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# Antirabies Vaccine
## Overview
Rabies vaccine is an inactivated virus preparation used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). It induces active immunity by stimulating the production of neutralizing antibodies.
## Primary Indications
* **Pre-exposure prophylaxis (PrEP):** For high-risk individuals (veterinarians, laboratory workers, cave explorers, travelers to endemic areas).
* **Post-exposure prophylaxis (PEP):** Following exposure to a confirmed or suspected rabid animal (bite, scratch, or mucosal contact).
## Adult Dosing
* **PrEP:** 1 mL IM (deltoid) on days 0 and 7. (Note: Some protocols may include a 3-dose series; verify local guidelines).
* **PEP (previously unvaccinated):** 1 mL IM (deltoid) on days 0, 3, 7, and 14.
* **PEP (previously vaccinated):** 1 mL IM on days 0 and 3. No rabies immune globulin (RIG) required.
## Pediatric Dosing
* **PrEP:** 1 mL IM (deltoid; anterolateral thigh in infants) on days 0 and 7.
* **PEP:** Identical to adult doses (1 mL IM). Do not inject into the gluteal region as absorption may be poor.
## Dose Adjustments
* **Immunocompromised:** Should receive a 3-dose PrEP series (days 0, 7, and 21 or 28) and potentially a post-vaccination serologic antibody titer test 1–2 weeks after the final dose.
* **Hepatic/Renal Impairment:** No adjustments required.
## Contraindications
* **PrEP:** Hypersensitivity to a previous dose or any vaccine component.
* **PEP:** There are **no absolute contraindications** for PEP, as rabies is universally fatal. If a serious allergic reaction occurs, manage symptoms (e.g., epinephrine) and continue the series under expert consultation.
## Adverse Effects
* **Local:** Injection site pain (very common), erythema, swelling, pruritus.
* **Systemic:** Fever, headache, muscle aches, nausea, malaise, dizziness.
* **Serious:** Rare reports of anaphylaxis or serum sickness-like reactions.
## Key Drug Interactions
* **Immunosuppressants/Corticosteroids:** May cause suboptimal antibody response. Avoid if possible during the vaccine series. Generally, do not interrupt PEP due to immunosuppressive therapy; follow up with antibody titers.
* **Rabies Immune Globulin (RIG):** Must be administered at a site distant from the vaccine (different extremity) on day 0 of PEP completion.
## Monitoring
* Monitor for signs of anaphylaxis for at least 15 minutes post-injection.
* In high-risk occupational groups, serologic titer checks may be required every 6 months to 2 years to determine the need for booster doses.
## Clinical Pearls
* **Wound Care:** Crucial. Wash all bite wounds thoroughly with soap and water immediately.
* **Administration:** Always administer IM. Never inject IV; ensure needle is not in a blood vessel.
* **Variability:** PEP protocols are strictly dictate by local health authorities and the CDC; always consult the local health department or the CDC Rabies guidance for specific exposure category assessments.
* **Sourcing:** Vaccine availability can be limited. Immediate coordination with local infectious disease departments is recommended for PEP.
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*Disclaimer: This information is for educational purposes only. Rabies protocols evolve and vary significantly by jurisdiction and exposure risk. Always verify current prescribing information, local public health guidelines, and CDC/WHO recommendations before administration.*
