I am Dr. Shamoon. Your confusion is very common, so let me set out the intradermal (ID) numbers plainly. For the intradermal route the dose is fixed at 0.1 ml per site, whichever cell-culture vaccine is used - the difference between schedules is only in how many sites you get on each day, never in the volume per site. For a fresh (previously unvaccinated) exposure, the schedule now recommended in India is the Updated Thai Red Cross / IPC 2-site regimen: on Day 0 you get 0.1 ml at TWO sites, one over each deltoid - that is 2 x 0.1 ml = 0.2 ml total on Day 0 - and the same 2 sites are repeated on Day 3 and Day 7 (the IPC variant stops there; the 4-visit variant adds Day 28). For a BOOSTER, that is a re-exposure in someone who has already completed a full pre-exposure or post-exposure course previously, the answer is different and much simpler: 0.1 ml at ONE site on Day 0 and 0.1 ml at ONE site on Day 3 only. No Day 7, no Day 28, and importantly no rabies immunoglobulin is needed for a properly vaccinated person, whatever the wound category. So the short version to remember: primary ID course = 2 sites x 0.1 ml on Day 0; ID booster = 1 site x 0.1 ml on Day 0. Two practical points that trip people up: the injection must raise a visible bleb of about 8 mm in the skin - if it goes subcutaneous the dose is wasted and must be repeated at an adjacent site immediately; and an opened vial reconstituted for ID use should be used within 6-8 hours, which is why ID is done in centres running batched sessions.
Next Steps
1) Decide which situation you are in before choosing the schedule: if this is your first ever rabies course, take 0.1 ml intradermally at 2 sites (one per deltoid) on Day 0, Day 3 and Day 7. If you have completed a full course any time in the past, you only need 0.1 ml at 1 site on Day 0 and 1 site on Day 3. 2) Carry your old vaccination card to the centre - the booster shortcut is only valid if the previous course was documented and complete. 3) Get it done at an anti-rabies clinic or a district hospital ARV centre that routinely runs the ID protocol, using an insulin/1 ml syringe with a fine needle; do not let a general pharmacy improvise the ID technique. 4) Watch the injection: a raised pale bleb must appear. If it does not, ask for the dose to be repeated at once at a nearby site. 5) Category III wounds (bleeding bite, licks on broken skin, mucous membrane contact) in a never-vaccinated person also need rabies immunoglobulin infiltrated into the wound on Day 0 - vaccine alone is not enough; a previously vaccinated person taking a booster does not need it. 6) Wash the wound with soap under running water for 15 minutes and apply povidone-iodine, and check that your tetanus cover is current. 7) Do not mix routes midway - if a dose was given intramuscularly, tell the next centre so the remaining schedule is planned correctly. If you would like me to look at your vaccination card and confirm exactly which schedule and which day you are on, you can book a consult with me on Practo, or see me at Synergy Multispeciality Hospital, Miraj.
Health Tips
Never delay the Day 0 dose while sorting out the schedule - rabies is nearly 100% fatal once symptoms start, and a day lost matters more than the route chosen. Also, do not accept the intradermal route if you are on long-term steroids, chemotherapy or are otherwise immunocompromised: such patients must get the full intramuscular schedule with immunoglobulin, and an antibody titre check afterwards.