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# Antirabies Vaccine
## Overview
Rabies vaccine is an inactivated, cell-culture-derived vaccine used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). Common products include Human Diploid Cell Vaccine (HDCV) and Purified Chick Embryo Cell Vaccine (PCECV).
## Primary Indications
* **PEP:** For individuals exposed to a suspected rabid animal. Must be administered in combination with Rabies Immune Globulin (RIG) for previously unvaccinated individuals.
* **PrEP:** For individuals with high-risk occupational exposure (e.g., veterinarians, animal control, laboratory workers) or travelers to endemic areas.
## Adult Dosing
* **PEP (Previously Unvaccinated):** 1 mL intramuscularly (IM) in the deltoid on days 0, 3, 7, and 14. RIG (20 IU/kg) should be administered on day 0 (infiltrate as much as possible around the wound, remainder IM in a site distant from vaccine).
* **PEP (Previously Vaccinated):** 1 mL IM on days 0 and 3. Do not administer RIG.
* **PrEP (Primary Series):** 1 mL IM on days 0, 7, and 21 or 28.
## Pediatric Dosing
* **Dosing:** Same as adult dosing (1 mL IM).
* **Anatomic Site:** In children < 1 year, administer in the anterolateral thigh. In children ≥ 1 year, the deltoid muscle is preferred. Never administer in the gluteal region, as vaccine efficacy is significantly reduced.
## Dose Adjustments
* **Renal/Hepatic:** No adjustments required.
* **Immunocompromised:** Individuals with immunocompromise (e.g., HIV, immunosuppressive therapy) should generally complete the 4-dose PEP series. Serological testing 1–2 weeks after the final dose is recommended to confirm seroconversion.
## Contraindications
* **PrEP:** Known severe allergic reaction (anaphylaxis) to a previous dose or any vaccine component (e.g., neomycin).
* **PEP:** No absolute contraindications. The high mortality rate of rabies outweighs the risks of potential allergic reactions. Monitor closely for hypersensitivity.
## Adverse Effects
* **Common:** Local injection site reactions (pain, erythema, swelling, induration).
* **Systemic:** Mild flu-like symptoms (headache, nausea, abdominal pain, muscle aches, dizziness, fever).
* **Rare:** Serum sickness-like reactions (may occur 2–21 days post-vaccination, particularly with boosters).
## Key Drug Interactions
* **Immunosuppressants/Corticosteroids:** May interfere with the immune response to the vaccine. Avoid, if possible, during the PEP course. If unavoidable, monitor rabies virus neutralizing antibody titers.
* **Chloroquine:** May reduce the antibody response; avoid for malaria prophylaxis while receiving rabies PrEP.
## Monitoring
* **Serology:** Routine monitoring is not required for healthy individuals. If exposed and immunocompromised, check antibody titers 1–2 weeks after the 4-dose series.
* **Hypersensitivity:** Observe patients for 15 minutes post-vaccination for acute reactions.
## Clinical Pearls
* **Wound Management:** The most critical step in rabies PEP is immediate, thorough washing of the wound with soap and water/antiseptic.
* **RIG Administration:** RIG is infiltrated into and around the wound. Any remainder is given IM at a site distant from the vaccine.
* **Local Protocols:** Dosing schedules and post-exposure management must align with local/state health department or CDC guidelines.
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**Educational Disclaimer:** This information is for educational purposes only. Always consult the most recent package insert, the CDC's *Yellow Book*, or local public health guidelines to verify exact dosing, current recommendations, and specific product instructions before prescribing or administering.
