After managing the wound, give rabies vaccine with or without HRIG (human rabies immunoglobulin), depending on the category and source of exposure. See:

If a person’s vaccination status is uncertain because documentation showing a full course of rabies vaccine is not available, give the full post-exposure prophylaxis regimen.

Vaccine given intradermally for pre- or post-exposure prophylaxis can be considered previous vaccination.

Table. Vaccinated people: post-exposure rabies prophylaxis based on immune status and exposure category

Vaccinated people have evidence of a completed recommended pre-exposure or post-exposure prophylaxis regimen at any time in the past, or have a documented VNAb (rabies virus neutralising antibody) titre of >0.5 IU per mL at any time in the past. For those with a history of partial immunisation, see Incomplete pre-exposure prophylaxis schedule.

Immune status Exposure category HRIG Dose 1 (day 0) Dose 2 (day 3) Dose 3 (day 7) Dose 4 (day 14) Dose 5 (day 28)
Immunocompetent Any category II or III Not needed Yes Yes Not needed Not needed Not needed
Mildly immunocompromised Any category II or III Not needed Yes Yes Not needed Not needed Not needed
Severely immunocompromised Any category II or III Not needed Yes Yes Yes Yes Yes

HRIG = human rabies immunoglobulin

Deviations of a few days from this schedule are probably unimportant.13

Severely immunocompromised refers to people for whom live vaccines are contraindicated. See People who are immunocompromised.

Table. Unvaccinated people: post-exposure rabies prophylaxis based on immune status and exposure category
Immune status Exposure category HRIG Dose 1 (day 0) Dose 2 (day 3) Dose 3 (day 7) Dose 4 (day 14) Dose 5 (day 28)
Immunocompetent Category II terrestrial animals Not needed Yes Yes Yes Yes Not needed
Category II bats and any category III Yes Yes Yes Yes Yes Not needed
Mildly immunocompromised Any category II or III Yes Yes Yes Yes Yes Yes
Severely immunocompromised Any category II or III Yes Yes Yes Yes Yes Yes

HRIG = human rabies immunoglobulin

Deviations of a few days from this schedule are probably unimportant.13

Severely immunocompromised refers to people for whom live vaccines are contraindicated. See People who are immunocompromised.

Administration of rabies vaccine for post-exposure prophylaxis by the intradermal route is not recommended.

No clinical trial has assessed the efficacy of rabies vaccine, but the rationale supporting a 4-dose schedule in immunocompetent people is based on numerous studies.18-20 There have been no reported cases in Australia or internationally of vaccine failure in people who have been potentially exposed and have received a complete course of post-exposure prophylaxis.31

Incomplete pre-exposure prophylaxis schedule

People who are immunocompetent and have previously received an incomplete pre-exposure prophylaxis schedule of 2 doses can receive the 2-dose post-exposure prophylaxis schedule described above.

People who have only received 1 dose previously as pre-exposure prophylaxis require 4 doses as post-exposure prophylaxis (similar to those who are unvaccinated): 

  • If the single dose was given intramuscularly within the 12 months before exposure, no HRIG is required. 
  • If the single dose was given more than 12 months before exposure, HRIG is required.
  • If the single dose was given intradermally, HRIG is required, regardless of when it was given.

People with any level of immunocompromise who received an incomplete pre-exposure prophylaxis schedule should receive post-exposure prophylaxis as for unvaccinated people, including HRIG.

People who are immunocompromised

Where possible, stop any immunosuppressive therapy (including corticosteroids) while giving post-exposure prophylaxis. Such treatment may interfere with the development of a protective response from the vaccine. Consult the person’s treating specialist to discuss the feasibility of this.

Measure the VNAb titre 2–4 weeks after the last dose. If the titre is <0.5 IU per mL, give another dose. Repeat the serological testing 2–4 weeks after this dose. If the titre is still <0.5 IU per mL, seek advice via state or territory health authorities. 

People who are severely immunocompromised (that is, people for whom live vaccines are contraindicated) should always receive a dose of rabies immunoglobulin in addition to rabies vaccine as post-exposure prophylaxis, even if they have previously received rabies vaccine.

Repeat rabies exposure

People with a repeat exposure within 3 months of completing previous post-exposure prophylaxis do not need any further vaccine doses and only need wound management.

Use of human rabies immunoglobulin

Some people with a potential exposure to rabies virus or other lyssaviruses are recommended to receive HRIG in addition to rabies vaccine as post-exposure prophylaxis. See: 

Where indicated, give a dose of HRIG as soon as possible, and within 7 days (168 hours), after the 1st vaccine dose. Do not give HRIG if more than 7 days (168 hours) have passed since the 1st vaccine dose.

HRIG provides localised anti-rabies antibody protection while the person responds to the rabies vaccine. For information on how to administer HRIG, see Vaccines, dosage and administration.

HRIG is not recommended in people who:

These people should receive rabies vaccine only.

Data are limited on the effectiveness of rabies vaccine and HRIG as post-exposure prophylaxis against infection with lyssaviruses other than classical rabies virus. However, the available animal data and clinical experience support their use.36-41

Page history

Last updated: 
27 September 2021
Last reviewed: 
27 September 2021

Definitions

HRIG
human rabies immunoglobulin
IU
international units