Rabies vaccines

Special situations only:
  • Following two situations included in 'high-risk category of children' for rabies vaccination and should be offered 'Pre-exposure prophylaxis' (Pre-EP):
    • Children having pets in home;
    • Children perceived with higher threat of being bitten by dogs such as hostellers, risk of stray dog menace while going outdoor.                                    
  • Only modern tissue culture vaccines (MTCVs) and IM routes are recommended for both 'post-exposure' and 'pre-exposure' prophylaxis in office practice
  • Post-exposure prophylaxis (PEP) is recommended following a significant contact with dogs, cats, cows, buffaloes, sheep, goats, pigs, donkeys, horses, camels, foxes, jackals, monkeys, mongoose, squirrel, bears and others. Domestic rodent (rat) bites and exposure to bats do not require post exposure prophylaxis in India.
  • Post-exposure prophylaxis (PEP):
    • MTCVs are recommended for all category II and III bites.
    • Dose: 1.0 ml intramuscular (IM) in antero-lateral thigh or deltoid (never in gluteal region) for Human Diploid Cell Vaccine (HDCV), Purified Chick Embryo Cell (PCEC) vaccine, Purified Duck Embryo Vaccine (PDEV); 0.5 ml for Purified Vero Cell Vaccine (PVRV).
      Intradermal (ID) administration is not recommended in individual practice.
    • Schedule: 0, 3, 7, 14, and 30 with day '0' being the day of commencement of vaccination.
    • The 2018 WHO recommendation recommends a PEP schedule of 4 doses: 0-3-7-14 to 28 days. However, this schedule is not recommended by the NCDC.
    • Rabies monoclonal antibodies or Rabies immunoglobin (RIG) along with rabies vaccines are recommended in all category III bites and category II bites in the immunocompromised.
    • Equine rabies immunoglobin (ERIG) (dose 40 U/kg) can be used if human rabies immunoglobin is not available;
  • Pre -exposure prophylaxis (PrEP):
    • Three doses are given intramuscularly in deltoid/ anterolateral thigh on days 0, 7 and 28 (day 21 may be used if time is limited but day 28 preferred).
    • The 2018 WHO recommendations, recommends a PrEP schedule of 2 doses: 0-7days
    • For re-exposure occurring more than 3 months after completed (and documented) pre or post exposure prophylaxis, two doses are given on days 0 and 3.
    • RIG is not required during re-exposure therapy.