Rabies vaccination

• currently two rabies vaccines licensed for intramuscular use in the UK:
  
  
  • human diploid cell vaccine (HDCV, 2.5 IU/ml) (Rabies Vaccine BP)
  • purified chick embryo cell rabies vaccine (PCEC, 2.5 IU/ml) (Rabipur R)
    
    
• vaccines are inactivated, do not contain live organisms and cannot cause the disease against which they protect
• HDCV and PCEC may be used inter-changeably to provide protection pre- or post-exposure (1)

Other WHO approved cell culture-derived vaccines are available in other countries and may contain different concentrations of rabies antigen. The UK licensed products contain 2.5IU rabies antigen in a 1ml dose; other products should be used as recommended by the manufacturer

Post-exposure prophylaxis

Seek Expert Advice

• schedule depends on assessment of risk and immunisation status of individual (consult Green Book for details)
• for example if
  • if bite for area where rabies risk is low risk
    • if unimmunised/incompletely immunised individual
      • five doses (each 1.0 ml) on days 0 3, 7, 14 and 30
    • if fully immunised individual
      • two doses (each 1.0ml) on days 0 and 3

Reactions to these vaccines are not common.

Pre-exposure prophylaxis

• for primary pre-exposure immunisation, three doses of 1.0ml of rabies vaccine should be given on days 0, 7 and 28. The third dose can be given from day 21 if there is insufficient time before travel.

The Joint Committee on Vaccination and Immunisation recommends the intramuscular rather than the intradermal route for pre-exposure prophylaxis use of rabies vaccine. The committee also recommends that only the intramuscular route (or deep subcutaneous route for those with bleeding disorders) is used for post-exposure treatment (1).

Human rabies immunoglobulin (HRIG)

• obtained from the plasma of immunised and screened human donors. Because of a theoretical risk of transmission of vCJD from plasma products, HRIG used in the UK is prepared from plasma sourced from outside the UK. All donors are screened for HIV and hepatitis B and C

Check uptodate details in the The Green Book before prescribing/administering a rabies vaccination.

Check the Summary of Product Characteristics (SPC) before prescribing/administering a rabies vaccine.

Reference:

1. Immunisation Against Infectious Disease - "The Green Book".Chapter 27 Polio (April 2019).