Rabies vaccine is used to prevent rabies infection and for the management of individuals after suspected exposure to the rabies virus. Rabies vaccine is used for preventive immunization against rabies and for the treatment of individuals after suspected exposure to the virus.

Pre-exposure Immunization:

• Individuals in occupations with frequent exposure risk
• Veterinary surgeons (including students in veterinary colleges)
• Technical staff working with veterinary professionals
• Laboratory personnel handling materials potentially contaminated with rabies virus
• Workers in slaughterhouses and knacker yards
• Taxidermists
• Gamekeepers, forestry workers, and naturalists in endemic areas
• Infants and children at increased risk of rabies exposure

Post-exposure Immunization:

• Management of individuals bitten by animals confirmed or suspected to have rabies
• Management of individuals exposed through contact with potentially rabid animals

Rabies vaccine for human use is a freeze-dried preparation of inactivated rabies virus produced in Vero cells. After reconstitution, it becomes a clear, colorless sterile solution intended for intramuscular administration.

To reconstitute the vaccine, transfer the full content of the supplied diluent into the vial containing the freeze-dried preparation. Do not shake. After reconstitution, the solution should be clear, colorless, and homogeneous, free from particles. The vaccine must be used immediately after reconstitution and any unused portion should be discarded.

Method of administration for intramuscular use: 1 ml dose of rabies vaccine should be administered intramuscularly in the deltoid muscle in adults and in the anterolateral thigh muscle in children under 1 year of age. It should not be injected into the gluteal region. Do not inject intravenously.

Pre-exposure immunization

• 1 ml for children and adults.
• Primary vaccination: Three doses administered intramuscularly on days 0, 7, and 28 (or day 21). A booster dose should be given after one year.
• Booster: Every 5 years or when there is a high risk of exposure.

Post-exposure immunization

• Local wound treatment: Immediate washing and flushing of the wound with soap, water, and disinfectant is essential. Do not bandage or suture the wound.
• Vaccination of non-immunized subjects.

Intramuscular schedules:

Standard regimen (1-1-1-1-1):

• Day 0: 1 ml
• Day 3: 1 ml
• Day 7: 1 ml
• Day 14: 1 ml
• Day 28: 1 ml

Abbreviated regimen (2-1-1):

• Day 0: 2 injections of 1 ml at separate sites
• Day 7: 1 ml
• Day 21: 1 ml

In cases of severe exposure (WHO Category III), rabies immunoglobulin should be administered as soon as possible along with the first dose of rabies vaccine. The immunoglobulin should be infiltrated locally into and around the wound(s) as much as feasible, with any remaining portion given by intramuscular injection. The rabies vaccine must be administered at a different injection site.

Vaccination in previously immunized individuals: If a patient has completed a full post-exposure vaccination schedule within the past 1 year and is bitten by a suspected rabid animal, only two booster doses are required on Day 0 and Day 3. If the patient completed the post-exposure vaccination more than 1 year ago, a full post-exposure vaccination schedule should be given. If a patient has completed a full vaccination schedule along with a booster within the last 3 years, only two doses (Day 0 and Day 3) are required after exposure. If more than 3 years have passed since completion of vaccination and booster, a complete post-exposure vaccination schedule is required. Post-exposure vaccination should always be determined based on the severity of exposure and administered under proper medical supervision.

Co-administration: The use of corticosteroids or immunosuppressive therapy may reduce antibody production and potentially lead to vaccine failure. In such cases, monitoring of neutralizing antibody levels is recommended.

Concurrent use with immunosuppressive drugs may reduce the effectiveness of the vaccine.

Rabies vaccine is contraindicated in the following cases:

Pre-exposure:
Severe fever, acute febrile illness, acute diseases, progressive chronic diseases, or known hypersensitivity to the rabies vaccine or any of its components.

Post-exposure:
There are no absolute contraindications, as rabies is a fatal disease. Treatment should not be withheld after exposure; any decision to delay should be carefully considered.

Common local reactions include pain, redness, swelling, itching, and induration at the injection site, usually lasting 24–48 hours. Other reactions may include moderate fever, chills, fainting, weakness, dizziness, respiratory symptoms (such as dyspnea or wheezing), abdominal pain, vomiting, and allergic skin reactions (urticaria, rash, itching).

Pregnancy: The potential risk of rabies vaccine during pregnancy is unknown. However, due to the severity of rabies, pregnancy is not considered a contraindication for post-exposure prophylaxis.

Lactation: It is not known whether the vaccine is excreted in breast milk. Considering the severity of rabies, breastfeeding is not considered a contraindication.

• Intravenous administration is strictly prohibited.
• Rabies vaccine and rabies immunoglobulin should not be administered using the same syringe or at the same injection site.
• Before use, check the packaging, label, appearance, and expiry date carefully.
• After reconstitution, the vaccine should be administered as soon as possible.
• Reconstituted vaccine should be stored at 2°C to 8°C and used within 8 hours or discarded.

Vaccines, Anti-sera & Immunoglobulin

Keep out of the reach and sight of children. Store and transport at 2°C to 8°C. Protect from light. Do not freeze.