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Recommendations on administration of rabies vaccine and immunoglobulin

Takeaway

  • Guidance from Public Health England (PHE) on appropriate administration of post-exposure rabies vaccine with or without rabies immunoglobulin.

PHE's Virus Reference Department has issued guidance for healthcare professionals outlining recommendations for post-exposure rabies vaccination and rabies immunoglobulin. The guidance forms a part of the larger ‘PHE Rabies post-exposure prophylaxis: management guidelines’.

Recommendations

  • The rabies post-exposure treatment (PET) vaccine is administered as an intramuscular injection in the deltoid muscle.
  • In the United Kingdom, the schedule for non-vaccinated individuals is 5 vaccine doses (+/- human rabies immunoglobulin [HRIG]) at 0, 3, 7, 14 and 28-30 days, with day 0 not necessarily being the day of exposure.
  • Sequential doses should be administered in alternate arms.
  • In case of a missed dose, the next dose of vaccine should be administered without any delay and should be considered as the missed dose. The subsequent schedule should be readjusted.
  • It is not advisable to administer the fifth and final dose of the vaccine before day 26.
  • If there are challenges in attaining the specified dosing intervals for the vaccine, it is crucial to administer the first 3 doses within +/- 1 day.
  • Alterations in the vaccine schedule may be considered for partially immune individuals after evaluation of individual cases.
  • HRIG may be administered in addition to vaccine after evaluating the risk for exposure. It helps to provide short-term protection during the initial 6 days after initiating PET vaccine regimen.
  • HRIG should not be administered after 7 days of initiating PET vaccine regimen or to partially immunised individuals.
  • HRIG is typically infiltrated in the muscle around the wound site. In case of inability to administer the full volume at the site, the rest is given in the anterolateral thigh.
  • It is not advisable to give vaccine and HRIG at the same anatomical site.
  • The recommended HRIG dose of 20 IU/kg for all ages must not be exceeded.

References


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