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A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sat 4 Apr 2009
From: Allan Grill
The regimen for an individual receiving rabies pre-exposure
prophylaxis consists of 3 intramuscular doses of rabies vaccine on
days 0, 7 and 21. This is usually recommended for certain groups who
may be at higher risk of exposure to the rabies virus (e.g.
veterinarians, individuals traveling to rabies endemic areas). Should
these individuals have a subsequent exposure to the rabies virus
(e.g. bite from a suspected rabid animal), they would require a
post-exposure prophylaxis regimen consisting of 2 intramuscular doses
of rabies vaccine on days 0 and 3 post-exposure. Rabies immune
globulin (RabIg) would not be required in this case.
For individuals who have not received rabies pre-exposure
prophylaxis, their 1st suspected rabies exposure would require 5
intramuscular doses of rabies vaccine on days 0, 3, 7, 14, and 28
days post-exposure. They would also require a dose of RabIg on day 0
post-exposure as well (given at a different anatomical site from the
1st dose of vaccine). Should these individuals ever have subsequent
suspected rabies exposures requiring post-exposure prophylaxis, the
regimen would be the same as the one mentioned above for individuals
who had received pre-exposure prophylaxis: 2 intramuscular doses of
rabies vaccine on days 0 and 3 post-exposure.
I believe it was mentioned in the previous posting [Rabies, canine,
human - Indonesia (07): comment on vaccination 20090404.1300] that
individuals who have had pre-exposure prophylaxis in the past require
3 doses of rabies vaccine post-exposure. As mentioned above, they
would only need 2 doses.
Communicated by:
Allan Grill, M.D., C.C.F.P., M.P.H.
Medical Consultant
Toronto Public Health
Toronto, Ontario, Canada
[ProMED-mail thanks Dr. Allan Grill for this additional
clarification. - Mod.CP]
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