Rabies PEP Management Summary with ID Preference + Tetanus Immunization After Wounds (หมากัด แมวข่วน รถล้ม แผลถลอก)

💉 Rabies PEP Management Summary with ID Preference

Exposure Category	Immune Status	Vaccination History	Management	Vaccine Schedule	RIG Required?
CAT 1	All	Any	❌ No treatment needed	–	❌ No
CAT 2	Normal	Vaccinated <6 months	Booster	✅ Day 0 only (1 dose) • IM or ID 2-site	❌ No
CAT 2	Normal	Vaccinated >6 months	Booster	✅ Day 0, 3 • IM or ID 2-site or ID 4-site Day 0	❌ No
CAT 2	Normal	Never vaccinated	Full vaccine	✅ ID 2-site Days 0, 3, 7, 28 or IM Days 0, 3, 7, 14, 28	❌ No
CAT 2	Immuno compromised	Any	Full vaccine + RIG	❗ IM only: Days 0, 3, 7, 14, 28	✅ Yes
CAT 3	Normal	Vaccinated <6 months	Booster + RIG	✅ Day 0 only (1 dose) • IM or ID 2-site	✅ Yes
CAT 3	Normal	Vaccinated >6 months	Booster + RIG	✅ Day 0, 3 • IM or ID 2-site or ID 4-site Day 0	✅ Yes
CAT 3	Normal	Never vaccinated	Full vaccine + RIG	✅ ID 2-site Days 0, 3, 7, 28 or IM Days 0, 3, 7, 14, 28	✅ Yes
CAT 3	Immuno compromised	Any	Full vaccine + RIG	❗ IM only: Days 0, 3, 7, 14, 28	✅ Yes

Dose: 0.1 mL per injection site
Sites:
- 2-site: One injection in each deltoid
- 4-site: Both deltoids + both anterior thighs or scapulae (only Day 0)

⚠️ Do NOT mix ID and IM regimens during the course — EXCEPTION: if vaccine shortage on Day 3.

Type	Dose	Administration
ERIG (Equine)	40 IU/kg	Infiltrate around the wound as much as anatomically feasible
HRIG (Human)	20 IU/kg	Same as above; dilute for mucosal contact (1:10 with NSS if to eye/oral mucosa)

❗ Do not inject remaining RIG elsewhere (e.g., gluteus)✅ Administer only once, within 7 days of first vaccine dose

Clean wound = clean, minor, superficial
Dirty wound = contaminated, puncture, soil/feces/saliva, devitalized tissue, burns, crush injuries, bites

Situation	Action
No or unknown tetanus history	🧷 Start full primary course (3 doses) • Dose 1: day 0 • Dose 2: ≥4 weeks after dose 1 • Dose 3: 6–12 months after dose 2 ➕ Add TIG if dirty wound
<3 doses received (incomplete series)	🧷 Complete the remaining doses • Continue where left off • Do NOT restart series ➕ Add TIG if dirty wound
≥3 doses, clean wound, last dose ≥10 years	💉 Booster dose (Td or Tdap) x1
≥3 doses, clean wound, last dose <10 years	✅ No booster needed
≥3 doses, dirty wound, last dose >5 years	💉 Booster dose (Td or Tdap) x1
≥3 doses, dirty wound, last dose ≤5 years	✅ No booster needed

✅ This row completes the table and avoids confusion in exams and practice.

❌ Never needed if: