- Practically all children need vaccination against rabies.
Following two situations included in 'highrisk category of children' for rabies vaccination and should be offered 'Pre-exposure Prophylaxis' (Pre-EP):
- Children having pets in home.
- Children perceived with higher threat of being bitten by dogs, risk of stray dog menace while going outdoor.
- Only modern tissue culture vaccines (MTCVs) and IM routes are recommended for both 'post-exposure' and 'pre-exposure' prophylaxis in office practice.
- Post-exposure prophylaxis (PEP) is recommended following a significant contact with dogs, cats, cows, buffaloes, sheep, goats, pigs, donkeys, horses, camels, foxes, jackals, monkeys, mongoose, squirrel, bears and others. Domestic rodent (rat) bites do not require post exposure prophylaxis in India.
- MTCVs are recommended for all category II and III bites.
- Dose: 1.0 ml intramuscular (IM) in anterolateral thigh or deltoid (never in gluteal region) for Human Diploid Cell Vaccine (HDCV), Purified Chick Embryo Cell (PCEC) vaccine, Purified Duck Embryo Vaccine (PDEV); 0.5 ml for Purified Vero Cell Vaccine (PVRV). Intradermal (ID) administration is not recommended in individual practice.
- Schedule: 0, 3, 7, 14, and 30 with day ‘0’ being the day of commencement of vaccination. A sixth dose on day 90 is optional and may be offered to patients with severe debility or those who are immuno-suppressed.
- Rabies Immunoglobulin (RIG) along with rabies vaccines are recommended in all category III bites.
- Equine Rabies Immunoglobulin (ERIG) (dose 40 U/kg) can be used if human rabies immunoglobulin is not available.
- Three doses are given intramuscular in deltoid/ anterolateral thigh on days 0, 7 and 28 (day 21 may be used if time is limited but day 28 preferred).
- For re-exposure at any point of time after completed (and documented) pre or post exposure prophylaxis, two doses are given on days 0 and 3.
- RIG is not required during re-exposure therapy.