Antirabies%2525252525252525252525252525252525252525252525252525252525252525252520vaccine

# Antirabies Vaccine ## Overview Rabies vaccines are inactivated virus vaccines used for post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). The goal is to prevent rabies infection by stimulating an immune response. ## Primary Indications * **Post-Exposure Prophylaxis (PEP):** Following potential exposure to rabies virus in humans and animals. * **Pre-Exposure Prophylaxis (PrEP):** For individuals at high risk of exposure to rabies virus. ## Adult Dosing **1. Pre-Exposure Prophylaxis (PrEP):** * **Intramuscular (IM):** Two 1-mL doses administered IM on days 0 and 7. **2. Post-Exposure Prophylaxis (PEP):** * **For unvaccinated individuals:** * Four 1-mL doses administered IM on days 0, 3, 7, and 14. * A fifth dose on day 28 may be administered depending on local guidelines and immune status. * **For previously vaccinated individuals (with documented primary vaccination series):** * Two 1-mL doses administered IM on days 0 and 3. * **For immunocompromised individuals (regardless of previous vaccination status):** * Four 1-mL doses administered IM on days 0, 3, 7, and 14, **PLUS** Rabies Immune Globulin (RIG) infiltrated around the wound(s) on day 0. * A fifth dose on day 28 may be administered depending on local guidelines and immune status. **Note:** The decision to administer PEP, the specific regimen, and the need for RIG are based on the type of exposure and the species of the animal involved. Consult CDC or local public health guidelines. ## Pediatric Dosing * Dosing is the same as for adults, based on weight. The volume of the dose (1 mL) is the same for all ages. * For PEP, Rabies Immune Globulin (RIG) should be infiltrated around the wound(s) for children as for adults. ## Dose Adjustments No specific dose adjustments are recommended for renal or hepatic impairment. ## Contraindications * Known severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or to any component of the vaccine. * Severe acute febrile illness (postponement of vaccination may be indicated). ## Adverse Effects * **Common:** Local reactions at the injection site (pain, redness, swelling, itching), mild systemic reactions (headache, dizziness, nausea, abdominal pain, muscle aches, joint pain, low-grade fever). * **Rare:** Severe allergic reactions (anaphylaxis), neurological events (neuropathy, myelitis) – causality not definitively established for modern vaccines. ## Key Drug Interactions * **Immunosuppressive therapies:** May reduce the immune response to rabies vaccine. Consider additional doses or serologic testing. * **Antimalarials (e.g., chloroquine, mefloquine):** May reduce the antibody response to rabies vaccine. If possible, administer rabies vaccine IM and avoid antimalarials for at least 4 weeks after completing the vaccination series. If antimalarials are necessary, administer rabies vaccine IM and consider serologic testing. ## Monitoring * **PEP:** Monitor for signs and symptoms of rabies infection. Assess the biting animal's health and vaccination status. * **PrEP:** Routine serologic monitoring is generally not recommended unless the individual is immunocompromised or at ongoing high risk. * **Adverse Events:** Monitor for local and systemic reactions. ## Clinical Pearls * Rabies vaccine is highly effective when administered correctly and promptly after exposure. * Rabies Immune Globulin (RIG) is crucial for PEP in unvaccinated individuals and should be infiltrated thoroughly around all wounds. If anatomical constraints prevent infiltration, administer the remaining volume IM at a site distant from vaccine administration. * The choice of vaccine (e.g., HDCV, PVRV) may influence specific scheduling, though the general principles of PEP and PrEP remain consistent. * Always consult the most current CDC guidelines for rabies prevention in the United States. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical judgment. Always verify current prescribing information and consult official guidelines before making any treatment decisions.