Rabies Vaccine

Pronunciation: RAY-beez
Class: Vaccine, viral

Trade Names

Imovax (Human Diploid Cell)
- Powder for injection, freeze-dried suspension of rabies virus strain PM-1503-3M grown in human diploid cell cultures (inactivated whole virus). Contains at least 2.5 international units rabies antigen/mL.

RabAvert
- Powder for injection, freeze-dried fixed-virus strain Flury LEP grown in cultures of chicken fibroblasts. Contains at least 2.5 international units rabies antigen/mL.

Pharmacology

Induces neutralizing antibodies and cellular immunity.

Indications and Usage

Induction of active immunity against rabies virus either before or after viral exposure.

Contraindications

Postexposure

No known contraindications.

Preexposure

Developing febrile illness ( Imovax ); history of anaphylaxis to any component of the product ( RabAvert ).

Dosage and Administration

Preexposure Prophylaxis
Adults and Children

IM 1 mL on days 0, 7, and 21 or 28. A booster dose may be given as needed to maintain an adequate titer in persons working with live rabies virus in research laboratories and in vaccine production facilities. Rabies antibody titers should be checked every 6 mo. Laboratory workers, such as those doing rabies diagnostic tests, spelunkers, veterinarians, and animal control and wildlife officers in areas where rabies is epizootic should have boosters every 2 yr or have their serum tested for rabies antibody every 2 yr.

Postexposure Prophylaxis
Adults and Children

IM Following administration of rabies immune globulin (RIG) on day 0, give 1 mL of rabies vaccine on days 0, 3, 7, 14, and 28. If a previously immunized person vaccinated with a cell culture vaccine or who previously demonstrated rabies antibody is exposed to rabies, that person should receive 2 IM doses of 1 mL each, one immediately and one 3 days later. RIG should not be given.

General Advice

  • Reconstitute vaccine with 1 mL of diluent. Gently stir contents until dissolved and withdraw entire contents of the vial. Use reconstituted vaccine immediately.
  • For postexposure vaccination, administer IM in deltoid area in older children and adults and in mid-lateral aspect of thigh in young children. Never administer rabies vaccine in gluteal area; this may result in inadequate immune response. Administer postexposure prophylaxis dose as soon as possible.

Storage/Stability

Imovax

Store at 35° to 46°F. Do not freeze.

RabAvert

Store at 36° to 46°F. Protect from light.

Drug Interactions

Antimalarials; immunosuppressant drugs (including high-dose corticosteroids)

May result in insufficient response to immunization. If possible, do not give immunosuppressive agents during postexposure therapy.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hot flashes, palpitations (postmarketing).

CNS

Headache (52%); dizziness, malaise (20%); encephalitis, Guillain-Barré syndrome, meningitis, multiple sclerosis, neuroparalysis, neuroparalytic reactions, retrobulbar neuritis, transient paralysis, vertigo, visual disturbance (postmarketing).

Dermatologic

Rash; pruritus, urticaria (postmarketing).

GI

Abdominal pain, nausea (20%).

Hematologic-Lymphatic

Lymphadenopathy (15%).

Local

Pain (84%); erythema and itching or swelling at injection site (25%); extensive limb swelling, induration (postmarketing).

Musculoskeletal

Myalgia (53%); muscle aches (20%); arthralgia; myelitis (postmarketing).

Respiratory

Bronchospasm (postmarketing).

Miscellaneous

Anaphylactic reactions; flu-like symptoms, including asthenia, fatigue, and fever; anaphylaxis, edema, type III hypersensitivity-like reactions (postmarketing).

Precautions

Monitor

Perform serologic testing in immunocompromised patients.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established ( Imovax ).

Hypersensitivity

In persons who experience immune complex–like (or serum sickness–like) hypersensitivity reactions during preexposure prophylaxis, do not give further doses of rabies vaccine unless they are exposed to rabies or they are likely to be unapparently or unavoidably exposed to rabies virus and have unsatisfactory antibody titers.

CNS disorder

Guillain-Barré syndrome has been rarely associated with Imovax administration.

Immunosuppressive illness

Can interfere with the development of active immunity and predispose the patient to developing rabies.

Infections

Because RabAvert contains albumin, a derivative of human blood, there is a risk of transmitting infectious agents (eg, viruses), including Creutzfeldt-Jakob disease.

Patient Information

  • Advise patient at risk for ongoing rabies exposure to receive rabies booster every 2 yr or more often (per serology every 6 mo) if very high risk (eg, veterinarians).
  • Advise patient to seek immediate medical attention should future rabies exposure occur. Emphasize danger of wound infection and need to evaluate rabies antibody response.
  • Teach patient/family wound care and signs of infection (eg, fever, increased pain at wound, wound drainage) prior to discharge.
  • Advise patient that aspirin/antihistamines can be taken to treat mild local or systemic reactions.
  • Encourage medical follow-up within 7 to 10 days after discharge for wound evaluation.

Copyright © 2009 Wolters Kluwer Health.

Hide
(web1)