Rabies Vaccine & Immune Globulin Fact Sheet
Post-Exposure Prophylaxis of Previously Unimmunized Individuals
Rabies Vaccine
The following two rabies vaccines are currently marketed
for active immunization of humans in Canada; both have
been approved for intramuscular (IM) use.
Imovax® Rabies, Sanofi Pasteur Ltd.
Imovax® is prepared from rabies virus grown in
human diploid cell culture (HDCV)
RabAvert®, Merck Frosst (distributor)
RabAvert® is a purified chick embryo cell vaccine
(PCECV)
Sterile diluent is supplied for reconstitution into a single
1.0 mL dose. Neutralizing antibodies, which develop 7 to
10 days after the initial rabies vaccine dose, persist for at
least 2 years.
_________________________________________
Administer 1.0 mL of either Imovax® or RabAvert®
on the following days.
Dose
Number
When to
Administer
Vaccine
Dose
Administration
Site
#1
First Dose
1.0 mL
Intramuscular
Deltoid
1.0 mL
Intramuscular
Deltoid
1.0 mL
Intramuscular
Deltoid
1.0 mL
Intramuscular
Deltoid
#2
#3
#4
3 days
After
First Dose
7 days
After
First Dose
14 days
After
First Dose
Additional 5th Dose only for those that meet the
Immunocompromised Persons Criteria.
#5
28 days
After
First Dose
1.0 mL
Intramuscular
Deltoid
Rabies Vaccine Administration Site
Administer the rabies vaccine intramuscularly. For
adults and children the vaccine should always
be administered in the deltoid area. In infants and small
children, the anterolateral aspect of the thigh is also
acceptable. The gluteal area should never be used for
injections because administration of rabies vaccine in this
area results in lower neutralizing antibody titres.
Immunocompromised Persons
Changes to rabies post-exposure prophylaxis now
include 4 doses on day 0, day 3, day 7 and day 14 with
the exception of those persons who are
immunocompromised, including those on corticosteroids,
other immunosuppressive drugs, chloroquine,
antimalarials and those with immunosuppressive
illnesses who will continue to require the 5th dose on day
28. Please have the ordering physician determine if the
patient is considered immunocompromised, requiring the
5 doses to ensure the correct amount is delivered.
Missed Doses
Every attempt should be made to adhere to the
recommended vaccination schedule. Minor deviations
from the schedule are unimportant provided doses are
not given earlier than prescribed; the vaccination
schedule can be resumed as though the patient were on
schedule. For example, if a patient misses the day 7
dose and presents for vaccination on day 10, the day 7
dose should be administered that day and the schedule
should be resumed. It is important to maintain the same
interval between doses. In this example, the remaining
two doses would be administered 17 days after the first
dose and 31 days after the first dose.
Previously Vaccinated Persons
Post-exposure prophylaxis for people who have
previously received rabies vaccine differs according to
which preparation of vaccine was received. Call Public
Health for more information.
Pregnancy
Due to the potential consequences of inadequately
managed rabies exposure, pregnancy is not considered a
contraindication to post exposure prophylaxis.
Storage and Handling
Vaccine must be protected from light and stored in
temperatures ranging between +2 ºC and + 8 ºC.
Rabies Vaccine Interchangeability
When possible, an immunization series should be
completed with the same product. However, if this is not
feasible, RabAvert® and Imovax® vaccine are
considered interchangeable in terms of indications for
use, immunogenicity, efficacy and safety. Other types of
tissue culture and avian culture vaccines are available in
other countries and are considered interchangeable.
Rabies Immune Globulin (RIG)


DO NOT mix the rabies vaccine in the same syringe
as the RIG.
DO NOT administer the rabies vaccine in the same
anatomical site as the RIG.

Storage and Handling
RIG must be stored in temperatures ranging between +2
ºC and + 8 ºC.
Administration
RIG should be administered as soon as possible after
exposure. This generally occurs on the same day that the
person receives their first dose of rabies vaccine. Since
vaccine-induced antibodies begin to appear within 1
week, there is no value in administering RIG more than 8
days after initiating an approved vaccine course.
RIG is always given intramuscularly and preferably
directly into the edges surrounding the wound. When
more than one wound exists, each area should be locally
infiltrated with a portion of the RIG using a separate
needle and syringe, if possible. In these instances, the
RIG may be diluted 2 to 3 fold in a solution of 0.9%
sodium chloride in order to provide the full amount of
human RIG required for good infiltration of sites at risk of
rabies.
Preferably, the full dose of RIG should be thoroughly
infiltrated into the wound and surrounding area. If not
anatomically feasible, any remaining volume should be
injected intramuscularly at a site distant from the vaccine
administration site.
If the site of the wound is unknown, the entire dose
should be administered intramuscularly. Due to
interference with active antibody production, the
recommended RIG dose should not be exceeded.
The recommended dose of RIG is 20 IU/kg
of body weight. RIG is supplied in 2 mL vials
containing 150 IU/ml. Use the following formula to
calculate the dose required and use the table to
determine how many vials to order. This formula is
applicable to all age groups, including children.

20 IU/kg X (client weight in kg) divided by
150 IU/ml = dose in mL
Refer to the Canadian Immunization
Guidelines (Rabies) for further details
regarding exposure criteria and
vaccine/RIG details
January 2013
9.09 IU/lb X (client weight in lbs) divided by
150 IU/mL = dose in mL
RIG is supplied in 2 mL vials
containing 150 IU/ml
Client’s Total Weight
Up to 33 lbs
34 - 66 lbs
67 - 99 lbs
100 - 132 lbs
133 - 165 lbs
166 - 198 lbs
199 - 231 lbs
232 - 264 lbs
265 - 297 lbs
298 - 330 lbs
(Up to 15kg)
(15 - 30 kg)
(30 - 45 kg)
(45 - 60 kg)
(60 - 75 kg)
(75 - 90 kg)
(90 - 105 kg)
(105 - 120 kg)
(120 - 135 kg)
(135 - 150 kg)
Number of RIG
Vials Required
1 vial
2 vials
3 vials
4 vials
5 vials
6 vials
7 vials
8 vials
9 vials
10 vials
Multiple Injections in Same Muscle
When administering a large volume of RIG, it may be
necessary to use the same muscle to administer more
then one injection. The distance separating two
injections, in the same limb, should be between 2.5 cm to
5.1 cm (1 to 2 inches) apart.
Drug Interactions
After receiving RIG, measles or varicella-containing
vaccine administration should be deferred for 4 months.
RIG can interfere with vaccine effectiveness when given
within 14 days after receiving the varicella, MMR or any
of the individual components of the MMR vaccine. Under
these circumstances, immunization should be repeated 4
months after receiving RIG. Or, a serologic test should be
performed 4 months after receiving RIG, to confirm
immunity. If RIG is administered more then 14 days after
vaccination with the above named vaccines,
immunization does not have to be repeated. Studies have
found no evidence that RIG interferes with the response
to inactivated vaccines, toxoids or the live vaccines for
yellow fever or polio.
TO ORDER RABIES VACCINE OR RIG call 905-546-2424
ex. 3327 (8:30 to 4:30) or 905-546-3570 afterhours
For vaccine or RIG information, please contact
Public Health Services
Immunization Program
905-540-5250
www.hamilton.ca/immunize