Antirabies%252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccines are used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent rabies infection. ## Primary Indications * **Pre-exposure prophylaxis (PrEP):** For individuals at high risk of exposure to rabies, such as veterinarians, animal handlers, rabies diagnostic laboratory workers, and persons traveling to or residing in areas with a high prevalence of rabies. * **Post-exposure prophylaxis (PEP):** For individuals who have been bitten or scratched by a potentially rabid animal, or have had mucous membrane or broken skin exposure to the saliva of a potentially rabid animal. PEP includes rabies vaccine and, in some cases, rabies immune globulin (RIG). ## Adult Dosing **Pre-exposure Prophylaxis (PrEP):** * Day 0, Day 7, and Day 21 (intramuscular [IM] injection). * Each dose: 1 mL IM. **Post-exposure Prophylaxis (PEP) - Unvaccinated or Incompletely Vaccinated Persons:** * Rabies vaccine IM: 1 mL on Days 0, 3, 7, and 14. * Rabies immune globulin (RIG) infiltrated around the wound and given IM on Day 0. * RIG dose: 20 International Units (IU)/kg. Do not exceed 3000 IU. **Post-exposure Prophylaxis (PEP) - Previously Vaccinated Persons:** * Rabies vaccine IM: 1 mL on Days 0 and 3. * RIG is not recommended. ## Pediatric Dosing Pediatric dosing for rabies vaccine is the same as for adults based on age and weight. Specific volumes are based on the vaccine product guidelines. * **Pre-exposure Prophylaxis (PrEP):** * Day 0, Day 7, and Day 21 (IM injection). * Each dose: 1 mL IM. * **Post-exposure Prophylaxis (PEP) - Unvaccinated or Incompletely Vaccinated Children:** * Rabies vaccine IM: 1 mL on Days 0, 3, 7, and 14. * Rabies immune globulin (RIG) infiltrated around the wound and given IM on Day 0. * RIG dose: 20 IU/kg. Do not exceed 3000 IU. * **Post-exposure Prophylaxis (PEP) - Previously Vaccinated Children:** * Rabies vaccine IM: 1 mL on Days 0 and 3. * RIG is not recommended. ## Dose Adjustments Dose adjustments are not typically required based on renal or hepatic impairment. ## Contraindications * Severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or to any component of the vaccine (e.g., neomycin, gelatin). ## Adverse Effects * **Common:** Pain, redness, swelling, itching at the injection site. Mild fever, headache, nausea, dizziness, muscle aches. * **Rare:** Neurologic events (e.g., encephalitis, transverse myelitis) have been reported but a causal relationship is often unclear. Severe allergic reactions. ## Key Drug Interactions * **Immunosuppressive Medications:** May reduce the immune response to rabies vaccine. For PrEP, if a patient is on immunosuppressants, consider a serum rabies antibody titer 1-2 weeks after completing the vaccine series to ensure adequate immunity. For PEP, complete the full vaccine series even in immunocompromised individuals. * **Chloroquine:** May decrease the antibody response to rabies vaccine; therefore, patients receiving chloroquine for malaria prophylaxis should be advised to take an alternative prophylactic agent if possible. If chloroquine is necessary, administer rabies vaccine IM, not intradermally. ## Monitoring * **PrEP:** Antibody titers may be checked periodically (e.g., every 2 years) for individuals with ongoing high risk of exposure. * **PEP:** Clinical assessment for signs and symptoms of rabies. ## Clinical Pearls * The decision to administer PEP depends on the species of the attacking animal, the circumstances of the attack, and the potential for rabies in the geographic area. * Rabies immune globulin (RIG) should be administered on Day 0 with the first dose of vaccine whenever indicated. It should be thoroughly infiltrated into the wound sites. Any remaining RIG should be given IM at a site distant from the vaccine injection. * Vaccine administration site should be rotated if multiple doses are given. *** ***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines for definitive drug management decisions. Local protocols may vary.*