Rabies Vaccine

Adults: To reconstitute Rabies Vaccine, transfer the contents of the supplied diluent into the vial containing the freeze-dried preparation. Do not shake it. After reconstitution the solution should be homogeneous, clear and free from any particles. Inject the vaccine immediately, and destroy the syringe after use. For intramuscular use, the 1 ml dose is given in the deltoid in adults and in the anterolateral aspect of the thigh muscle in children under 1 year. Don't inject it into the gluteal region, and never inject it intravenously. Pre-exposure immunization is 1 ml for children and adults. For primary vaccination, the WHO recommends 1 injection by the intramuscular route on days D0, D7, D21 or D28, followed by a booster dose one year later. After that, boosters are given as one injection every 5 years, or when the titre is found to be less than 0.5 IU/ml. For post-exposure immunization, the wound needs local treatment first. Wash it promptly and gently but thoroughly with soap or detergent, then flush it with running tap water for at least 15 minutes. After washing, apply a disinfectant such as ethanol (700 ml/l), a tincture or aqueous solution of iodine, or povidone iodine. Don't bandage or suture the wound. In non-immunized subjects, one intramuscular (IM) dose is 1 ml. The standard intramuscular (1-1-1-1-1) regimen is 1 injection of 1 ml on each of Day 0, Day 3, Day 7, Day 14 and Day 28. The abbreviated multisite (2-1-1) regimen is 2 injections each of 1 ml at separate sites on Day 0, then 1 injection of 1 ml on Day 7 and 1 injection of 1 ml on Day 21. In severe wounds (WHO category 3), rabies immunoglobulin should be given as soon as possible, together with the first dose of the vaccine. As much of the anti-rabies immunoglobulin as possible should go into and around the wound as local soakage injections, and the rest is given by muscle injection. The rabies vaccine should be given at a different injection site. For subjects already immunized, the schedule depends on the earlier vaccination. If a patient completed a post-exposure immunization schedule within 1 year and is bitten by a suspected rabid animal, 1 dose is needed on Day 0 and on Day 3. If the patient completed the post-exposure schedule 1 year ago and is bitten by a suspected rabid animal, the complete post-exposure immunization is required. A patient who completed the immunization schedule and booster immunization within 3 years, and is bitten by a suspected rabid animal, needs 1 dose on Day 0 and on Day 3. A patient who completed the immunization schedule and booster immunization 3 years ago, and is bitten by a suspected rabid animal, needs the complete post-exposure immunization. Post-exposure vaccination must be given according to the severity of the exposure, under medical supervision.