Rabies Vaccine – 6 Important Facts

Rabies Vaccine: What You Need To Know

1. What is rabies?

Rabies is a serious disease. It is caused by a virus.

Rabies is mainly a disease of animals. Humans get rabies when they are bitten by infected animals.

At first there might not be any symptoms. But weeks, or even months after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis. Human rabies is almost always fatal.

Wild animals—especially bats—are the most common source of human rabies infection in the United States.

Skunks, raccoons, dogs, cats, coyotes, foxes and other mammals can also transmit the disease.

Human rabies is rare in the United States. There have been only 55 cases diagnosed since 1990.

However, between 16,000 and 39,000 people are vaccinated each year as a precaution after animal bites. Also, rabies is far more common in other parts of the world, with about 40,000–70,000 rabies-related deaths worldwide each year. Bites from unvaccinated dogs cause most of these cases.

Rabies vaccine can prevent rabies.

2. Rabies vaccine

Brand Names

  • Imovax
  • RabAvert

Rabies vaccine is given to people at high risk of rabies to protect them if they are exposed. It can also prevent the disease if it is given to a person after they have been exposed.

Rabies vaccine is made from killed rabies virus. It cannot cause rabies.

Rabies vaccine is a parenteral preparation of inactivated rabies virus used to promote active immunity to rabies in individuals exposed to the disease or virus.

Prophylactic doses of rabies vaccine are administered to certain groups of people.

Advantages of providing preexposure vaccination include reduced number of doses of the vaccine after a rabies exposure, elimination of need for human rabies immune globulin (RIG) postexposure, possible protection in persons whose postexposure therapy is delayed, and possible protection for persons at risk for inapparent exposures to rabies.

Preexposure vaccine is recommended for individuals who are at high risk of exposure to the rabies virus (e.g., physicians, veterinarians, laboratory workers, animal handlers).

Preexposure vaccination should also be considered for other persons whose activities involve frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other species at risk for having rabies.

Additionally, preexposure vaccination should be evaluated for international travelers who are likely to come in contact with animals in areas where dog rabies is enzootic and immediate access to appropriate medical care, including biologics, might be limited.

Postexposure vaccine should be accompanied with human rabies immune globulin (RIG) in all non-immunized individuals following exposure to a rabid animal.

Prompt wound care and the administration of RIG plus the rabies vaccine are highly effective in preventing human rabies following exposure, when the recommended treatment protocol is maintained.

However, rabies has occasionally developed among humans when key elements of the rabies postexposure prophylaxis regimens were omitted or incorrectly administered.

The available vaccine products differ only in the cell culture used to develop the vaccine. Imovax uses human diploid cell (HDC) culture, and RabAvert uses purified chick embryo cell culture.

Imovax was approved for use in the US in June 1980; RabAvert was approved for use in October 1997.

3. Who should get rabies vaccine and when?

Preventive vaccination (no exposure)

  • People at high risk of exposure to rabies, such as veterinarians, animal handlers, rabies laboratory workers, spelunkers, and rabies biologics production workers should be offered rabies vaccine.
  • The vaccine should also be considered for:
    • People whose activities bring them into frequent contact with rabies virus or with possibly rabid animals.
    • International travelers who are likely to come in contact with animals in parts of the world where rabies is common.

The pre-exposure schedule for rabies vaccination is 3 doses, given at the following times:

  • Dose 1: As appropriate
  • Dose 2: 7 days after Dose 1
  • Dose 3: 21 days or 28 days after Dose 1

For laboratory workers and others who may be repeatedly exposed to rabies virus, periodic testing for immunity is recommended, and booster doses should be given as needed. (Testing or booster doses are not recommended for travelers.) Ask your doctor for details.

Vaccination after an exposure

Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should clean the wound and see a doctor immediately. The doctor will determine if they need to be vaccinated.

A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine—one dose right away and additional doses on the 3rd, 7th, and 14th days. They should also get another shot called Rabies Immune Globulin at the same time as the first dose.

