Rabies Vaccine and Immune Globulin Information for Healthcare Providers

Assessing Need for Post-exposure Prophylaxis (PEP

The rabies virus is shed in the saliva of infected mammals and can be transmitted via a bite wound, open cuts in the skin, or mucous membranes. The following should be considered: 

  • Domestic Animals: In Canada, rabies is generally less likely. If a dog, cat or ferret is healthy and available for 10-day observation, PEP is not usually required. The exception is a bite to the head or neck region or a severe wound. Please consult Public Health for input on risk assessment in these cases.
  • Non-domestic Animals: PEP should begin immediately following exposure to a wild terrestrial carnivore (such as a fox, skunk or raccoon) unless the animal is available for testing and rabies is not considered likely.
  • Bats: When there is a known bat bite, scratch or saliva exposure to a wound or mucous membrane, rabies PEP should be initiated immediately. For suspect bat bites or scratches please consult Public Health.

Post-exposure Prophylaxis for Non-immunized Individuals

Post-exposure Prophylaxis for Non-immunized Individuals
Treatment Regimen
Wound Cleansing Thorough cleaning and flushing the wound with soap and water is an important post-exposure measure. 
Rabies Immune Globulin (Rablg)

20 IU/kg body weight administered once on day 0.

Each 2 mL vial contains 150 IU/mL. 
Each 1 mL vial contains 300 IU/mL. 

  1. Calculate the dose of RabIg (20 IU/kg body weight) and the number of vials required for this dose.
  2. Draw up one vial at a time in order to save any unopened vials that you don’t use.
  3. Infiltrate as much of the calculated dose as possible around the wound(s) or site of exposure (if a bite or scratch is not evident). Note: Infiltration of wounds with RabIg in some anatomical sites (finger tips) must be carried out with care in order to avoid increased pressure in the tissue compartment. When more than one wound exists, each wound should be locally infiltrated with a portion of the RabIg using a separate needle and syringe. In such instances, RabIg can be diluted twofold to threefold in a solution of 0.9% sodium chloride in order to provide the full amount of RabIg required for thorough infiltration of all wounds.
  4. If the entire calculated dose of RabIg cannot anatomically be infiltrated around the wound(s) or site of exposure, do NOT give the remainder of the dose IM. Save any unopened vials for use in another case.
  5. For situations that are not clear, the attending healthcare provider makes the final decision regarding the administration of RabIg, along with input from the Medical Officer of Health.
Rabies Vaccine

IMOVAX® or RabAvert® 1.0 mL, IM (deltoid area; anterolateral thigh in infants), one each on days 0, 3, 7 and 14. Never administer vaccine to the gluteal area.

For immunocompromised persons and those taking antimalarials a fifth dose of vaccine should be given on day 28.

Post-exposure Prophylaxis for Immunized Individuals

Post-exposure Prophylaxis for Immunized Individuals
Treatment Regimen
Wound Cleansing Thorough cleaning and flushing the wound with soap and water is an important post-exposure measure. 
Rabies Vaccine IMOVAX® or RabAvert® 1.0 mL, IM (deltoid area; anterolateral thigh in infants), one each on days 0 and 3. Never administer vaccine to the gluteal area. 

Rabies Vaccines and Immunoglobulin Available in Canada

Rabies Vaccines: IMOVAX® Rabies, RabAvert® 
Rabies Immune Globulins: Imogam® Rabies Pasteurized, HyperRAB® S/D 
Store and transport vaccines and Rablg between 2°C and 8°C; do not freeze. 

Missed Doses 

Patients should be encouraged to complete vaccine schedule as closely as possible and to receive all recommended doses. Minor variations from the schedule are not significant. If a dose of vaccine is delayed, it should be given as soon as possible, and the schedule resumed with the same interval between doses. The prescribed vaccination schedule represents the minimum interval between doses. 

If Rablg is not administered as recommended at the initiation of the rabies vaccine series, Rablg can be administered up to day 7 after vaccine is initiated.

Contraindications and Precautions

There are no definite contraindications to rabies vaccine after significant exposure to a proven rabid animal. 

  • Pregnancy and lactation are not contraindications to post-exposure rabies prophylaxis, but it is prudent to delay pre-exposure immunization of pregnant women unless there is a substantial risk of exposure.
  • Egg allergyIMOVAX® Rabies is the preferred vaccine for those with a severe hypersensitivity reaction to egg or egg products.
  • Interaction with other vaccines: MMR or varicella vaccine effectiveness is affected if given either two weeks prior to or up to 4 months after receiving Rablg.

Common and Local Adverse Events

For both rabies vaccines and Rablg, the most common adverse events are local reactions at the injection site (pain, erythema, swelling and induration). With Rablg, systemic reactions such as headache and low-grade fever are also common. Please consult Public Health for significant or unusual adverse events following immunization.

Contact Us 

  • 1-800-265-7293 (Inspection: ext. 4753 / Clinical Consultation: ext. 4744)
  • After Hours / Emergency: 1-877-884-8653
  • Fax: 1-855-934-5463