Q. One of the four rabies vaccine was given in the gluteal region. Will that vaccine be effective?

Answered by
Dr. Clinton Leinweber
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Feb 21, 2021

Hi doctor,

I am a 24-year-old male. My height is 5'8, and my weight is 150 pounds. A few weeks ago, I had an encounter with a bat early in the morning. I am not sure if I was bitten or if it was a brief encounter. I got a rabies vaccine administered on that day (day 0), as well as days 3, 7, and 14. I have one more injection prescribed for day 28 (it is currently the end of Day 21). The injections on days 0, 3, and 7 were given on my shoulders or deltoid. On day 14, it was given on my right hip (from my understanding, the ventrogluteal muscle). I was curious about this, so I went online, various sources claim that the rabies vaccine should not be administered in the gluteal region. I went to two doctors here, and both said it was fine, as the injection was still intramuscular.

However, I have read from two sources that many doctors and nurses have failed in this regard over the years, and people have died due to their negligence, which is apparently one of the primary reasons for rabies deaths. I am not an expert, obviously, but combined with what I read earlier in various medical site's specific instructions not to inject in the gluteal region, it has made me extremely concerned and untrusting at the moment.

So my question is, should I go get another vaccine done tomorrow (day 22) as well as day 28 and 29?

#

Hi,

Welcome to icliniq.com.

Thank you for your question. I am sorry to hear what you have been through. It sounds like you were in a category one exposure, which is low risk. However, it still requires post-exposure treatment. At present, in a person who is not immunocompromised, only four doses are required. In your risk category, you would not require rabies immunoglobulin on day 0. Since your four shots were given incorrectly, you should get the additional shot in the shoulder. You are correct in that the injections should only be given to the shoulder. Other sites can result in lower antibody levels.

It should be fine if the additional dose is given properly. If you have any further questions, let me know. If you are still concerned, you can have post-vaccination serologic (antibody) testing to confirm protective levels.


Probable diagnosis:

Possible rabies exposure.

Treatment plan:

Receive one additional rabies vaccine shot in the deltoid region.

Regarding follow up:

Follow up with your primary doctor.

Hi doctor,

Thank you for your response.

Should I get the vaccine tomorrow, or should I wait till the originally prescribed day 28 (7 days from now)?

#

Hi,

Welcome back to icliniq.com.

You can wait until the original date, or anytime in the next 3 to 5 days. Take care and have a great day.


The Probable causes:

Possible animal exposure.

Investigations to be done:

None.

Probable diagnosis:

Post rabies exposure prophylaxis.

Treatment plan:

Complete one additional rabies vaccine in next 3 to 7 days in the deltoid muscle.

Regarding follow up:

As needed with your primary doctor.

Hello doctor,

I am really sorry to repeat, but I just want to be clear and thorough since this whole situation has been very confusing and stressful for me. So, I had taken the vaccine in the correct location (shoulder) on days 0, 3, and 7. It was given on the hip for day 14, and as you stated previously, that is an incorrect administration. It is the end of day 21 now. Can I wait for 3 to 5 days from now, or get it on the original prescribed day (day 28), which means I can get it done any time from day 24 to 28. Am I correct?

#

Hi,

Welcome back to icliniq.com.

Yes, that is correct. There is no need to apologize. I want you to be comfortable with this.

You would have had some protection from the incorrect shot. It is fine to wait until day 28 with the original schedule. Taking it a few days sooner would be acceptable as that may ease your stress somewhat.


Probable diagnosis:

Post rabies prophylaxis.

Treatment plan:

Complete one additional rabies shot in deltoid region.


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