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What to do if person got Anti rabies vaccine intradermal first dose and then got intadermal second dose.

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rabies AND intradermal vaccination

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WHO rabies post-exposure prophylaxis intradermal schedule days 0 3 7 2025

If the first and second anti-rabies vaccine doses were both given intradermally on the scheduled days, this is usually correct. Do not restart the vaccine course just because it was intradermal.
For a person not previously vaccinated after a possible rabies exposure, the WHO intradermal PEP regimen is usually 2 injection sites on days 0, 3, and 7. Some local programs still use a 4-visit ID schedule: days 0, 3, 7, and 28. Complete the exact schedule given by the treating anti-rabies clinic. The WHO PEP recommendations describe the 1-week, 2-site intradermal schedule.
Important:
  • If the person was previously fully vaccinated against rabies, the usual schedule is only day 0 and day 3, and rabies immunoglobulin is not needed.
  • If this is a Category III exposure such as a bite that breaks skin, bleeding scratch, saliva on mucosa/open wound, or bat exposure, they may need rabies immunoglobulin or monoclonal antibody infiltrated into/around the wound. It should be given as soon as possible and generally not after day 7 from the first vaccine dose.
  • If they received only one tiny ID injection at each visit despite never having been vaccinated before, confirm with the clinic promptly because standard PEP often requires two ID sites per visit.
  • Wash the wound thoroughly with soap and running water for at least 15 minutes and use povidone-iodine if available.
Go back to the anti-rabies clinic today with the vaccination card so they can confirm the schedule, vaccine product, number of injection sites, exposure category, and whether immunoglobulin is needed.

Non vaccinated patient got Intradermal ARV at first dose then got intramuscular at second dose. What to continue as dose?

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rabies post exposure prophylaxis switch intradermal to intramuscular route missed dose guideline India

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rabies intradermal intramuscular interchangeability

Do not continue a mixed ID and IM course on your own. Return to the anti-rabies clinic today with the vaccine record.
For a previously unvaccinated person, ID and IM PEP schedules should not normally be interchanged mid-course. The clinic should select one route and complete a valid schedule, according to local/national protocol and the vaccine brand used.
  • If the clinic changes the patient to IM, the standard IM Essen schedule is vaccine on days 0, 3, 7, 14, and 28. An IM dose is a full vial dose in the deltoid (or anterolateral thigh in small children), never the buttock.
  • If continuing by ID, standard programs use two 0.1 mL ID injections at separate sites on the prescribed visit days, commonly days 0, 3, 7, and 28 in India, though some WHO programs use days 0, 3, and 7.
Because the first dose was ID and the second dose IM, a clinician must decide whether the IM second dose can be counted and whether any dose needs repeating. This depends on:
  1. exact day of each injection,
  2. vaccine brand and dose/volume,
  3. whether the initial ID dose was correctly given as a visible skin bleb,
  4. local protocol, and
  5. whether the person is immunocompromised.
Do not delay the next scheduled visit while sorting it out. WHO notes that if an intended ID dose is accidentally given into muscle, it should be corrected with a properly administered ID dose if the ID regimen is being followed. WHO rabies PEP guidance and Indian training guidance list distinct ID and IM schedules rather than a conversion schedule.
Also ensure that for a Category III exposure such as a bleeding bite/scratch, saliva on broken skin, or mucosal exposure, rabies immunoglobulin or a rabies monoclonal antibody was considered. It should be infiltrated into and around the wounds as soon as possible, and is generally not given after day 7 from the first vaccine dose.
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