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# Antirabies vaccine
## Overview
Rabies vaccine is 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, and laboratory workers, or individuals traveling to or residing in areas with a high prevalence of rabies.
* **PEP:** For individuals who have been bitten or scratched by an animal suspected of having rabies, or who have had mucous membrane or parenteral contact with saliva or neural tissue from such an animal.
## Adult Dosing
### Pre-Exposure Prophylaxis (PrEP)
* **Intramuscular (IM):** 1 mL administered on days 0, 7, and 21 or 28.
* **Intradermal (ID):** 0.1 mL (0.2 mL total) administered on days 0, 7, and 21 or 28. *Note: ID administration is generally reserved for situations where IM administration is not feasible or cost is a major concern, and requires careful technique and adequate training.*
### Post-Exposure Prophylaxis (PEP) - Unvaccinated Individuals
* **IM:** 1 mL administered on days 0, 3, 7, 14, and 28.
* **ID:** 0.1 mL (0.2 mL total) administered on days 0, 3, 7, and 28. *Note: ID administration for PEP requires careful technique.*
### Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Individuals
* **IM:** 1 mL administered on days 0 and 3.
* **ID:** 0.1 mL (0.2 mL total) administered on day 0.
## Pediatric Dosing
Pediatric dosing is weight-based or by age, but the volume of vaccine administered is the same as for adults (1 mL IM or 0.1 mL ID).
### Pre-Exposure Prophylaxis (PrEP)
* **IM:** 1 mL administered on days 0, 7, and 21 or 28.
* **ID:** 0.1 mL (0.2 mL total) administered on days 0, 7, and 21 or 28.
### Post-Exposure Prophylaxis (PEP) - Unvaccinated Children
* **IM:** 1 mL administered on days 0, 3, 7, 14, and 28.
* **ID:** 0.1 mL (0.2 mL total) administered on days 0, 3, 7, and 28.
### Post-Exposure Prophylaxis (PEP) - Previously Vaccinated Children
* **IM:** 1 mL administered on days 0 and 3.
* **ID:** 0.1 mL (0.2 mL total) administered on day 0.
## 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 to any component of the vaccine (e.g., neomycin, streptomycin, polymyxin B).
## 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 include anaphylaxis.
## Key Drug Interactions
* **Immunosuppressive agents:** May reduce the immune response to rabies vaccine.
## Monitoring
* Monitor for signs and symptoms of allergic reactions following vaccination.
* For PEP, clinical assessment of the exposure incident and the biting animal is critical to guide rabies vaccination decisions.
## Clinical Pearls
* Rabies vaccine should be administered to appropriate muscle (e.g., deltoid) for IM injections.
* ID administration requires specific technique and may lead to local reactions including persistent itching or a palpable nodule at the injection site.
* PEP is recommended for any direct contact with a potentially rabid animal, even if the animal appears healthy. The decision to administer PEP should be made in consultation with public health authorities.
* Rabies immune globulin (RIG) should be administered with the first dose of PEP vaccine to unvaccinated individuals.
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**Disclaimer:** This information is intended for clinical decision support and does not replace comprehensive prescribing information or clinical judgment. Always consult the most current product information and local protocols before prescribing.
