Antirabies%2525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccine is an inactivated virus vaccine that stimulates the immune system to produce antibodies against the rabies virus, preventing rabies infection. ## Primary Indications * Post-exposure prophylaxis (PEP) following potential rabies virus exposure. * Pre-exposure prophylaxis (PrEP) for individuals at high risk of rabies exposure. ## Adult Dosing **Post-Exposure Prophylaxis (PEP):** * **For previously unvaccinated individuals:** 1 mL intramuscularly (IM) on days 0, 3, 7, 14, and (if not given biologics) day 28. Rabies immune globulin (RIG) should also be administered on day 0. * **For previously vaccinated individuals:** 1 mL IM on days 0 and 3. RIG is not recommended. **Pre-Exposure Prophylaxis (PrEP):** * **For individuals at high risk:** 1 mL IM as a primary series of 2 doses given on days 0 and 7. Some protocols may recommend a third dose on day 21 or 28. Dosing and schedule may vary by local protocol and WHO recommendations. ## Pediatric Dosing Pediatric dosing is the same as adult dosing based on weight. The vaccine is administered intramuscularly into the anterolateral thigh in infants and young children. **Post-Exposure Prophylaxis (PEP):** * **For previously unvaccinated children:** 1 mL IM on days 0, 3, 7, 14, and (if not given biologics) day 28. RIG should also be administered on day 0. * **For previously vaccinated children:** 1 mL IM on days 0 and 3. RIG is not recommended. **Pre-Exposure Prophylaxis (PrEP):** * **For children at high risk:** 1 mL IM as a primary series of 2 doses given on days 0 and 7. Some protocols may recommend a third dose on days 21 or 28. Dosing and schedule may vary by local protocol and WHO recommendations. ## Dose Adjustments No dose adjustments are necessary for renal or hepatic impairment. ## Contraindications * Severe, life-threatening allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or to any component of the vaccine. ## Adverse Effects Common adverse effects include pain, redness, and swelling at the injection site; headache; nausea; abdominal pain; muscle aches; dizziness; and fatigue. Rare but serious adverse effects include anaphylaxis and neurological events. ## Key Drug Interactions * **Immunosuppressive medications:** May decrease the immune response to rabies vaccine. Consider antibody titers to assess immune response. * **Antimalarials (e.g., chloroquine, mefloquine):** May interfere with the immune response to rabies vaccine; administer vaccine at a different site than antimalarials if possible. ## Monitoring * Monitor for signs and symptoms of anaphylaxis following administration. * For PrEP, consider antibody titers at 6-12 months and every 2 years thereafter to assess the need for booster doses. * For PEP, assess wound status. ## Clinical Pearls * Rabies vaccine is safe and effective for PEP regardless of the time elapsed since exposure, although treatment should be initiated as soon as possible. * RIG should be infiltrated around the wound as much as possible and the remainder administered IM at a site distant from the vaccine. * PEP is indicated for all bites from potentially rabid animals. For non-bite exposures, PEP decisions are based on the likelihood of virus transmission. * The choice of vaccine and PEP regimen may depend on the source animal, its condition, and local public health recommendations. *** **Important Disclaimer:** This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always refer to the most current prescribing information, package insert, and local guidelines before making any treatment decisions.