Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Injection of the human rabies immune globulin (HRIG) for immediate protection is based on
your exact weight. This is not a situation where more is better. Therefore, you should not overestimate your weight. If the exact weight is not known, you will be weighed at the hospital.
Once the dose is determined, as much as possible is injected into and around the bite site. If the entire volume does not fit into the tissue in that area (for example, the tip of the finger), then the remaining volume will be injected into some other site in your body, such as the arm, leg, or buttocks. The doctor may use numbing medicine to decrease the pain associated with injection of HRIG into the tissues at the bite site.
If you have been previously immunized adequately against rabies, then the HRIG is not needed. You would need only the vaccine described in the next section.
Injection of the vaccine will begin during this initial visit to the emergency department and will proceed on a schedule over the next 14 days, with a total of
four small injections.
There are two different types of rabies vaccines licensed for use in the United States (human diploid cell [HDCV] and purified chick embryo cell culture vaccine [PCECV]). If given properly and on schedule, both of types will protect you against rabies.
The dose for each is 1 cc, or milliliter, delivered into the muscle. This vaccine must be delivered into the deltoid, or shoulder muscle,
in adults or older children. The front, outside aspect of the thigh muscle
is acceptable in younger children. It must never be injected into the
buttocks. Injection into the proper site ensures absorption. It must be administered in a site different from the remainder of the immune globulin that is not injected into the bite site.
If you have never been vaccinated against rabies, then vaccine shots will be given on the day of the visit (day zero), and again on days
and 14. If you have already been adequately immunized against rabies, a series of
two booster vaccine injections will be given on day zero and again on day three only. This is sufficient to stimulate your body's immune system, or
memory, and provide protection against rabies.