Please check your internet connection and try again.
# Antirabies Vaccine
## Overview
Rabies vaccine is an inactivated virus vaccine used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). In the U.S., major products include Human Diploid Cell Vaccine (HDCV) and Purified Chick Embryo Cell Vaccine (PCECV).
## Primary Indications
* **Post-exposure prophylaxis (PEP):** Following suspected rabies exposure (e.g., animal bite, scratch, or mucous membrane contact with saliva from a suspect animal).
* **Pre-exposure prophylaxis (PrEP):** For high-risk individuals (e.g., veterinarians, animal control, laboratory workers, travelers to high-risk endemic areas).
## Adult Dosing
* **Post-Exposure Prophylaxis (Previously unvaccinated):** 1.0 mL IM in the deltoid region on days 0, 3, 7, and 14.
* *Note:* Rabies Immune Globulin (RIG) should be administered on day 0 at 20 IU/kg, infiltrated into and around the wound with any remaining amount injected IM at a site distant from the vaccine.
* **Post-Exposure Prophylaxis (Previously vaccinated):** 1.0 mL IM on days 0 and 3. Do not administer RIG.
* **Pre-Exposure Prophylaxis:** 1.0 mL IM on days 0 and 7.
## Pediatric Dosing
* **Dose:** Same as adults (1.0 mL IM).
* **Site:** Deltoid muscle in older children/adolescents. Anterolateral thigh may be used in infants/young toddlers. **Never administer in the gluteal region** due to poor seroconversion.
* **Post-Exposure:** Follow the same day-schedule (0, 3, 7, 14) as adults.
## Dose Adjustments
* **Immunocompromised patients:** For PEP, use a 5-dose regimen (days 0, 3, 7, 14, and 28) and consult infectious disease specialists. Immunosuppressed individuals should be tested for rabies virus neutralizing antibody (RVNA) titer 1–2 weeks after the final dose.
* **Hepatic/Renal:** No specific dose adjustments established.
## Contraindications
* **Pre-exposure:** Life-threatening hypersensitivity to any component (e.g., neomycin).
* **Post-exposure:** There are **no absolute contraindications** due to the 100% fatality rate of clinical rabies. If a severe reaction occurs, weigh the risk of rabies against the risk of the reaction.
## Adverse Effects
* **Common:** Injection site pain, redness, swelling, induration, headache, nausea, abdominal pain, muscle aches, and dizziness.
* **Rare:** Serum sickness-like reaction (usually occurs 2–21 days after the booster dose).
## Key Drug Interactions
* **Corticosteroids/Immunosuppressants:** May interfere with the development of active immunity. Avoid if possible during the vaccine series. If mandatory, check serology/antibody titers.
## Monitoring
* **Efficacy:** Monitor for appropriate immune response in high-risk individuals via RVNA titers.
* **Adverse Reactions:** Monitor for signs of hypersensitivity reactions following administration.
## Clinical Pearls
* **Wound Management:** The most important step in PEP is immediate, thorough washing of the wound with soap and water or a virucidal agent (e.g., povidone-iodine).
* **RIG administration:** Always infiltrate as much of the calculated RIG dose as possible into/around the wound(s).
* **Local Protocol:** Rabies management must follow guidelines established by the CDC and the specific state or local health department regarding animal testing and quarantine status.
* **Storage:** Vaccines must be stored in the refrigerator (2°C to 8°C). Do not freeze.
***
**Educational Disclaimer:** This information is intended for educational purposes only. Always verify current prescribing information, state-specific exposure guidelines, and the most recent CDC/ACIP recommendations prior to clinical use.
