Human diploid cell vaccine (HDCV) is the treatment of choice for exposure to rabies. Post-exposure prophylaxis should be initiated upon bite or nonbite exposure to wild animals (especially skunks, raccoons, foxes, coyotes, bobcats, and bats). The likelihood of a domestic dog or cat being infected with rabies varies, depending on the area, so indications for post-exposure vaccination may vary.

Post-exposure prophylaxis involves the administration of five 1.0-ml doses of HDCV given intra-muscularly, preferably in the deltoid or anterolateral thigh area, as soon as possible after exposure. The first dose should also be accompanied by human rabies immune globulin (HRIG) in the gluteal area. Five doses of HDCV should be administered within 28 days, on days 0, 3, 7, 14, and 28.

Pre-exposure vaccination is sometimes offered to high risk groups, e.g., veterinarians, animal handlers, certain laboratory workers, or people who may spend time in foreign countries where rabies is a constant threat. The latter applies especially to children, as statistics show that children are more at risk than adults.

Pre-exposure prophylaxis for high risk individuals involves the administration of three 1.0 ml-IM or 0.1-ml intradermal injections on days 0, 7, and 21 or 28. Depending on risk, serologic testing for neutralizing antibody titer is usually performed at 2- to 6-year intervals. If titers fall below 1:5, booster doses of one 1.0 ml IM or 0.1 ml intradermal are administered. Pre-exposure immunization of immune-suppressed persons is not recommended.

Rabies vaccine is medically necessary for post-exposure to rabies and for pre-exposure in high-risk groups.

Plans whose contracts or certificates of coverage exclude coverage for preventive care should also exclude pre-exposure prophylaxis for rabies.

The place of service for the initial administration of the post-exposure vaccination may be an emergency room, hospital clinic, urgent care facility, or physician’s office. Subsequent injections are only covered in the physician’s office. An exception to this may be on day 3, if the physician does not stock the vaccine, and is not able to obtain it by day 3.

A search of literature was completed through the MEDLINE database for the period of January 1993 through October 1996. The search strategy focused on references containing the following Medical Subject Heading:

- Rabies Vaccine

Research was limited to English-language journals on humans.

See also:

Physicians’ Desk Reference, 1996

Rabies vaccine
Vaccine, rabies