No

Vaccine

Pre-exposure immunization: Vaccinate persons with greater than usual risk due to occupation or avocation including veterinarians, rangers, animal handlers, certain laboratory workers, and persons living in or visiting countries for longer than 1 month where rabies is a constant threat.

The Food and Drug Administration has not approved the I.D. use of rabies vaccine for postexposure prophylaxis (only I.M.). The type of and schedule for postexposure prophylaxis depends upon the previous rabies vaccination status or the result of a previous or current serologic test for rabies antibody.

C

Developing febrile illness (during pre-exposure therapy only); allergy to neomycin, gentamicin, or amphotericin B; life-threatening allergic reactions to rabies vaccine or its components (however, carefully consider a patient's risk of rabies before continuing therapy)

Report serious reactions to the State Health Department or the manufacturer/distributor, an immune complex reaction is possible 2-21 days following booster doses of HDCV; hypersensitivity reactions may be treated with antihistamines or epinephrine, if severe.

Mild systemic reactions occur at an incidence of ~8% to 10% with RVA and 20% with HDCV. All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DHHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967.

Central nervous system: Dizziness, malaise, encephalomyelitis, transverse myelitis, fever, pain, headache, neuroparalytic reactions

Dermatologic: Itching, erythema

Gastrointestinal: Nausea, abdominal pain

Local: Local discomfort, pain at injection site

Neuromuscular & skeletal: Myalgia

Note: Serum sickness reaction is much less frequent with RVA (<1%) vs the HDCV (6%)

Decreased effect with immunosuppressive agents, corticosteroids, antimalarial drugs (ie, chloroquine); persons on these drugs should receive RIG (3 doses/1 mL each) by the I.M. route

Refrigerate dried vaccine; HDCV can presumably tolerate 30 days at room temperature; reconstituted vaccine should be used immediately

Rabies vaccine is an inactivated virus vaccine which promotes immunity by inducing an active immune response. The production of specific antibodies requires about 7-10 days to develop. Rabies immune globulin or antirabies serum, equine (ARS), is given in conjunction with rabies vaccine to provide immune protection until an antibody response can occur.

Onset of effect: I.M.: Rabies antibody appears in the serum within 7-10 days

Peak effect: Within 30-60 days and persists for at least 1 year

Pre-exposure prophylaxis: 1 mL I.M. or 0.1 mL I.D. on days 0, 7, and 21 to 28. Note: Prolonging the interval between doses does not interfere with immunity achieved after the concluding dose of the basic series.

Postexposure prophylaxis: All postexposure treatment should begin with immediate cleansing of the wound with soap and water

Persons not previously immunized as above: Rabies immune globulin 20 units/kg body weight, half infiltrated at bite site if possible, remainder I.M.; and 5 doses of rabies vaccine, 1 mL I.M., one each on days 0, 3, 7, 14, 28

Persons who have previously received postexposure prophylaxis with rabies vaccine, received a recommended I.M. pre-exposure series of rabies vaccine, or have a previously documented rabies antibody titer considered adequate: 1 mL of either vaccine I.M. only on days 0 and 3; do not administer RIG

Booster (for occupational or other continuing risk): 1 mL I.M. or 0.1 mL I.D. every 2-5 years or based on antibody titers

Antibody titers greater than or equal to 115 as determined by rapid fluorescent-focus inhibition test are indicative of adequate response; collect titers on day 28 postexposure

No information available to require special precautions

No effects or complications reported

Refrigerate

For intramuscular injection only; this rabies vaccine product must not be administered intradermally; in older children and adults it should be given in deltoid area for best response

Injection:

Imovax® rabies I.D. vaccine: Rabies antigen 0.25 units/0.1 mL (1 mL)

Rabies vaccine (adsorbed): 1 mL

"A New Rabies Vaccine," Med Lett Drugs Ther, 1998, 40(1029):64-5.

Dreesen DW and Hanlon CA, "Current Recommendations for the Prophylaxis and Treatment of Rabies," Drugs, 1998, 56(5):801-9.

Lang J and Plotkin SA, "Rabies Risk and Immunoprophylaxis in Children," Adv Pediatr Infect Dis, 1997, 13:219-55.

Strady A, Lang J, Lienard M, et al, "Antibody Persistence Following Pre-exposure Regimens of Cell-Culture Rabies Vaccines: 10-Year Follow-up and Proposal for a New Booster Policy," J Infect Dis, 1998, 177(5):1290-5.