Rabies vaccine

Indications

Prevention of rabies after category II and III exposures.

Composition, forms, route of administration

• Inactivated virus vaccine prepared from cell cultures (CCEEV), in embryonated egg or purified cells such as chick embryo-cells, Vero-cells, or human diploid-cells.
• Powder for injection in monodose vial, to be dissolved with the entire vial of the diluent, 0.5 ml or 1 ml depending on the manufacturer.
• IM route: do not administer into the gluteal muscle. Child under 2 years: inject into the anterolateral part of the thigh. Child 2 years and over and adult: inject into the deltoid muscle.
• ID route: child and adult, inject into the deltoid muscle, the anterolateral part of the thigh, or the suprascapular region.
• Child and adult: one IM dose equals 0.5 or 1 ml depending on the vaccine used; one ID dose equals 0.1 ml regardless of vaccine used.

Dose and vaccination schedule

The simplest vaccination schedules endorsed by the WHO are the following.

Vaccination schedules may vary from country to country. The schedule depends on the patient's vaccination status at the moment of exposure and the route of administration used. Follow manufacturer's instructions.

The first dose should be administered as soon as possible after exposure, even if the patient seeks care long after exposure. The patient must receive all recommended doses.

If a vaccine dose is delayed or the route of administration is changed, continue according to the chosen route and do not recommence the schedule.

Contra-indications, adverse effects, precautions

• Do not administer corticoids concomitantly because vaccine efficacy is diminished.
• May cause benign local reactions at the injection site such as pain and induration, fever, malaise, headache, fatigue, gastrointestinal disturbances, and rarely anaphylactic reaction.
• Ensure that the vaccine does not enter a blood vessel. Aspirate prior to injection to confirm that the needle is not in a vein.
• Intradermal vaccination: incorrect ID technique results in treatment failure. If correct technique cannot be assured, use IM route.
• If administered simultaneously with rabies immunoglobulin and other vaccines, use different syringes and injection sites.
• Pregnancy and breast-feeding: no contra-indication.
• Rabies vaccine is also used for pre-exposure vaccination in persons at high risk of infection.
• Avoid the use of vaccines prepared from animal nerve tissue because they are less immunogenic and more likely to cause severe adverse effects.