rabies vaccine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
rabies vaccine: clinical details
Prescribing considerations
- Undertake a prompt exposure risk assessment; previous vaccination does not remove the need for assessment.
- Record the product name and batch number.
- Immunodeficiency or immunosuppressive treatment may reduce response and requires specialist management and serological confirmation.
- Use caution with thrombocytopenia or coagulation disorders because intramuscular injection may cause bleeding.
- Ensure treatment and supervision for anaphylaxis are immediately available.
- Consider respiratory monitoring in very premature infants, particularly those with respiratory immaturity.
Contraindications and cautions
- For pre-exposure use: hypersensitivity to the active substance, excipients, relevant trace antibiotics, a previous administration or a vaccine containing the same components.
- Postpone pre-exposure vaccination during an acute febrile illness.
- There are no product contraindications to indicated post-exposure vaccination because of the severity of rabies; previous hypersensitivity requires specialist supervision.
Monitoring
- Observe for immediate hypersensitivity and protect against injury from vasovagal syncope.
- Confirm antibody response when immune function may be impaired.
- Assess urgently for reported severe allergic, auditory or neurological symptoms.
Clinical pharmacology
An inactivated rabies vaccine produced in Vero cells from the Wistar Rabies PM/WI38 strain. Protection is mediated by induction of rabies-virus-neutralising antibodies.
Formulation and product differences
- Supplied as a powder with solvent for reconstitution before injection.
- May contain traces of polymyxin B, streptomycin and neomycin.
- Contains phenylalanine; this is relevant to people with phenylketonuria.
- Tip caps on prefilled syringes without an attached needle contain a natural-rubber latex derivative.
rabies vaccine interactions
Important practical interactions include:
Immunosuppressants, including long-term systemic corticosteroids
They may weaken antibody production and cause vaccine failure, so specialist management and antibody testing may be required.
Chloroquine
It may suppress the response to intradermal pre-exposure vaccination, so that route should be avoided in people taking it.
Human rabies immunoglobulin
When indicated, it must be administered according to specialist guidance and must not be mixed with the vaccine or injected at the same site.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.