Rabies Vaccine

1. See Also
   1. Rabies
   2. Dog Bite
2. Indications
   1. Post-Exposure Prophylaxis
   2. Pre-Exposure Prophylaxis
      1. Veterinarians
      2. Animal control and wildlife professionals
      3. Lab workers
      4. Adventure travelers to Rabies endemic areas
      5. Archaeology work
3. Preparations
   1. General
      1. All preparations in U.S. produced in cell culture
      2. Safer than infected animal brain preparations
   2. HDCV (Imovax)
      1. Human Diploid Cells
      2. Risk of Serum Sickness risk on booster doses: 6%
   3. RVA (Rabies Vaccine Absorbed)
      1. Fetal rhesus diploid lung cells
   4. PCEC (RabAvert)
      1. Developed in chick Embryo
      2. New preparation with fewer side effects
      3. Contraindicated in severe egg allergy
4. Adverse Effects
   1. Mild erythema, swelling, and local pain
   2. Serum Sickness (Type III) Hypersensitivity Reaction
      1. Seen with HDCV on booster dose
5. Protocol: Post-Exposure Prophylaxis
   1. Wash wound with soap and water
   2. Human Rabies immune globulin 20 IU/kg
      1. Inject into and around all wound sites
      2. Neutralize Rabies virus before it enters nerve
   3. Rabies Vaccine (HDCV, RVA, PCEC)
      1. Administer 1 ml Vaccine IM in Deltoid
      2. Days 0, 3, 7, 14, 28
      3. Five Dose course costs $700 - $800
   4. Prior cell-culture vaccine OR Antibody response
      1. No immune globulin needed
      2. Rabies Vaccine on Days 0, 3
6. Protocol: Pre-Exposure Prophylaxis
   1. Rabies Vaccine 1 ml IM deltoid days 0, 7, and 21-28
7. Precautions
   1. Safe in HIV and Pregnancy
8. References
   1. Wilde (2003) Clin Infect Dis 37:96-100