Human Rabies Immune Globulin (HRIG)
HRIG is administered only once, at the beginning of post-exposure prophylaxis. If anatomically feasible, the full dose of HRIG should be thoroughly infiltrated in the area around and into the wounds. Any remaining volume should be injected intramuscularly (IM) at a site distant from rabies vaccine administration.
The gluteal muscle is not an acceptable site for HRIG. HRIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose.
Note: If HRIG is not given on day 0, it may be administered up to seven days after the first rabies vaccine.
A regimen of four vaccine doses is typically administered. Rabies vaccine should be administered IM in the deltoid for adults and children. Use the anterolateral thigh for infants. The gluteal muscle should not be used for rabies vaccine injections. Administration in this area can result in a decreased antibody response. Doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated. HRIG and vaccine must be given in different sites on the body.
The patient will receive the remaining vaccines on 3, 7, and 14 days after the first vaccination. If the person exposed is immunocompromised, a 5th vaccine on day 28 should be given and titers should be checked to ensure an acceptable antibody response after completing the series.
The following is the treatment regimen for patients not previously vaccinated against rabies. Day 0 is date of initiation of treatment.