The Australian Immunisation Handbook 10th Edition 2013

of an even more accelerated schedule for those with limited time before travel to
a rabies-enzootic area.
Post-exposure prophylaxis (PEP)
In persons previously unvaccinated, the recommended schedule for postexposure
prophylaxis (PEP) for immunocompetent persons consists of 4 doses
of vaccine. The 1st dose of vaccine is given as soon as practicable (day 0), and
subsequent doses are given on days 3, 7 and 14; deviations of a few days from
this schedule are probably unimportant. 22
The recommended schedule for PEP for previously unvaccinated
immunocompromised persons consists of 5 doses of vaccine. The 1st dose of
vaccine is given as soon as practicable (day 0), and subsequent doses are given
on days 3, 7, 14 and 28; deviations of a few days from this schedule are probably
unimportant.
The recommended schedule for PEP for people who have been previously
vaccinated against rabies consists of 2 doses of rabies vaccine on days 0 and 3
(noting caveats in Figures 4.16.1 and 4.16.2).
For more detailed information see 4.16.8 Recommendations below.
Human rabies immunoglobulin
When HRIG is indicated, the dose is 20 IU per kilogram of body mass and is the
same for infants, children and adults. HRIG should be administered at the same
time as the 1st dose (day 0) of rabies vaccine. Do not administer HRIG if 8 days
or more have elapsed since the 1st dose of vaccine, as the HRIG may interfere
with the immune response to the vaccine. For more detailed information see
4.16.8 Recommendations below.
HRIG should be infiltrated in and around all wounds using as much of the calculated
dose as possible, and the remainder of HRIG administered intramuscularly at a
site away from the rabies vaccine injection site. If the wounds are severe and the
calculated volume of HRIG is inadequate for complete infiltration of all wounds
(e.g. extensive dog bites in a young child), the HRIG should be diluted in saline
to make up an adequate volume for the careful infiltration of all wounds.
Wounds to fingers and hands may be small, particularly following exposures to
bats, and infiltration of HRIG into these wounds is likely to be both technically
difficult and painful for the recipient. 32 However, due to the extensive nerve
supply to these sites9,10,33 it is important that as much of the calculated dose of
HRIG as possible should be infiltrated into finger and hand wounds using either
a 25 or 26 gauge needle. To avoid the development of a compartment syndrome,
the HRIG should be infiltrated very gently, and should not cause the adjacent
finger tissue to go frankly pale or white. It may be necessary to give a ring-block
using a local anaesthetic. 32
PART 4 VACCINE-PREVENTABLE DISEASES 357
4.16 RABIES AND OTHER
LYSSAVIRUSES (INCLUDING
AUSTRALIAN BAT LYSSAVIRUS)