Rabies virus (inactivated, strain flury lep): clinical use

Prescribing considerations

• Base post-exposure management on prompt formal assessment of exposure risk, previous vaccination and immune status.
• Vaccination complements rather than replaces immediate wound cleansing; rabies immunoglobulin may also be indicated.
• Immunocompromised people require specialist consideration because their immune response may be inadequate.
• Ensure facilities and trained personnel are available to manage anaphylaxis.

Contraindications and cautions

• For pre-exposure use, severe hypersensitivity to the active substance, excipients or manufacturing residues is a contraindication.
• Postpone pre-exposure vaccination during severe febrile illness; a minor infection alone need not delay it.
• There is no contraindication to post-exposure prophylaxis because untreated rabies is almost invariably fatal. Previous severe allergy requires administration where anaphylaxis can be managed.

Monitoring

• Observe for immediate allergic or fainting-related reactions after injection.
• Consider rabies-virus-neutralising antibody testing in immunocompromised people and others for whom official recommendations require confirmation of response.
• Review ongoing occupational risk and the need for antibody surveillance or further vaccination under official guidance.

Clinical pharmacology

Purified chick-embryo-cell-derived, inactivated Flury LEP rabies virus stimulates lymphocytes and antibody-secreting plasma cells to produce rabies-virus-neutralising antibodies. Conventional pharmacokinetic assessment is not applicable.

Formulation and product differences

• Rabipur is supplied as freeze-dried powder with solvent in a pre-filled syringe and must be reconstituted immediately before intramuscular administration.
• It contains polygeline and may contain residues of chicken proteins, human serum albumin, neomycin, chlortetracycline and amphotericin B.