Antirabies%252525252525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccines are inactivated virus vaccines used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent rabies infection. ## Primary Indications * **Pre-exposure Prophylaxis (PrEP):** For individuals with an increased risk of exposure to rabies virus, such as veterinarians, animal handlers, laboratory workers, and travelers to rabies-endemic areas. * **Post-exposure Prophylaxis (PEP):** For individuals who have been bitten or scratched by an animal suspected of having rabies, or have had mucous membrane or parenteral exposure to a potentially rabid animal. ## Adult Dosing **Pre-exposure Prophylaxis (PrEP):** * **Intramuscular (IM):** Two 1-mL doses given on days 0 and 7. * **Intradermal (ID):** Two 0.1-mL doses given on days 0 and 7 may be used in some regions, but IM administration is standard in the US. **Post-exposure Prophylaxis (PEP):** The choice of PEP regimen depends on the individual's rabies vaccination history and the specifics of the exposure. Rabies immune globulin (RIG) is typically administered concurrently with the vaccine in unvaccinated individuals. * **Unvaccinated or Incompletely Vaccinated Individuals:** * Four IM doses of 1-mL vaccine on days 0, 3, 7, and 14. * For individuals with severe immunocompromise, five IM doses of 1-mL vaccine on days 0, 3, 7, 14, and 28 may be considered. * Administer RIG (20 IU/kg body weight) on day 0, infiltrated around the wound(s) and the remainder IM at a site distant from vaccine administration. Do not administer RIG after a full course of vaccine. * **Previously Vaccinated Individuals (completed a full PRV series previously):** * Two IM doses of 1-mL vaccine given on days 0 and 3. * RIG is **not** indicated. Local protocols and public health guidance should be consulted for specific PEP recommendations based on animal species, behavior, and local rabies epidemiology. ## Pediatric Dosing * **PrEP:** Dosing is the same as in adults based on volume (1 mL IM per dose). * **PEP:** Dosing is the same as in adults based on volume (1 mL IM per dose). Special attention to RIG dosing, which is calculated by body weight (20 IU/kg). ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment. ## Contraindications * Known severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine (e.g., neomycin, polymyxin B, ethanol, phenol). ## Adverse Effects Common adverse effects include local reactions at the injection site (pain, redness, swelling, itching), headache, nausea, abdominal pain, muscle aches, and dizziness. Rare but serious adverse effects can include anaphylaxis. ## Key Drug Interactions * **Immunosuppressive Medications:** May reduce the immune response to rabies vaccine. If possible, defer vaccination until completion of immunosuppressive therapy or monitor antibody titers. * **Antimalarial Drugs (e.g., Chloroquine):** May interfere with the antibody response to rabies vaccine if given concurrently. Administer rabies vaccine IM; if ID administration is used, consider delaying chloroquine for 2 weeks after completion of vaccination. ## Monitoring * Monitor for injection site reactions and systemic adverse effects. * For PrEP, antibody titers are not routinely recommended but may be considered for individuals with ongoing increased risk or concerns about vaccine effectiveness (e.g., immunocompromised individuals). * For PEP, assess the exposure event, animal status, and compliance with the vaccination schedule. ## Clinical Pearls * Rabies vaccine for PrEP is recommended for people at high risk of exposure or potential exposure. * Rabies PEP is a medical emergency; **do not delay** treatment if an exposure has occurred. * RIG is crucial for unvaccinated and incompletely vaccinated individuals receiving PEP as it provides passive immunity. * Always consult the animal bite management guidelines from the Centers for Disease Control and Prevention (CDC) or local public health authorities for definitive PEP recommendations. * Confirm vaccine product and administration route (IM is preferred) with current prescribing information and local protocols. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and local guidelines, as drug information can change. Verify doses and indications specific to your patient and clinical situation.