Rabies update from Illinois dept of public health

The Illinois department of public health 1 issued an update to the post exposure prophylaxis protocol this week, titled “Rabies post exposure prophylaxsis protocol March 20132 it reiterates the previously released guidelines from the CDC. This is an update to the CDC recommendations from 2008 3.

Exposed but not previously immunized

  • Concurrent human rabies immunoglobulin (HRIG) 20 IU/kg at the site of bite and remaining in the deltoid AND rabies vaccine (never given in the gluteus) on day 0
  • Followed by rabies vaccination on days 3, 7 and 14
  • The previously recommended fifth dose is no longer necessary except in the immunocompromised

Exposed and previously immunized

  • Same as above but without the immunoglobulin

General information

  • Site of bite should be washed with soap and water as soon as possible
  • Both immunoglobulin and the vaccine should not be given in the same syringe or site
  • HRIG should be infiltrated at the site of the bite and the remaining in the deltoid or anterior thigh. If no bite then HRIG is given in the gluteus, upper outer quadrant
  • Rabies vaccine is always given in the deltoid and NOT in the gluteus
  • There is no time limit after exposure where vaccine and immunoglobulin cannot be given
  • No need to check serology prior to starting prophylaxis
  • No need to check post vaccination serology

References