Antirabies%252525252525252525252525252525252525252525252525252525252520vaccine

# 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 * **PrEP:** For individuals at high risk of exposure to rabies virus, such as veterinarians, animal handlers, travelers to endemic areas, and laboratory workers. * **PEP:** For individuals who have been bitten or scratched by a potentially rabid animal, or have had mucous membrane or parenteral exposure to the virus. ## Adult Dosing **Pre-Exposure Prophylaxis (PrEP):** * **Intramuscular (IM):** Two doses of 1 mL each, given IM on days 0 and 7. * **Intradermal (ID):** Two 0.1 mL doses each, given ID on days 0 and 7. (Note: ID administration is less common and may depend on local protocols and vaccine availability). **Post-Exposure Prophylaxis (PEP):** * **Unvaccinated Individuals:** Four doses of 1 mL each, given IM on days 0, 3, 7, and 14. A fifth dose on day 28 may be administered depending on the specific vaccine and local guidelines. * **Previously Vaccinated Individuals:** Two doses of 1 mL each, given IM on days 0 and 3. Immune globulin is not administered. * **PEP with Rabies Immune Globulin (RIG):** RIG should be administered along with the vaccine in unvaccinated individuals. Administer 20 IU/kg of RIG infiltrated around the wound(s) and any remaining infiltrated IM. Do not administer RIG in the same syringe as the vaccine. RIG is not recommended for previously vaccinated individuals. Dosing and specific schedules for PEP can vary based on the vaccine used and local public health recommendations. ## Pediatric Dosing **Pre-Exposure Prophylaxis (PrEP):** * **IM:** Same as adult: Two 1 mL doses IM on days 0 and 7. * **ID:** Same as adult: Two 0.1 mL doses ID on days 0 and 7. **Post-Exposure Prophylaxis (PEP):** * **Unvaccinated Individuals:** Four doses of 1 mL each, given IM on days 0, 3, 7, and 14. A fifth dose on day 28 may be administered depending on the specific vaccine and local guidelines. * **Previously Vaccinated Individuals:** Two doses of 1 mL each, given IM on days 0 and 3. * **PEP with Rabies Immune Globulin (RIG):** 20 IU/kg RIG infiltrated around the wound(s) and any remaining infiltrated IM on day 0. Do not administer RIG in the same syringe as the vaccine. ## Dose Adjustments No dose adjustments are typically required for renal or hepatic impairment. However, immunocompromised individuals may require different PEP regimens, often including specialist consultation. ## Contraindications * Severe allergic reaction (e.g., anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine. * Inactivated vaccines are generally safe in pregnancy, and PEP is indicated regardless of pregnancy status if exposure risk is present. ## Adverse Effects * **Common:** Local reactions at the injection site (pain, redness, swelling), headache, nausea, abdominal pain, muscle aches, dizziness, fatigue. * **Rare:** Neurologic events (e.g., Guillain-Barré syndrome) have been reported but are extremely rare and causality is often unclear. Anaphylaxis. ## Key Drug Interactions * **Immunosuppressive therapy:** May reduce the immune response to the vaccine. Consider increased doses or additional doses as per specialist advice. * **Corticosteroids:** Long-term or high-dose systemic corticosteroids may interfere with vaccine response. * **Antimalarials:** Chloroquine and hydroxychloroquine may reduce the antibody response to rabies vaccine when administered intradermally. IM administration is preferred if these agents are being used. ## Monitoring * **PrEP:** Antibody titers are generally not required but may be considered for individuals with ongoing high risk or compromised immune status. * **PEP:** Clinical signs and symptoms of rabies. Assessment of animal's health status where applicable according to public health guidelines. ## Clinical Pearls * Rabies vaccine is highly effective when administered correctly for both PrEP and PEP. * PEP should be initiated as soon as possible after exposure. * RIG is crucial for PEP in unvaccinated individuals to provide immediate passive immunity. * Even with PrEP, PEP (vaccine only, no RIG) is required after significant exposure. * Always confirm the specific vaccine product and follow current CDC or local public health recommendations for PEP protocols, especially regarding the number of doses and timing. *** *This information is intended for healthcare professionals. Always consult the official prescribing information and current guidelines for the most up-to-date and comprehensive details.*