Antirabies%2525252525252525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccine is used for post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). PEP is recommended after potential exposure to rabies virus. PrEP may be recommended for individuals with ongoing occupational or recreational risk. ## Primary Indications * Post-exposure prophylaxis (PEP) following known or potential rabies virus exposure. * Pre-exposure prophylaxis (PrEP) for individuals at high risk of exposure. ## Adult Dosing **Post-Exposure Prophylaxis (PEP):** * **Intramuscular (IM) Administration:** * **Vaccination-naive individuals:** 4 doses of 1 mL IM on days 0, 3, 7, and 14. * **Previous rabies vaccination:** 2 doses of 1 mL IM on days 0 and 3. Rabies immune globulin (RIG) is not recommended. * **Intradermal (ID) Administration (where available and recommended by local guidelines):** * **Vaccination-naive individuals:** 2 ID injections of 0.1 mL each on day 0 (one in each deltoid or other recommended sites), followed by 1 mL IM on day 7, and 1 mL IM on day 14. * **Previous rabies vaccination:** 2 doses of 1 mL IM on days 0 and 3. RIG is not recommended. **Pre-Exposure Prophylaxis (PrEP):** * **IM Administration:** 3 doses of 1 mL IM on days 0, 7, and 21 or 28. * **ID Administration (where available and recommended by local guidelines):** 2 ID injections of 0.1 mL each on days 0 and 7. ## Pediatric Dosing Pediatric dosing is the same as adult dosing, adjusted for age and weight where appropriate. Specifically, for IM administration, the volume of 1 mL per dose remains the same. For ID administration, the volume of 0.1 mL per injection remains the same. ## Dose Adjustments No dose adjustments are necessary based on renal or hepatic impairment. ## Contraindications * Severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine (e.g., neomycin, polymyxin B, neomycin, phenol). * Acute severe febrile illness (postponement of vaccination is generally recommended, but PEP should proceed regardless). ## Adverse Effects Common adverse effects include injection site reactions (pain, redness, swelling), headache, dizziness, nausea, muscle aches, and fatigue. Severe allergic reactions are rare but possible. Neurological events are extremely rare. ## Key Drug Interactions * **Corticosteroids and other immunosuppressants:** May decrease the immune response to rabies vaccine. If PEP is given to an immunosuppressed individual, additional doses of vaccine and testing of rabies antibody titers may be considered. RIG should be given with the first dose of vaccine in PEP. * **Other vaccines:** Rabies vaccine can be administered concurrently with other vaccines. ## Monitoring * Monitor for adverse reactions following vaccination. * For individuals receiving PEP, evaluation of the biting animal and public health recommendations are critical. * For PrEP, periodic assessment of antibody titers may be considered for individuals with ongoing risk, though not routinely recommended by all guidelines. ## Clinical Pearls * Rabies immune globulin (RIG) should be administered to unvaccinated individuals receiving PEP, infiltrated around the wound site as much as possible, and the remainder given IM. RIG is not given to those with a documented history of prior rabies vaccination. * The decision to administer PEP should be based on the type of exposure, the species of the animal, the availability of the animal for testing, and local public health recommendations. * It is crucial to complete the entire PEP series as prescribed. * Local guidelines may vary, especially regarding intradermal administration schedules and the use of specific vaccine formulations. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for accurate and complete drug information, including indications, contraindications, warnings, precautions, adverse effects, and drug interactions, specific to your patient's situation and local protocols.