Postexposure Prophylaxis
PEP is any preventive medical treatment started immediately after exposure to a pathogen (such as rabies) in order to prevent infection by the pathogen and the development of disease.7
Left untreated, rabies has the highest fatality rate of any infectious disease, making rapid response essential.8
HyperRAB® (rabies immune globulin [human]), in conjunction with a vaccine, provides critical, comprehensive protection against rabies in previously unvaccinated persons. Rabies vaccine and HyperRAB should be given to all persons suspected of exposure to rabies, with one exception: persons who have been previously immunized with rabies vaccine and have confirmed adequate rabies antibody titer should receive only vaccine. HyperRAB should be administered as promptly as possible after exposure, but can be administered within 7 days after the first dose of rabies vaccine.9
Imminent Threat
Vaccines can take weeks to build efficacy but can protect for years. HyperRAB provides critical protection immediately, allowing the vaccine time to establish active immunity.2
Immediate Protection
HyperRAB contains high titers of rabies antibodies for PEP, providing rapid immune protection.9 Along with appropriate wound cleansing, a human rabies immune globulin such as HyperRAB is recommended by the CDC and World Health Organization (WHO) to be administered at the same time as the rabies vaccine in previously unvaccinated persons immediately following a transdermal bite or scratch by an animal suspected of being rabid.8,10
For unvaccinated individuals, the combination of human rabies immune globulin and vaccine is recommended for both bite and nonbite exposures, regardless of the time interval between exposure and initiation of PEP. If PEP has been initiated and appropriate laboratory diagnostic testing (ie, the direct fluorescent antibody test) indicates that the animal that caused the exposure was not rabid, PEP may be discontinued.2
Rabies PEP schedule – United States2
Vaccination status
|
Intervention |
Regimen* |
Not previously vaccinated
|
Wound cleansing |
All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (eg, povidine-iodine solution) should be used to irrigate the wounds. |
Human rabies immune globulin (HRIG) |
Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because rabies immune globulin (RIG) might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered. |
Vaccine |
Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL IM (deltoid area†), 1 each on days 0,§ 3, 7, and 14.‡ |
Previously vaccinated**
|
Wound cleansing |
All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds. |
HRIG |
HRIG should not be administered. |
Vaccine |
HDCV or PCECV 1.0 mL IM (deltoid area†), 1 each on days 0§ and 3. |
Rabies PEP schedule – United States2
Not previously vaccinated
Wound cleansing regimen*
All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent (eg, povidine-iodine solution) should be used to irrigate the wounds.
Human rabies immune globulin (HRIG) regimen*
Administer 20 IU/kg body weight. If anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered at an anatomical site (intramuscular [IM]) distant from vaccine administration. Also, HRIG should not be administered in the same syringe as vaccine. Because rabies immune globulin (RIG) might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
Vaccine regimen*
Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL IM (deltoid area†), 1 each on days 0,§ 3, 7, and 14.‡
Previously vaccinated||
Wound cleansing regimen*
All PEP should begin with immediate thorough cleansing of all wounds with soap and water. If available, a virucidal agent such as povidone-iodine solution should be used to irrigate the wounds.
HRIG regimen*
HyperRAB® S/D should not be administered.
Vaccine regimen*
HDCV or PCECV 1.0 mL IM (deltoid area†), 1 each on days 0‡ and 3.