A person who has been previously vaccinated should get 2 doses of rabies vaccine—one right away and another on the 3rd day. Rabies Immune Globulin is not needed.

4. Tell your doctor if…

Talk with a doctor before getting rabies vaccine if you:

  1. ever had a serious (life-threatening) allergic reaction to a previous dose of rabies vaccine or to any component of the vaccine; tell your doctor if you have any severe allergies,
  2. have a weakened immune system because of:
    1. HIV/AIDS, or another disease that affects the immune system,
    1. treatment with drugs that affect the immune system, such as steroids,
    1. cancer, or cancer treatment with radiation or drugs.

If you have a minor illness, such as a cold, you can be vaccinated. If you are moderately or severely ill, you should probably wait until you recover before getting a routine (non-exposure) dose of rabies vaccine.

If you have been exposed to rabies virus, you should get the vaccine regardless of any other illnesses you may have.

5. What are the side effects of rabies vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from rabies vaccine are very rare.

Mild side effects

  • soreness, redness, swelling, or itching where the shot was given (30%–74%)
  • headache, nausea, abdominal pain, muscle aches, dizziness (5%–40%)
  • abdominal pain
  • anaphylactoid reactions
  • angioedema
  • arthralgia
  • asthenia
  • bronchospasm
  • chills
  • dizziness
  • edema
  • erythema
  • fatigue
  • fever
  • Guillain-Barre syndrome
  • headache
  • hot flashes
  • injection site reaction
  • lymphadenopathy
  • malaise
  • meningitis
  • muscle paralysis
  • myalgia
  • myelitis
  • nausea
  • neuritis
  • palpitations
  • paresthesias
  • pruritus
  • rash
  • syncope
  • urticaria
  • vertigo
  • visual impairment

Moderate side effects

  • hives, pain in the joints, fever (about 6% of booster doses)

Other nervous system disorders, such as Guillain-Barré syndrome (GBS), have been reported after rabies vaccine, but this happens so rarely that it is not known whether they are related to the vaccine.

NOTE: Several brands of rabies vaccine are available in the United States, and reactions may vary between brands. Your provider can give you more information about a particular brand.

6. What if there are serious side effects or reactions?

What should I look for?

  • Look for anything that concerns you, such as signs of a severe allergic reaction, very high fever, or behavior changes.

Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.

What should I do?

  • If you think it is a severe allergic reaction or other emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
  • Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS web site at www.vaers.hhs.gov  or by calling 1-800-822-7967.

VAERS is only for reporting reactions. They do not give medical advice.

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • acquired immunodeficiency syndrome (AIDS)
  • agammaglobulinemia
  • albumin hypersensitivity
  • anticoagulant therapy
  • bovine protein hypersensitivity
  • breast-feeding
  • coagulopathy
  • corticosteroid therapy
  • egg hypersensitivity
  • Guillain-Barre syndrome
  • hemophilia
  • human immunodeficiency virus (HIV) infection
  • hypogammaglobulinemia
  • immunosuppression
  • infants
  • intraarterial administration
  • intravenous administration
  • neomycin hypersensitivity
  • neonates
  • neoplastic disease
  • pregnancy
  • radiation therapy
  • severe combined immunodeficiency (SCID)
  • subcutaneous administration
  • syncope
  • thrombocytopenia
  • viral infection
  • vitamin K deficiency

Interactions

  • Adalimumab
  • Antimalarials
  • Artemether; Lumefantrine
  • Atovaquone
  • Atovaquone; Proguanil
  • Chloroquine
  • Etanercept
  • Hydroxychloroquine
  • Mefloquine
  • Ocrelizumab
  • Primaquine
  • Pyrimethamine
  • Pyrimethamine; Sulfadoxine
  • Quinine
  • Rabies Immune Globulin, human RIG
  • Siponimod
  • Sulfadiazine
  • Tafenoquine

Seek Additional Information

  • Ask your doctor.
  • Call your local or state health department.
  • Contact the Centers for Disease Control and Prevention (CDC):

CDC Vaccine Information Statement Rabies Vaccine 10/6/09

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