Is it dangerous to receive extra doses of ARVs?

Question

Hello doctor,

My mom completed her ARV (anti-rabies vaccination) schedule about four months ago. A few days ago, she was scratched by a dog. Unfortunately, that same day, the dog died in a car accident. My mom went to the hospital, and the doctor prescribed a zero and three-day vaccine schedule. I believe this is a booster. However, when she went to get the booster today, the pharmacist at our local government hospital (who handles vaccination appointments) gave her a four-day schedule instead.

Since my mom is illiterate, she did not understand the change, and the nurse had already given her the first dose. Now, I am unsure whether she received the booster dose (meant for previously vaccinated individuals) or the first dose of the full PEP (post-exposure prophylaxis) series, which is usually given to unvaccinated people.

Please advise me. What should I do now?

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern, and you are absolutely doing the right thing by checking on your mom’s care. Let me walk you through it step by step.

Your mom’s rabies vaccine history:

She completed the full ARV (anti-rabies vaccine) schedule about 3.5 months ago.
Recently, she was scratched by a dog, and unfortunately, the dog died the same day in a car accident (not due to illness).
A doctor prescribed a zero and three-day vaccination schedule, which means two booster doses, which is the standard PEP (post-exposure prophylaxis) for people who are already vaccinated.

What happened at the hospital:

The pharmacist or hospital staff scheduled her for four doses, which is usually the full PEP series for unvaccinated individuals (given on days zero, three, seven, and 14).
Your mom already received the first dose.
You are now unsure whether she has started the booster schedule (two doses) or the full PEP course (four doses).

So, what is the concern?

Since your mom was already vaccinated, she may be getting more doses than necessary.
Is this dangerous?
No, it is not harmful.
Getting extra rabies vaccine doses is generally safe.
The worst that might happen is some temporary side effects like soreness, mild fever, or tiredness.

What should you do now?

Best step: Go back to the hospital (or call) and explain this clearly.
If they confirm she is on the two-dose booster, they might cancel the extra doses.
If they already started the four-dose PEP, that is okay too, it is just extra, not dangerous.

If you can not get clarification:

Let her finish the four-dose schedule.
It is not harmful, just more than needed.

Is PEP the same as a booster?

PEP (post-exposure prophylaxis) is the general name for treatment after exposure to rabies.
For vaccinated people, PEP is usually just a booster: Two doses on day zero and day three.
For unvaccinated people, PEP is a four- or five-dose series.
So yes, a booster is a form of PEP, but it is shorter and simpler for people who are already vaccinated.

I hope this helps you.

Thank you for using iCliniq. Have a great day!