Rabies preexposure prophylaxis

Rabies Inactivated virus Intramuscular (IM) Preexposure Three doses at days 0, 7, and 21 or 28 Serologic testing every 6 months to 2 years in persons at high risk 1. Preexposure prophylaxis in persons at risk for contact with rabies virus... 

Human diploid cell vaccine (HDCV), rabies vaccine adsorbed (RVA), and purified chick embryo cell culture rabies vaccine (PCEC) are killed vaccines used for preexposure and postexposure rabies virus prophylaxis. Transmission of rabies can occur via percutaneous, per-mucosal, or airborne exposure to the rabies virus. Circumstances favoring such transmission include animal bites or attacks and contamination of scratches, cuts, abrasions, or mucous membranes with saliva or other infectious material (brain tissue). Unprovoked attacks and daytime attacks by nocturnal animals are considered highly suspect. Common wild animal transmitters include skunks, coyotes, foxes, and raccoons. Almost 60% of human rabies deaths in the United States since 1980 were associated with bat contact. Canine rabies is very common in many foreign countries (most of Asia, Africa, and Latin America). Rodents, rabbits, and hares are infected rarely. There have been a few reports of a person-to-person transmission. ... 

All three vaccine preparations may be administered for preexposure prophylaxis as a three-dose series of 1 mL IM on days 0 and 7 and once between days 21 and 28. Alternatively, HDCV can be administered intradermally in a dose of 0.1 mL using the same schedule. HDCV must be given using the specific intradermal dosage form and syringe. Lower rabies antibody concentrations have been observed in individuals immunized using the intradermal route while taking malaria prophylaxis concurrently. The IM route is recommended in this situation. ... 

A) Rabies immune globulin is recommended only in patients who demonstrate an antibody response from preexposure prophylaxis... 

Rabies immune globulin should be given as soon as possible after exposure and must be combined with immunization using human diploid cell-derived rabies vaccine. Passive immunization is not recommended for individuals with demonstrated antibody response to preexposure prophylaxis with rabies vaccine. The answer is (A). 

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