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# Antirabies Vaccine
## Overview
Rabies vaccine is an inactivated virus preparation (either Human Diploid Cell Vaccine [HDCV] or Purified Chick Embryo Cell Vaccine [PCECV]) used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). It induces active immunity to the rabies virus.
## Primary Indications
* **Post-Exposure Prophylaxis (PEP):** Following potential exposure to a rabid animal (e.g., bites, scratches, mucosal contact).
* **Pre-Exposure Prophylaxis (PrEP):** For individuals at high risk of exposure (e.g., veterinarians, animal control, laboratory workers, travelers to endemic areas).
## Adult Dosing
* **PEP (Previously unvaccinated):** 1 mL IM (deltoid) on days 0, 3, 7, and 14. Immunocompromised individuals require a 5th dose on day 28. Rabies Immune Globulin (RIG) 20 IU/kg must be administered with the first vaccine dose.
* **PEP (Previously vaccinated):** 1 mL IM on days 0 and 3. Do not administer RIG.
* **PrEP:** 1 mL IM on days 0 and 7.
## Pediatric Dosing
* **Dosing:** Same volume (1 mL) as adults.
* **Anatomical Site:** Children <1 year: Anterolateral thigh. Children ≥1 year: Deltoid muscle. **Never** administer into the gluteal region, as efficacy may be reduced.
## Dose Adjustments
* **Immunocompromised patients:** Must receive the 5-dose regimen for PEP and should have rabies virus neutralizing antibody titers measured 1-2 weeks after vaccine completion to ensure seroconversion.
* **Renal/Hepatic:** No specific dose adjustments established.
## Contraindications
* **PrEP:** Known hypersensitivity to any component (e.g., neomycin).
* **PEP:** No absolute contraindications. If a serious allergic reaction occurs, seek infectious disease consultation regarding benefit vs. risk.
## Adverse Effects
* **Common:** Injection site reactions (pain, erythema, swelling), low-grade fever, headache, dizziness, and muscle aches.
* **Serious:** Serum sickness-like reactions (usually 2–21 days post-vaccination), anaphylaxis (rare).
## Key Drug Interactions
* **Immunosuppressants/Corticosteroids:** May interfere with the immune response. If possible, avoid during the rabies vaccine series.
* **Chloroquine:** May decrease the antibody response; avoid if an alternative anti-malarial is available.
## Monitoring
* Monitor for signs of anaphylaxis for 15-30 minutes post-injection.
* In high-risk individuals (lab workers), monitor serology (titer) every 6 months to 2 years to determine the need for booster doses.
## Clinical Pearls
* **Wound Care:** Thoroughly irrigate all bite/scratch wounds with soap and water immediately, as this significantly reduces viral load.
* **RIG Administration:** Infiltrate as much of the RIG dose as possible into/around the wound. Administer any remaining volume IM at a site distant from the vaccine.
* **Local Protocols:** PEP protocols vary by jurisdiction and local prevalence of rabies; always verify with local public health authorities or the CDC/WHO guidelines.
* **Vaccine Storage:** Store at 2°C to 8°C (36°F to 46°F); do not freeze.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and local public health recommendations for rabies management can change. Always verify current prescribing information and consult local health authority protocols before initiating treatment.
