treatment after a delay of 48 hr. or more.
In patients where RIG is indicate but is unavailable.