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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). It induces active immunity by stimulating the production of neutralizing antibodies.
## Primary Indications
* **Post-Exposure Prophylaxis (PEP):** Following exposure to a rabid or suspected rabid animal (bite, scratch, or mucous membrane contact).
* **Pre-Exposure Prophylaxis (PrEP):** For individuals at high risk of exposure (e.g., veterinarians, laboratory workers handling rabies virus, spelunkers, international travelers to endemic areas).
## Adult Dosing
* **PEP (previously unvaccinated):** 1 mL IM (deltoid) on days 0, 3, 7, and 14. Note: Rabies Immune Globulin (RIG) should be administered on day 0 (20 IU/kg, infiltrated around wound and remainder IM).
* **PEP (previously vaccinated):** 1 mL IM on days 0 and 3; no RIG indicated.
* **PrEP:** 1 mL IM on days 0 and 7. Boosters depend on risk assessment/titer monitoring.
## Pediatric Dosing
* **PEP and PrEP:** Dose is the same as adults (1 mL IM).
* **Injection Site:** Children <1 year: anterolateral thigh. Children ≥1 year: deltoid area preferred; if insufficient muscle mass, anterolateral thigh. **The gluteal muscle must never be used** due to risk of poor immunogenicity.
## Dose Adjustments
* **Immunocompromised patients:** In PEP, a 5-dose series (days 0, 3, 7, 14, and 28) plus RIG is required. Serologic testing 1–2 weeks post-series is recommended to confirm seroconversion.
* **Renal/Hepatic:** No adjustments required.
## Contraindications
* **PEP:** None. Because rabies is invariably fatal, there are no absolute contraindications to post-exposure vaccination.
* **PrEP:** Severe allergic reaction (anaphylaxis) to a previous dose or vaccine component.
## Adverse Effects
* **Local:** Pain, erythema, swelling, or pruritus at the injection site (common).
* **Systemic:** Fever, malaise, headache, dizziness, nausea, abdominal pain, or myalgia. Rare instances of serum sickness-like reactions reported.
## Key Drug Interactions
* **Immunosuppressants/Corticosteroids:** May interfere with the development of active immunity. If possible, avoid immunosuppressive therapy during the PEP series; if unavoidable, monitor antibody titers.
* **Chloroquine:** May decrease the antibody response; avoid if used for malaria prophylaxis during vaccination.
## Monitoring
* **PEP:** Adherence to the full schedule is critical. No routine antibody testing is needed for immunocompetent patients.
* **High-risk individuals (e.g., lab workers):** Periodic serologic titer monitoring (every 6 months to 2 years depending on risk) is recommended.
## Clinical Pearls
* **Wound Care:** Immediate and thorough cleansing with soap and water (or povidone-iodine) is the most effective intervention to reduce risk.
* **RIG Administration:** Always infiltrate as much of the 20 IU/kg dose as feasible into the bite wound(s). Any remaining volume should be injected IM at a separate site from the vaccine.
* **Local Protocol:** Exact schedules and regional post-exposure protocols vary by country/state. Consult local public health department guidelines for specific endemic disease status and protocol variations.
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**Educational Disclaimer:** This information is for educational purposes only. Rabies prophylaxis is a life-saving but complex medical intervention. Always verify current prescribing information, state/local health department guidelines, and CDC/ACIP recommendations before administering.
