Rabies

exp date isn't null, but text field is

Rabies is a preventable disease. Strategies to prevent rabies include dog vaccination (through the veterinary department) and human pre- or post-exposure vaccination. 

Human vaccination

Vaccination for adults and older children (> 5yrs) use the deltoid area.

For younger children (<5 yrs) the outer aspect of the thigh can be used.

Vaccine should never be used in the gluteal area. 

Prevention of Rabies in Humans

• Pre-exposure prophylaxis

Individual pre-exposure immunisation should be offered to persons at high risk of exposure, such as animal handlers, veterinarians, National Parks and Wildlife personnel. 

2-2* vaccination schedule

Medicine	Adult Dose	Frequency	Duration
Rabies vaccine, human diploid cell intradermal (ID)	0.1mL (>0.5 IU)	once	day 0 and 7

*2-2: Dose and Site(s)

Alternative pre exposure immunisation schedule intramuscular (IM) regimen: 

Medicine	Adult Dose	Frequency	Duration
Rabies vaccine, human diploid cell im	0.5mL (>2.5 IU/IM dose)	single doses on day 0 and 7

Give a booster every 2-3 years if serological testing is not available to monitor antibody titre which should be >0.5IU/ml

• Post-exposure Prophylaxis (PEP) 

In dog and other animal bites, the wound should be thoroughly cleaned with povidone-iodine or soap and water as soon as possible. 

Exposure Categories and Appropriate Management

Category I	Feeding, touching or licks to intact skin	No PEP
Category II	Nibbling of skin, minor abrasions, scratches without bleeding	give PEP
Category III	Transdermal bites, scratches, saliva mucous membrane contamination	give immunoglobulin (RIG) and PEP*

*If RIG (rabies immunoglobulin) not available proceed with PEP

Prophylaxis

In an individual where there is a high risk of rabies, i.e.:

• Category II and III exposure
• Uncertain animal vaccination history or strong suspicion of rabid animal give: 

Preferred cheaper and shorter vaccination using the 7 day ID multi-site regimen: 

2-2-2 vaccination schedule:

Medicine	Adult Dose	Frequency	Duration
Rabies vaccine, (human diploid cell) intradermal (ID) deltoid area	0.1ml	once only	day 0,3,7

Alternative vaccination using the abbreviated IM (>2.5IU/IM dose) 21 day multi-site regimen:

2-1-1 vaccination schedule:

Medicine	Adult Dose	Frequency	Duration
Rabies vaccine, (human diploid cell) im (upper arm site)	0.5mL in each arm	once only	day 0
	then 0.5mL in one arm	one dose	on days 7 and 21

Use a separate syringe and needle for each dose; store vials at 4-8°C after reconstitution and use as soon as possible. Opened vials should be used within 6-8 hours.  

Use of Human Rabies Immunoglobulin (RIG) for passive immunization. 

In case of category III exposure, human RIG should be infiltrated at the wound site after thorough washing with soap and water or with betadine. 

	Medicine	Adult dose	Frequency	Duration
	human rabies immunoglobulin (RIG) (instilled and infiltrated locally around the wound)	10 IU/kg	once only	-
and	human rabies immunoglobulin im (gluteal)	10 IU/kg	once only	-

Notes

• In case of bite from a domestic animal with lapsed immunisation against rabies
  • Follow the above recommended vaccination schedule but without giving immunoglobulin
• In previously vaccinated individuals give one site intradermal (ID) or one site intramuscular (IM) vaccine on day 0,3 only. 
• Rabies vaccines labelled for IM use can be used safely via the ID route, even if this constitutes off-label use. 
• In the case of exposure to confirmed rabid animals vaccine should be given regardless of the time since exposure even years afterwards. 
• A change in route of administration during PEP or PreP is acceptable if such a change is unavoidable.