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Pre-exposure Vaccination
People work with rabies in laboratory settings and animal control and wildlife officers are just a
few of the people who should consider rabies pre-exposure vaccinations.
If you are traveling to a country where rabies is widespread, you should consult your doctor about
the possibility of receiving preexposure vaccination against rabies.
Your planned activity will bring you into contact with wild or domestic animals, for
example if you are a biologist, veterinarian, or agriculture specialist working with
animals.
You will be visiting remote areas where medical care is difficult to obtain or may be
delayed, for example, hiking through remote villages where dogs are common.
Your stay is longer than 1 month in an area where dog rabies is common. The longer
your stay, the greater the chance of an encounter with an animal.
Although pre-exposure vaccination does not eliminate the need for additional therapy after a rabies
exposure, it simplifies management by eliminating the need for rabies immune globulin and
decreasing the number of doses of vaccine needed. This is of particular importance for persons at
high risk for exposure to rabies in areas where immunizing products might not be available or
where lesser quality biologics might be used which would place the exposed person at increased
risk for adverse events.
Pre-exposure prophylaxis may also protect people whose post-exposure therapy is delayed and
provide protection to people who are at risk for unapparent exposures to rabies.
Rabies Pre-exposure Prophylaxis Guide
Risk Preexposure
Nature of Risk Typical Population
Category Recommendations
Virus present
continuously, often in
Primary course. Serologic
high concentrations.
Rabies research laboratory testing every 6 months;
Specific exposures
Continuous workers; rabies biologics booster vaccination if
likely to go
production workers. antibody titer is below
unrecognized. Bite, non-
acceptable level.
bite, or aerosol
exposure.
Exposure usually
Rabies diagnostic lab workers,
episodic, with source Primary course. Serologic
spelunkers, veterinarians and
recognized, but testing every 2 years;
staff, and animal-control and
Frequent exposure also might be booster vaccination if
wildlife workers in rabies-
unrecognized. Bite, non- antibody titer is below
enzootic areas. All persons
bite, or aerosol acceptable level.
who frequently handle bats.
exposure.
Veterinarians and terrestrial
animal-control workers in
areas where rabies is
Exposure nearly always
uncommon to rare. Veterinary Primary course. No
episodic with source
Infrequent students. Travelers visiting serologic testing or booster
recognized. Bite or non-
areas where rabies is enzootic vaccination.
bite exposure.
and immediate access to
appropriate medical care
including biologics is limited.
Primary vaccination
Three 1.0-mL injections of HDCV or PCEC vaccine should be administered intramuscularly
(deltoid area) — one injection per day on days 0, 7, and 21 or 28. Vaccine preparations for
intradermal administration are no longer available in the United States.
Booster doses
Continuous risk
People who work with rabies virus in research laboratories or vaccine production facilities are at
the highest risk for unapparent exposures. Such persons should have a serum sample tested for
rabies antibody every six months. Intramuscular booster doses of vaccine should be administered
to maintain a serum titer corresponding to at least complete neutralization at a 1:5 serum dilution
by the RFFIT.
Frequent risk
This group includes other laboratory workers such as those performing rabies diagnostic testing,
spelunkers, veterinarians and staff, and animal-control and wildlife officers in areas where animal
rabies is enzootic. The frequent-risk category also includes persons who frequently handle bats,
regardless of location in the Unites States. Persons in the frequent risk group should have a serum
sample tested for rabies antibody every 2 years; if the titer is less than complete neutralization at a
1:5 serum dilution by the RFFIT, the person also should receive a single booster dose of vaccine.
Infrequent risk
Veterinarians, veterinary students, and terrestrial animal-control and wildlife officers working in
areas where rabies is uncommon to rare (infrequent exposure group) and at-risk international
travelers fall into this category and do not routine preexposure booster doses of vaccine after
completion of primary preexposure vaccination
All cases of suspected rabies exposure should be treated immediately to prevent the onset of
clinical symptoms and death. Post-exposure prophylaxis (PEP) consists of wound treatment,
the administration of rabies vaccines based on WHO recommendations, and if indicated, the
administration of rabies immunoglobulin (See table below).
Human diploid cell vaccine Imovax®/ Sanofi Pasteur > 2.5 international units (IU) of
(HDCV)*,†,‡ rabies antigen
Purified chick embryo cell vaccine RabAvert®/ Novartis Vaccines >2.5 IU of rabies antigen
(PCECV)*,†,‡ and Diagnostics
*Dose: Single dose vial of vaccine should be reconstituted with accompanying sterile diluent to
final volume of 1mL before administration.
†Administration Route: Intramuscular in the deltoid area for adults, in the deltoid area or the
anterolateral aspect of the thigh for children. DO NOT use the gluteal area for HDCV or PCECV.
‡Indications: Pre-exposure2 AND post-exposure prophylaxis.
Rabies Immunoglobulin
Prevention
Rabies is a serious disease, but individuals and governments can and do act to control and prevent,
and, in some cases, wipe it out completely.
Strategies include:
• regular anti-rabies vaccinations for all pets and domestic animals
• bans or restrictions on the import of animals from some countries
• widespread vaccinations of humans in some areas
• educational information and awareness
Individual precautions
Individuals should follow some safety rules to reduce the chance of contracting rabies.
Vaccinate pets: Find out how often you need to vaccinate your cat, dog, ferret, and other
domestic or farm animals, and keep up the vaccinations.
Protect small pets: Some pets cannot be vaccinated, so they should be kept in a cage or
inside the house to prevent contact with wild predators.
Keep pets confined: Pets should be safely confined when at home, and supervised when
outside.
Report strays to the local authorities: Contact local animal control officials or police
departments if you see animals roaming
Do not approach wild animals: Animals with rabies are likely to be less cautious than usual,
and they may be more likely to approach people.
Keep bats out of the home: Seal your home to prevent bats from nesting. Call an expert to
remove any bats that are already present.
In 2015, a woman died from rabies after being bitten by a bat during the night. She did not realize
she had been bitten.
People are encouraged to seek medical help after an encounter with a wild animal, even if they do
not have bite marks or other outward signs of injury.
The World Health Organization (WHO) calls rabies a "100-percent vaccine-preventable disease."
They note that at least 70% of dogs in an area must be vaccinated to break the cycle of transmission.
In the U.S., vaccinations control rabies in domestic dogs. Nevertheless, between 30,000 and 60,000
people seek rabies postexposure prophylaxis every year, following contact with suspect animals.
Hundreds of thousands of animals undergo tests and observation.
Between 60 and 70 dogs and around 250 cats are reported rabid each year in the U.S. Most of these
have not been vaccinated, and they were exposed to the virus through wild animals, such as bats.
Sources:
(2018, September 19) Treatment, World Health Organization Retrieved from:
http://www.who.int/rabies/about/home_treatment/en
(2017, November 15) Rabies: Symptoms, causes, treatment, and prevention, Medical News Today
Retrieved from: https://www.medicalnewstoday.com/articles/181980.php
(2011, April 22) Rabies, Centers for Disease Control and Prevention Retrieved from:
https://www.cdc.gov/rabies/exposure/index.html