Antirabies%252525252525252525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Antirabies vaccines are inactivated virus vaccines that stimulate an immune response to prevent rabies infection. They are administered post-exposure prophylaxis (PEP) or, rarely, pre-exposure prophylaxis (PrEP). ## Primary Indications * **Post-Exposure Prophylaxis (PEP):** To prevent rabies infection after potential exposure to a rabid or potentially rabid animal. * **Pre-Exposure Prophylaxis (PrEP):** For individuals at high risk of rabies exposure (e.g., veterinarians, animal handlers, spelunkers, certain laboratory workers, travelers to rabies-endemic areas). ## Adult Dosing **Post-Exposure Prophylaxis (PEP) - No previous vaccination:** * **Rabies Immune Globulin (RIG):** 20 International Units (IU)/kg ideally given on day 0, infiltrated around the wound(s). If infiltration is not feasible, administer intramuscularly (IM) in a site distant from vaccine administration. * **Rabies Vaccine:** * **Intramuscular (IM) Schedule:** * Days 0, 3, 7, and 14 (4 doses). * **Intradermal (ID) Schedule:** (Less common, requires specific training and vaccine formulation) * 0.1 mL ID in two different sites on Day 0, then 0.1 mL ID in one site on Days 3, 7, and 28 (for WHO-standard vaccine). * Note: Specific ID schedules vary by global region and vaccine manufacturer. **Always consult local protocols.** **Post-Exposure Prophylaxis (PEP) - Previous vaccination:** * **Rabies Immune Globulin (RIG):** Not recommended. * **Rabies Vaccine:** 2 doses IM. * Days 0 and 3. **Pre-Exposure Prophylaxis (PrEP):** * **Intramuscular (IM) Schedule:** * 2 doses IM on days 0 and 7. * **Intradermal (ID) Schedule:** (Less common) * 0.1 mL ID on days 0, 7, and 21 or 28 (for WHO-standard vaccine). ## Pediatric Dosing Dosing is weight-based for RIG. Vaccine doses are the same as adult doses regardless of age. **Post-Exposure Prophylaxis (PEP) - No previous vaccination:** * **Rabies Immune Globulin (RIG):** 20 IU/kg (maximum adult dose usually applies). * **Rabies Vaccine:** Same as adult IM schedule (Days 0, 3, 7, 14). **Post-Exposure Prophylaxis (PEP) - Previous vaccination:** * **Rabies Immune Globulin (RIG):** Not recommended. * **Rabies Vaccine:** Same as adult IM schedule (Days 0, 3). **Pre-Exposure Prophylaxis (PrEP):** * Same as adult IM schedule (Days 0, 7). ## Dose Adjustments No dose adjustments are typically required 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. * Severe, life-threatening allergic reaction to RIG. ## Adverse Effects * **Common:** Pain, redness, swelling, itching at the injection site; mild fever, headache, nausea, dizziness, muscle aches. * **Less Common/Rare:** Neurological events (rarely associated with vaccine, more commonly with RIG if contaminated), severe allergic reactions. ## Key Drug Interactions * **Immunosuppressive Medications:** May reduce the immune response to the vaccine. Consider PrEP or increased monitoring if concurrent use is unavoidable. ## Monitoring * Monitor for adverse reactions (local and systemic). * For PrEP, antibody titers can be checked 2-4 weeks after the final dose to confirm immunity, especially for individuals with ongoing high risk. ## Clinical Pearls * Rabies PEP should be initiated as soon as possible after exposure. * RIG is not administered to previously vaccinated individuals. * RIG should be infiltrated around the wound(s) whenever possible. * The need for PEP depends on the species of the animal, the circumstances of the bite, and the prevalence of rabies in the geographic area. Consult with public health authorities (e.g., local health department, CDC) for guidance. * Vaccine administration technique (IM vs. ID) and specific schedules can vary by manufacturer and regional guidelines. *** **Disclaimer:** This information is intended for clinical professionals. Always consult the most current prescribing information, local guidelines, and infectious disease resources for definitive patient management. Dosing and recommendations can change.