Table 2.

Questions frequently asked by patients (2 A) and healthcare providers (2B).

Category	Question	Answer
(A)	I was scratched/bitten a long time ago. Do I still need rabies vaccination?	Yes, because the rabies incubation period can be very long.
	If I start rabies vaccination, will I need to change my diet?	No, you can eat whatever you want.
	Will you give me many injections in the stomach?	No, that was done with the outdated nerve tissue vaccine (NTV). Modern vaccines only require a few doses and a normal injection in the arm, as with any other injectable vaccine.
	Will there be adverse effects?	As with any vaccination, there may be adverse effects. But they are likely to be minor (such as redness, pain or swelling at the site of injection) or, even unlikely, mild (such as some fever, headache, dizziness or gastrointestinal symptoms). Serious adverse effects like allergic reactions are rare.
	What happens if I forget to come for the next vaccination?	Make sure you don’t forget by having your relatives/friends remind you about it. But if you forget, come as soon as possible and we will continue the vaccination, not restart it.
	I had milk from a rabid animal. Do I need rabies vaccination?	No, you don’t need any PEP, but avoid it next time and, anyway, milk should best be boiled before consumption.
	I had meat from a rabid animal. Do I need rabies vaccination?	No, you don’t need any PEP, but avoid it next time and, anyway, meat should best be cooked before consumption.
	I processed the meat of a rabid animal. Do I need rabies vaccination?	Probably yes. Tell me more.
	I was bitten by a mouse/small rat. Do I need rabies vaccination?	No, there is no risk of rabies.
	I am pregnant? Is rabies vaccination safe for me and my baby?	Yes.
	I am breastfeeding? Is rabies vaccination safe for my baby?	Yes.
(B)	Does the dose of rabies vaccine depend on age or weight?	No. Age only determines the site of rabies vaccination: the deltoid area for adults and the anterolateral area of the thighs for children < 2 years. Weight only determines the maximum amount of RIG/RmAbs to use: 20 IU/kg of body weight for hRIG, 40 IU/kg of body weight for eRIG, 3.33 IU/kg body weight for single mAb and 40 IU/kg body weight for cocktail mAb.
	Can I change the administration route or vaccine product during the vaccination schedule?	Yes, if unavoidable, you can do it. Don’t restart vaccination, just continue it.
	How does intradermal vaccination work when the dose is so small?	The antigen-presenting cells in the dermis are more effective in presenting the vaccine/antigen to the immune system than the ones in the muscles, so they can stimulate a very strong and prompt immunologic/antibody response.
	The rabies vaccine box only mentions intramuscular vaccination. Can I administer the vaccine intradermally?	Yes, all vaccines can be given both intramuscularly and intradermally, but choose the intradermal route whenever possible because it’s cheaper for the healthcare system and the patient, requires fewer visits, and one vaccine vial can be shared across many patients. However, check the rabies vaccines that your national drug regulatory authority approves for intradermal use.
	Can I inject the rabies vaccine in the gluteal area?	No, the vaccine would not be fully absorbed and effective because of the fat present in that body part.
	If the wound(s) is on an arm, where should I inject the rabies vaccine?	You should inject the vaccine intradermally in the anterolateral area of the thighs or the suprascapular areas. RIG must be injected in the wound(s).
	If RIG/RmAbs is not available on day 0, should I delay rabies vaccination?	No, never. But refer the patient to a healthcare facility where RIG/RmAbs is available, after administering the first dose of rabies vaccine.
	Can I administer RIG/RmAbs later on in the vaccination schedule?	Yes if RIG/RmAbs is not available on day 0, but never after day 7. Anyway, RIG/RmAbs should be given as soon as possible after exposure.
	Can I give RIG/RmAbs to a patient who has already received any rabies vaccination in their lifetime?	No, thanks to the previous vaccination, there are already demonstrable antibody titres or immune memory cells. In case of re-exposure, 1-site intradermal rabies vaccine administration on days 0 and 3 or 4-sites intradermal rabies vaccine administration on day 0 will produce good antibodies due to anamnestic response.
	Should I perform a skin test before administering eRIG?	No, because they poorly predict severe adverse events and their results must anyway not be the reason for not giving eRIG if it is needed. However, all RIG should be administered under conditions that would allow management of an anaphylactic reaction.
	Can I give rabies biologicals to a patient who is receiving treatment with chloroquine or hydroxychloroquine?	Yes, given the fatal outcome of rabies, there is no contraindication to the concomitant use of any medication.
	Can I give rabies biologicals to a patient who is receiving other vaccines in this period?	Yes, given the fatal outcome of rabies, priority is given to rabies biologicals (rabies vaccine and RIG/RmAbs). If the patient receives RIG, live vaccines should be postponed for 3–4 months, if possible.
	Should I perform an antibody test on the patient following rabies vaccination?	No, unless the patient is immunocompromised. In this case, a Rapid Fluorescent Foci Inhibition Test (RFFIT) or a Fluorescent Antibody Virus Neutralization (FAVN) test should be performed 2–4 weeks after vaccination to assess whether an additional vaccine administration is needed. Consultation with an infectious disease specialist or an immunologist is advised.
	Are there special recommendations for patients undergoing chemotherapy?	Yes, they are to be treated as immunocompromised patients. So: emphasis on proper wound washing; immediate RIG/RmAbs and rabies vaccine, even if previously immunized, for category-II and -III exposure; complete rabies vaccination course; Rapid Fluorescent Foci Inhibition Test 2–4 weeks after vaccination.
	Are all HIV-infected individuals considered immunocompromised?	No. HIV-infected individuals who receive antiretroviral therapy and are clinically well and immunologically stable (i.e., normal CD4% > 25% for children aged < 5 years or CD4 cell-count ≥ 200 cells/mm³ if aged ≥5 years) are not considered immunocompromised.
	Can intradermal administration be used for immunocompromised individuals or individuals receiving chloroquine, hydroxychloroquine drugs or long-term corticosteroid or other immunosuppressive therapy?	Yes.