Because of the potential consequences of inadequately treated rabies exposure, pregnancy is not considered a contraindication to postexposure prophylaxis. If possible, administration of antimalarials should be avoided during use of the rabies vaccine for postexposure prophylaxis. The RIG and the rabies vaccine must be administered via separate syringes and at different anatomical site. The active antibody response requires approximately 7 to 10 days to develop, and detectable rabies virus neutralizing antibodies generally persist for several years. Preexposure Dosage: Primary Immunization: In the US, ACIP recommends 3 injections of 1 mL each: 1 injection on Day 0 and 1 on Day 7, and 1 either on Day 21 or 28 (for criteria for preexposure vaccination, see Table 1). Whenever possible, children should complete the routine immunizations of childhood on a normal schedule. The safety and efficacy of Imovax and RabAvert have not been established in neonates. If possible, administration of antimalarials should be avoided during use of the rabies vaccine for postexposure prophylaxis. 1 mL for 5 doses (on days 0, 3, 7, 14, and 28 or 30), to be administered into deltoid region; in infants anterolateral thigh is recommended, rabies immunoglobulin also to be given (but is not required if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine). • The 4 dose regimen with RIG in both categories II and III Vaccines should be injected into the deltoid muscle for adults and children aged 2 years and more. If possible, administration of antimalarials should be avoided during use of the rabies vaccine for postexposure prophylaxis. Yellow fever, a disease transmitted by mosquitoes, is endemic in certain areas of Africa and South America (see Maps 4-13 and 4-14). The duration of protection is undefined; therefore, persons with continued exposure to rabies should obtain serum titers every 6 months to 2 years (depending on exposure risk) to ensure acceptable antibody concentrations (see Indications). Infants and children aged ≥9 months can be vaccinated if they travel to countries within the yellow fever–endemic zone. Unscrew the syringe tip cap by twisting it counterclockwise.Attach the reconstitution needle to the syringe by gently twisting the needle clockwise into the syringe until slight resistance is felt.Reconstitute the freeze-dried vaccine by injecting the diluent from the syringe into the vial. Saving Lives, Protecting People, Chapter 7 - Traveling Safely with Infants & Children, www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html, www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html, www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html, Clinical Update: Interim CDC Guidance for Travel to and from Countries Affected by the New Polio Vaccine Requirements, www.cdc.gov/japaneseencephalitis/vaccine/vaccineChildren.html, Chapter 2, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country, www.polioeradication.org/Keycountries/PolioEmergency.aspx, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Global Migration and Quarantine (DGMQ), Obtención de atención médica en el extranjero, Zika: A CDC Guide for Travelers infographic, Guidelines for US Citizens and Residents Living in Areas with Zika, Vaccine Recommendations for Infants & Children. Rabies post-exposure prophylaxis can be abridged to a two-dose, three-session, 1 week regimen to improve post-exposure prophylaxis coverage and equity at no risk to patients. NOTE: Previously vaccinated patients include those who received a complete vaccination series (pre- or postexposure prophylaxis) with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer after vaccination with other types of vaccines.