Booster algorithm for people at ongoing risk of exposure to rabies virus or other lyssaviruses

PEP = post-exposure prophylaxis

This flowchart helps to decide if people at ongoing occupational risk need booster doses of rabies vaccine. Perform serological testing every 6 months for at-risk laboratory staff, and every 2 years for veterinary workers, people who handle bats or may need to handle bats, and people who have ongoing exposure to potentially rabid terrestrial animals in rabies enzootic countries. For those who have a neutralising antibody titre of >0.5 IU/mL, no further action is needed until the next serological testing period elapses, or until the person is exposed to rabies virus or lyssavirus (then give post-exposure prophylaxis as per post-exposure algorithms). For those with an antibody titre of <0.5 IU/mL, give a single booster dose for an immunocompetent. If the person is immunocompromised, give a single booster dose then check serological levels after 2–4 weeks. If the antibody titre is <0.5 IU/mL, give another booster dose. If further exposure occurs, give post-exposure prophylaxis as per rabies or bat post-exposure algorithms.

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Figure. Anatomical markers used to identify the ventrogluteal injection site

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Figure. Positioning a child

Last updated: 
12 June 2018
Last reviewed: 
12 June 2018

Definitions

PEP
post-exposure prophylaxis
IU
international units