Antirabies%2525252525252525252525252525252525252520vaccine

# Antirabies Vaccine ## Overview Antirabies vaccine is an inactivated virus vaccine used for post-exposure prophylaxis (PEP) against rabies. It is administered intramuscularly. ## Primary Indications * **Rabies Post-Exposure Prophylosis (PEP):** Recommended for individuals with a potential for rabies exposure, based on the type of exposure and the health status of the potential rabies vector. * **Pre-exposure Prophylaxis (PrEP):** Recommended for individuals at high risk of rabies exposure, such as veterinarians, animal handlers, laboratory workers, and travelers to rabies-endemic areas. ## Adult Dosing **Post-Exposure Prophylaxis (PEP) - Unvaccinated Individuals:** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0, 3, 7, and 14. * **Rabies Immune Globulin (RIG):** 20 IU/kg IM infiltrated around the wound on day 0. If infiltration is not possible, administer IM at a site distant from vaccine administration. *Maximum dose of RIG is typically 3000 IU. Consult product labeling for specific maximums.* **Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Individuals:** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0 and 3. * **Rabies Immune Globulin (RIG):** Not recommended if the individual has received a full vaccination series (Primary or Booster) within their lifetime. **Pre-exposure Prophylaxis (PrEP):** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0, 7, and 21 or 28. * **Booster Doses:** For people with ongoing exposure risk, a serum rabies antibody titer should be checked every 2 years. If the titer is insufficient, a booster dose is indicated. ## Pediatric Dosing Pediatric dosing for rabies vaccine is generally weight-based for RIG, but vaccine doses are typically the same volume as adults. **Post-Exposure Prophylaxis (PEP) - Unvaccinated Children:** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0, 3, 7, and 14. * **Rabies Immune Globulin (RIG):** 20 IU/kg IM infiltrated around the wound on day 0. *Maximum dose of RIG is typically 3000 IU. Consult product labeling for specific maximums.* **Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Children:** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0 and 3. * **Rabies Immune Globulin (RIG):** Not recommended. **Pre-exposure Prophylaxis (PrEP):** * **Rabies Vaccine (e.g., HDCV, RCEV):** 1 mL IM on days 0, 7, and 21 or 28. * **Booster Doses:** As per adult guidelines. ## Dose Adjustments No specific dose adjustments are necessary for renal or hepatic impairment. ## Contraindications * Severe, life-threatening allergic reaction to a previous dose of rabies vaccine or any component of the vaccine. * Severe hypersensitivity to egg protein (for vaccines derived from chick embryo cell culture, e.g., older formulations). Newer cell culture vaccines are generally safe for individuals with egg allergies. ## Adverse Effects Common: Pain, redness, swelling, itching at injection site; headache, nausea, dizziness, muscle aches. Less Common: Hives, joint pain, fever. Rare: Anaphylaxis, neurological events (extremely rare and causality is often not established). ## Key Drug Interactions * **Immunosuppressive Therapies:** Corticosteroids, other immunosuppressants, and antimalarial drugs (e.g., chloroquine, mefloquine) may reduce the immune response to rabies vaccine. If these are used concurrently, serum rabies antibody titers should be checked post-vaccination. * **Other Vaccines:** Concomitant administration with other vaccines is generally acceptable, but administer in separate limbs. ## Monitoring * Monitor for signs of allergic reaction following vaccination. * For pre-exposure prophylaxis, monitor rabies antibody titers as recommended, especially in individuals on immunosuppressive therapy. ## Clinical Pearls * RIG is essential for unvaccinated individuals receiving PEP as it provides immediate passive immunity. * RIG should be administered on day 0 only, and infiltrated around the wound as much as possible. * The decision to administer PEP depends on the species of the animal, the circumstances of the bite/exposure, and the availability of the animal for testing. Consult local public health guidelines. * Documentation of vaccination history is critical. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines, as recommendations and product details can change. Local protocols may vary.