Health Advisory
RABIES EXPOSURE MANAGEMENT GUIDANCE

Previously the Advisory Committee on Immunization Practices recommended a 5-dose vaccination regimen for rabies postexposure prophylaxis (PEP). The 2010 recommendation has reduced the number of vaccine doses to four (4) in combination with rabies immune globulin (RIG). Below is additional information about these changes.

Recommendations of the Advisory Committee on Immunization Practices (ACIP), March 2010

Previously Unvaccinated Persons:

The current recommendation for rabies PEP is a 4-dose vaccination regimen in combination with rabies immune globulin (RIG). For previously unvaccinated persons, the first dose of the 4-dose course should be administered as soon as possible after exposure (day 0). Additional doses should follow on days 3, 7 and 14 after the first vaccination. ACIP recommendations for the use of RIG remain unchanged. RIG is administered once to previously unvaccinated persons to provide rabies virus neutralizing antibody coverage until the patient responds to vaccination by actively producing virus-neutralizing antibodies. RIG is administered once on day 0 at the time PEP is initiated with the first dose of rabies vaccination.

Persons Who Previously Received a Complete Vaccination Series:

The current recommendation is a 2-dose rabies vaccination series. The first dose should be given immediately and the second dose 3 days later. Administration of RIG should not be given to avoid possible inhibition of the relative strength or rapidity of an expected anamnestic response.

Persons with Altered Immunocompetence:

For such persons, PEP should comprise a 5-dose vaccination regimen (1 dose of vaccine on days 0, 3, 7, 14 and 28) with 1 dose of RIG.

Prompt rabies PEP combining thorough wound care, infiltration of RIG into and around the wound, and multiple doses of rabies cell-culture vaccine are highly effective in preventing human rabies.

The Delaware Division of Public Health (DPH) only tests animals for rabies when there has been human exposure.

Raccoons, foxes, bats, skunks and cats have been the most frequent carriers of rabies in Delaware. During 2010, DPH conducted rabies testing on 158 animals in which there was human contact. Of those 158, ten resulted positive for rabies. Historically, from 1999-2009, DPH confirmed 445 animals that were positive for rabies.

In Delaware, rabies vaccine is only available from emergency departments at all Delaware hospitals. Healthcare providers are encouraged to contact DPH, Bureau of Epidemiology, Rabies Program (866-972-9705 or (302) 744-1033) to assist in determining the risk of rabies exposure through epidemiological assessment, and quarantine or laboratory testing of the biting animal. An epidemiologist is available 24/7 for assistance.

For detailed information regarding Rabies Vaccine or Human Rabies Immune Globulin:

• CDC Rabies Vaccine: http://www.cdc.gov/rabies/medical_care/vaccine.html
• CDC Human RIG: http://www.cdc.gov/rabies/medical_care/hrig.html

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