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Executive Summary
The Association of Physicians of India
Evidence-Based Clinical Practice Guidelines on Adult
Immunization
Expert Group of the Association of Physicians of India on Adult Immunization in India
Table 6 : Regimens for post-exposure prophylaxis Table 7 : Definition of categories of exposure and use of
rabies biologicals
Route Regimen Dose Schedule (Days)
Intradermal Two-site* 0.1 ml Day 0, 3, 7, 28† Category III
Single or multiple transdermal bites, scratches or
Intradermal Eight-site ‡
0.1 ml Day 0 (8 doses ), §
contamination of mucous membrane with saliva (i.e., licks),
7 (4 doses#), 28¶, 90¶ exposure to bats
Two site regimen signifies right and left upper arm (total 2 sites)
*
Wound management plus rabies immunoglobulin plus vaccination is
†
On each day, one injection is administered in right and left upper indicated
arm
Category II
‡
Eight site regimen signifies both upper arms, both lateral thighs, Minor scratches or abrasions without bleeding or licks on broken
both suprascapular regions and both sides of the lower quadrant
skin and nibbling of uncovered skin
region of the abdomen (total 8 sites)
Wound management and use of vaccine alone is indicated
§
One injection each in both upper arm, both lateral thigh, both
suprascapular region, and on both sides of the lower quadrant Category I
region of the abdomen (total 8 doses) Touching, feeding of animals or licks on intact skin
#
One injection each in both upper arm and both lateral thigh (total No exposure has occurred. Therefore, if history reliable, no prophylaxis is
4 doses) indicated
¶
One dose in one upper arm only
Management of re-exposure
manufacturer’s guidelines. The Expert Group observed that the On re-exposure following a full course of either pre-or post-
use of immunoglobulins needs to be encouraged after following exposure vaccination, 2 booster doses are to be administered
proper precautions. intramuscularly or intradermally on days 0 and 3 irrespective
The rabies immunoglobulin should be infiltrated as of category of exposure or time that has elapsed since previous
much as possible into and around the wounds; remaining vaccination. Rabies immunoglobulin is not indicated in this
immunoglobulin, if any, should be given intramuscularly at a scenario. All subjects who have received incomplete vaccination
site away from the site where vaccine has been administered. should be treated as fresh cases.
If the rabies immunoglobulin volume is insufficient, it can be
diluted with sterile normal saline (up to equal volume).