Antirabies%252525252525252525252525252525252520vaccine

# Antirabies Vaccine ## Overview An inactivated virus vaccine that induces immunity against rabies virus. Available as Rabies Vaccine Adsorbed (purified chick embryo cell vaccine, PCECV) and Rabies vaccine (human diploid cell vaccine, HDCV) or (fibroblast diploid cell vaccine, FDCV). ## Primary Indications Prophylaxis against rabies: * Pre-exposure prophylaxis (PrEP) for individuals at high risk of exposure. * Post-exposure prophylaxis (PEP) for individuals exposed to rabies virus. ## Adult Dosing **Pre-Exposure Prophylaxis (PrEP):** * **Intramuscular (IM):** Two 1 mL doses given on days 0 and 7. Alternatively, a 3-dose regimen (1 mL IM on days 0, 7, and 28) may be used. * **Intradermal (ID):** Two 0.1 mL doses given on days 0 and 7. Dosing may vary by manufacturer and local protocol. **Post-Exposure Prophylaxis (PEP):** * **No previous vaccination:** * Four 1 mL IM doses given on days 0, 3, 7, and 14. * One 1 mL IM dose of rabies immune globulin (RIG) infiltrated around the wound on day 0, followed by five 1 mL IM doses of vaccine on days 0, 3, 7, 14, and 28. * **Previous vaccination:** * Two 1 mL IM doses of vaccine given on days 0 and 3. RIG is not indicated. * **Intradermal (ID) PEP:** Dosing varies significantly by manufacturer and local protocol. Typically involves smaller doses on multiple days. ## Pediatric Dosing Dosing is weight-based for intramuscular administration, equivalent to adult doses per kilogram. **Pre-Exposure Prophylaxis (PrEP):** * **IM:** Same as adult doses. * **ID:** Same as adult doses. **Post-Exposure Prophylaxis (PEP):** * **No previous vaccination:** * **IM:** Four 1 mL IM doses given on days 0, 3, 7, and 14. * Rabies immune globulin (RIG) infiltrated around the wound on day 0, followed by vaccine doses. * **Previous vaccination:** * **IM:** Two 1 mL IM doses of vaccine given on days 0 and 3. ## Dose Adjustments No dose adjustments are necessary for hepatic or renal impairment. ## Contraindications * Severe, life-threatening allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine. * Severe acute illness. ## Adverse Effects * **Common:** Local reactions (pain, redness, swelling at injection site), headache, mild fever, nausea, abdominal pain, muscle aches. * **Less Common:** Urticaria, joint pain, dizziness, lymphadenopathy. * **Rare:** Serious allergic reactions (anaphylaxis). Neurological events are extremely rare and temporal association does not imply causation. ## Key Drug Interactions * **Immunosuppressive therapy:** May reduce the immune response to the vaccine. Consider serological testing to confirm adequate immunity. * **Corticosteroids:** High-dose or long-term corticosteroid use may impair vaccine response. ## Monitoring * **PrEP:** Routine serological monitoring is generally not recommended but may be considered for individuals with ongoing high risk. * **PEP:** Clinical assessment of wound and exposure circumstances. Serological testing is generally not required for PEP administration unless there is concern about vaccine response. ## Clinical Pearls * Rabies vaccine is safe and effective. * RIG should be given on day 0 along with the first vaccine dose for unvaccinated individuals receiving PEP. Infiltrate as much RIG as anatomically possible around the wound. If administered IM, it must be given at a different site than the vaccine. * RIG is not recommended for previously vaccinated individuals receiving PEP. * Washing the wound thoroughly with soap and water is crucial post-exposure. * The decision to administer PEP should be based on the judgment of public health officials and healthcare providers, considering the species of animal, the circumstances of the bite, and the availability of the animal for observation or testing. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for current prescribing information. Always consult the official product monograph and local guidelines for definitive and up-to-date recommendations.