Mechanism of effect
Inactivated virus vaccine provides immunity to rabies by eliciting an active immune response
Pharmacokinetics
Onset (antibodies): 7-10 days
Duration (antibodies): >1 year
Peak Plasma Time (antibodies): 30-60 days
Dosage
-Rabies Preexposure Immunization
Primary
1 mL IM (deltoid region, in small children and infants anterolateral region of thigh) x3 doses
Administer on days 0, 7, and 21 or 28
Booster
1 mL IM (deltoid region) to maintain a serum titer >1:5 serum dilution by RFFIT
-Rabies Postexposure Immunization
Unimmunized individuals
1 mL IM x5 doses
Administer on days 0, 3, 7, 14, and 28 in conjunction with administration of human rabies immune globulin (HRIG) on day 0
HRIG: 20 IU/kg; if anatomically feasible, the full dose should be infiltrated around and into the wound(s), and any remaining volume should be administered IM at an anatomical site distant from vaccine administration
Previously immunized individuals
1 mL IM x2 doses on days 0 and 3
Drug contraindications
allergic reactionIn Preexposure prophylaxis:Known life-threatening hypersensitivity to vaccine, neomycin, or any component of a vaccine
Side effects
Diarrhea , Headache , nausea , abdominal pain , vomiting , Seizures , vertigo , Wheeziness , asthenia , neuropathy , edema , myalgia , Anaphylactic reaction , itchingInjection site reactions (eg, pain, erythema, swelling or itching) -Headache -Nausea -Abdominal pain -Muscle aches -Dizziness -Serum sickness -Lymphadenopathy-Anaphylactic reaction- dermatitis allergic- pruritus (itching)- edema-Paresthesia-neuropathy-convulsion- encephalitis-Guillain-Barré-like syndrome-Vomiting- diarrhea-Arthralgia-Asthenia- malaise- fever and-chills (shivering), injection site hematoma-Wheezing- dyspnea
Interactions
Alefacept , Oxaliplatin , Everolimus , Ifosfamide , Budesonide , Procarbazine , Tacrolimus , Rilonacept , Temsirolimus , Siponimod , ozanimod , secukinumab , Basiliximab , Anakinra , Ibrutinib , Ocrelizumab , Muromonab-CD3 , Ustekinumab , Prednisolone , Chloroquine , Golimumab , Mechlorethamine , Tocilizumab , Canakinumab , Hydrocortisone , mercaptopurine , prednisone , cortisone , Adalimumab , Certolizumab , Lomustine , Mycophenolate mofetil , Methotrexate , Methylprednisolone , Melphalan , Hydroxychloroquine , Deflazacort , Rituximab , Sirolimus , Cyclosporine , Fludrocortisone , Glatiramer acetateAlerts
- You should not receive a booster vaccine if you had a life threatening allergic reaction after the first shot.
-Serum sickness type reactions reported in persons receiving booster doses for preexposure prophylaxis; characterized by onset ~2-21 days post-booster, presents with a generalized urticaria, and may also include arthralgia, arthritis, angioedema, nausea, vomiting, fever, and malaise
-Rare cases of neurologic illness resembling Guillain-Barré-like syndrome have occurred
-Product contains albumin; remote risk for transmission of viral diseases and variant Creutzfeldt-Jakob disease (vCJD)
-Immunosuppressive illnesses can interfere with vaccine efficacy
- Corticosteroids or other immunosuppressive can interfere with the development of active immunity and predispose the patient to developing rabies
Points of recommendation
- When dose must be administered to person with history of hypersensitivity, antihistamines may be given; have epinephrine (1:1000) and other appropriate agents readily available to counteract anaphylactic reactions while carefully monitoring after immunization
- Do not administer immunosuppressive agents during postexposure therapy, unless essential for the treatment of other conditions
-When rabies postexposure prophylaxis is administered to persons receiving steroids or other immunosuppressive therapy, test for rabies antibody to ensure that an adequate response has developed
- Before receiving this vaccine, tell the doctor if you have:
- a weak immune system (caused by disease or by using certain medicine);
- any type of infection or severe illness;
- an allergy to chicken or beef proteins; or
- a history of allergic reaction to gelatin, amphotericin B, or neomycin.
Pregnancy level
Preexposure
- Animal reproduction studies have not been conducted
- It is also not known whether rabies vaccine can cause fetal harm when administered to pregnant women or can affect reproductive capacity
- Administer to pregnant women only if potential benefits outweigh potential risks
- If there is substantial risk of exposure to rabies, preexposure prophylaxis may also be indicated during pregnancy
Postexposure
- Because of the potential consequences of inadequately treated rabies exposure and limited data that indicate that fetal abnormalities have not been associated with rabies vaccination, pregnancy is not considered a contraindication to postexposure prophylaxis
Breast feeding warning
Unknown if excreted in human milk; exercise caution
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