Pt on anti rabies ID schedule 0,3,7,28, but pt missed 3rd dose came on 7th day
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anti rabies intradermal schedule missed dose day 3 came on day 7 WHO guidelines management
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WHO rabies PEP intradermal 0 3 7 28 missed dose catch up schedule guidelines 2024
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missed dose interrupted schedule catch up rabies intradermal 0 3 7 28
The WHO document itself states clearly: "there is no need to restart the series if the doses are not given on the exact schedule." Now I have everything needed for a complete answer.
Management: Missed Day 3 Dose, Patient Presents on Day 7
The Principle (WHO/Universal Rule)
Do NOT restart the series. Resume from where you left off. The series should never be restarted simply because of a delayed dose. The vaccination timeline adjusts from the point the missed dose is given.
What to Do on Day 7 (Today)
The patient is on the ID schedule: Days 0, 3, 7, 28 (2-site ID, 0.1 mL/site - the Thai Red Cross / 2-2-2-0-2 regimen).
Since they missed Day 3 and present on Day 7:
| Action | Explanation |
|---|---|
| Administer the Day 3 dose today | This visit counts as Dose 2 (the missed dose). Call today "Day 3" for scheduling purposes. |
| Do NOT give Day 7 dose on the same visit | Do not double-dose on the same day to "catch up." |
| Recalculate the remaining schedule from today | Today = new "Day 3" → next dose in 4 days = new "Day 7" → Day 28 dose remains from the original Day 0. |
Revised Schedule After Catch-Up
| Dose | Day (from original Day 0) | Action |
|---|---|---|
| Dose 1 | Day 0 | Done |
| Dose 2 | Day 7 (today, counted as "Day 3") | Give today - 2 sites ID 0.1 mL each |
| Dose 3 | Day 11 (7 days from original Day 0 + 4 days) | Give in 4 days from today |
| Dose 4 | Day 28 (from original Day 0) | As originally planned |
In practice: Give dose 2 today. Dose 3 should follow approximately 4 days later (7 days from Day 0 per the original schedule, but since you're already on Day 7, give it as soon as practically appropriate - within a few days). Dose 4 on or near Day 28 from the original first dose.
Key Points
- No restart needed - this is the WHO rule for interrupted schedules.
- No need for additional RIG - if RIG was given on Day 0, it remains valid.
- Do not give two doses in one sitting to compensate for missed dose.
- Immunocompromised patients: require closer follow-up and serology check after completion; consider 5-dose IM schedule.
- The WHO (2018 position paper) now actually recommends a 3-visit schedule (Days 0, 3, 7 only) as the preferred ID regimen - the Day 28 dose is no longer required by WHO globally, though many countries (including India) still follow the 4-dose 0-3-7-28 schedule.
Summary
Give the missed Day 3 dose today. Reschedule the Day 7 dose about 4 days from now, and complete the Day 28 dose as originally planned from the first injection date. The series does not need to be restarted. (WHO PEP Guide)
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