Antirabies%2525252525252525252525252525252525252525252525252525252520vaccine

# Antirabies vaccine ## Overview Rabies vaccines are inactivated virus vaccines used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent rabies. ## Primary Indications * **PrEP:** For individuals at high risk of exposure to rabies (e.g., veterinarians, animal handlers, spelunkers, laboratory workers, travelers to rabies-endemic areas). * **PEP:** For individuals exposed to a potentially rabid animal. This includes bites, scratches, or mucous membrane exposure to saliva. ## Adult Dosing ### Pre-Exposure Prophylaxis (PrEP) * **Intramuscular (IM):** 1 mL, administered IM on days 0, 7, and 21 (or 28). * **Intradermal (ID):** 0.1 mL, administered ID in the deltoid region on days 0, 7, and 21 (or 28). *Note: ID administration is often used in resource-limited settings and requires specific training.* ### Post-Exposure Prophylaxis (PEP) - Unvaccinated Individuals * **IM:** 1 mL, administered IM on days 0, 3, 7, 14, and 28. * **Rabies Immune Globulin (RIG):** 20 International Units (IU)/kg body weight, infiltrated around the wound(s) and remaining dose administered IM on day 0. If anatomical location is not possible for infiltration, administer IM in a site distant from vaccine administration. ### Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Individuals * **IM:** 1 mL, administered IM on days 0 and 3. * RIG is **not** recommended for previously vaccinated individuals. *Note: Specific recommendations for PEP may vary based on the type of exposure, the animal involved, and local public health guidelines.* ## Pediatric Dosing Pediatric dosing is generally weight-based, but vaccine volume administered IM is typically the same as adults (1 mL). ### Pre-Exposure Prophylaxis (PrEP) * **IM:** 1 mL, administered IM on days 0, 7, and 21 (or 28). * **ID:** 0.1 mL, administered ID on days 0, 7, and 21 (or 28). ### Post-Exposure Prophylaxis (PEP) - Unvaccinated Children * **IM:** 1 mL, administered IM on days 0, 3, 7, 14, and 28. * **RIG:** 20 IU/kg body weight, infiltrated around wound(s) and remaining dose IM on day 0. ### Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Children * **IM:** 1 mL, administered IM on days 0 and 3. * RIG is **not** recommended. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment. ## Contraindications * Severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine. * Severe febrile illness (may postpone vaccination until recovery). ## Adverse Effects * **Common:** Local reactions at the injection site (pain, redness, swelling, itching), mild fever, headache, nausea, muscle aches. * **Rare:** Severe allergic reactions, neurological events. ## Key Drug Interactions * **Immunosuppressive Therapies:** May reduce the immune response to rabies vaccine. If possible, defer vaccination until the completion of immunosuppressive therapy. If deferral is not possible, assess antibody titers to ensure adequate response. * **Corticosteroids:** High doses may interfere with vaccine response. * **Antimalarials (e.g., Chloroquine, Mefloquine):** May reduce the antibody response to ID rabies vaccine. IM vaccination is preferred in patients receiving these medications. If ID vaccination