The individual dose for adults, children, and infants is 1 mL, given intramuscularly. In adults, administer vaccine by intramuscular (IM) injection into the deltoid muscle. In small children and infants, administer vaccine into the anterolateral zone of the thigh.
Administer three injections of 1.0 mL each:
The individual booster dose is 1 mL, given intramuscularly. Booster immunization is given to persons who have received previous rabies immunization and remain at increased risk of rabies exposure by reasons of occupation or avocation.
The continuous-risk category includes persons who work with live rabies virus in research laboratories or vaccine production facilities.
Persons in the continuous-risk category should have a serum sample tested for rabies antibodies every 6 months. The minimum acceptable antibody level is complete virus neutralization at a 1:5 serum dilution by the rapid fluorescent focus inhibition test (RFFIT). A booster dose should be administered if the titer falls below this level.
The frequent-risk category includes other laboratory workers such as those doing rabies diagnostic testing, spelunkers, veterinarians and staff, animal-control and wildlife officers in areas where rabies is epizootic.
Persons in the frequent-risk category should have a serum sample tested for rabies antibodies every 2 years and, if the titer is less than complete neutralization at a 1:5 serum dilution by RFFIT, should have a booster dose of vaccine. Alternatively, a booster can be administered in the absence of a titer determination.
The infrequent-risk category, including veterinarians, animal-control and wildlife officers working in areas of low rabies enzooticity (infrequent-exposure group) and international travelers to rabies enzootic areas do not require routine preexposure booster doses of RABAVERT after completion of a full primary preexposure vaccination scheme.
Immunization should begin as soon as possible after exposure. A complete course of immunization consists of a total of 5 injections of 1 mL each: one injection on each of days 0, 3, 7, 14, and 28 in conjunction with the administration of Human Rabies Immune Globulin (HRIG) on day 0. Begin with the administration of HRIG. Give 20 IU/kg body weight. This formula is applicable to all age groups, including infants and children.
The recommended dosage of HRIG should not exceed 20 IU/kg body weight because it may otherwise interfere with active antibody production. Since vaccine-induced antibody appears within 1 week, HRIG is not indicated more than 7 days after initiating postexposure prophylaxis with RABAVERT.
Serologic testing is indicated in unusual circumstances, as when the patient is known to be immunosuppressed. Contact the appropriate state health department or the CDC for recommendations.
When rabies exposure occurs in a previously vaccinated person, then that person should receive two IM (deltoid) doses (1.0 mL each) of RABAVERT: one immediately and one 3 days later. HRIG should not be given in these cases.