Antirabies%25252525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccine is used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent rabies infection. ## Primary Indications * **PrEP:** For individuals at high risk of exposure to rabies virus, such as veterinarians, animal handlers, spelunkers, and international travelers to rabies-endemic areas. * **PEP:** For individuals who have been bitten or scratched by a potentially rabid animal, or have had mucous membrane contact with saliva of a potentially rabid animal. ## Adult Dosing **PrEP:** * Intramuscular (IM): 1 mL given on days 0, 7, and 21 (or 28). **PEP (Vaccine Only, no immunoglobulin):** * IM: 1 mL given on days 0, 3, 7, 14, and 28. **PEP (Vaccine with Rabies Immunoglobulin):** * IM: 1 mL given on days 0, 3, 7, 14, and 28. * Rabies immune globulin (RIG) should be administered on day 0 at the time of the first vaccine dose, if indicated. *Note: Specific PEP regimens may vary based on the type of exposure, animal involved, and local public health guidelines. Consult current CDC or local public health protocols.* ## Pediatric Dosing Pediatric dosing is the same as adult dosing based on weight (1 mL IM). ## Dose Adjustments No specific dose adjustments are necessary for renal or hepatic impairment. ## Contraindications * Severe, life-threatening allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine. * Severely compromised immune system (e.g., HIV/AIDS, leukemia, lymphoma, generalized malignancy, therapy with alkylating agents, antimetabolites, radiation, or corticosteroids). In these cases, PEP should still be administered, butRIG should also be given if indicated, and antibody titers should be checked. ## Adverse Effects Common: Pain, redness, swelling, itching at injection site, headache, dizziness, nausea, muscle aches, fatigue. Rare: Anaphylaxis, urticaria, angioedema, fever, joint pain. ## Key Drug Interactions * **Corticosteroids and other immunosuppressants:** May reduce the immune response to the vaccine. If these medications are necessary, consider antibody titer testing and potentially additional vaccine doses. * **Antimalarials (e.g., Chloroquine):** May interfere with the immune response. If antimalarials are needed, PEP should still be administered, but consider antibody testing. ## Monitoring * **PrEP:** Antibody titers are not routinely recommended but may be considered for individuals with ongoing risk or immunocompromised status. * **PEP:** Antibody titers are not typically done for PEP as they do not reflect immediate protection. Clinical assessment for signs and symptoms of rabies is crucial. ## Clinical Pearls * Rabies vaccine is highly effective when administered correctly for both PrEP and PEP. * For PEP, the decision to administer vaccine and/or RIG should be determined by a healthcare professional in consultation with public health authorities based on the specific exposure incident. * Inactivated rabies vaccine is available in both adult and pediatric formulations, but doses are generally the same (1 mL). * Rabies immune globulin (RIG) should be infiltrated around the wound site as much as possible, and any remaining volume given IM. Vaccines should be given IM at a different site. *** ***Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and local guidelines before making clinical decisions. This information does not replace professional medical advice.*