Antirabies%25252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccine is an inactivated virus vaccine 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 virus (e.g., veterinarians, animal handlers, travelers to endemic areas). * **Post-exposure Prophylaxis (PEP):** For individuals who have been bitten or scratched by a potentially rabid animal, or have had mucous membrane exposure to saliva of a potentially rabid animal. ## Adult Dosing **Pre-exposure Prophylaxis (PrEP):** * Intramuscular (IM): 1 mL on days 0, 7, and 21 or 28. * Intradermal (ID): Use of ID schedules varies by product and local guidelines; typically involves smaller volumes (e.g., 0.1 mL or 0.2 mL) at multiple sites on days 0, 7, and 21 or 28. Consult specific product information and local protocols. **Post-exposure Prophylaxis (PEP):** * **Vaccinated Individuals (Previous full PrEP or PEP series):** * IM: 1 mL on days 0 and 3. * ID: Consult product information and local protocols. * **Unvaccinated Individuals:** * IM: 1 mL each on days 0, 3, 7, 14, and 28. * ID: Consult product information and local protocols. * **Rabies Immune Globulin (RIG):** Administer 20 IU/kg on day 0 for unvaccinated individuals. Half the dose into the wound(s) if feasible, the remainder IM at a separate site. Do not administer RIG to previously vaccinated individuals. ## Pediatric Dosing Dosing is weight-based for RIG if used, but vaccine doses are typically the same volume as adults. * **PrEP (IM):** 1 mL on days 0, 7, and 21 or 28. * **PEP (IM - Unvaccinated):** 1 mL on days 0, 3, 7, 14, and 28. * **RIG (if applicable):** 20 IU/kg. ## Dose Adjustments No specific dose adjustments are mandated for renal or hepatic impairment. ## Contraindications * Severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine. * Careful consideration of risk vs. benefit for individuals with known severe allergies to vaccine components. ## Adverse Effects Common: Pain, redness, swelling at injection site, headache, nausea, muscle aches, dizziness, fatigue. Serious: Anaphylaxis, neuroparalytic events (rare). ## Key Drug Interactions * Other vaccines: Administer PEP vaccines at separate sites from RIG. Concurrent administration of other vaccines may potentially reduce the antibody response to rabies vaccine if given IM; however, this is usually not a reason to postpone PEP. ID administration of rabies vaccine may be more susceptible to interference. * Immunosuppressive therapy: May reduce the antibody response. ## Monitoring * Vaccination status: Document dates, vaccine type, and lot numbers. * Adverse events: Monitor for local and systemic reactions. * Serological testing: Typically not required for routine PrEP if vaccine schedule is completed. May be considered for high-risk individuals or in cases of potential vaccine failure, guided by public health recommendations. ## Clinical Pearls * PEP is vital and should be initiated as soon as possible after potential exposure. * RIG should be administered to unvaccinated individuals receiving PEP and infiltrated into the wound(s) whenever possible to provide immediate passive immunity. * The decision to administer PEP depends on the species of the animal, the circumstances of the exposure, and local public health guidance. * Consult the CDC's "Rabies Vaccine: Recommendations for Human Postexposure Prophylaxis" and the specific vaccine manufacturer's prescribing information for detailed guidance. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and current guidelines before making clinical decisions. Local protocols and product availability may vary.