Verorab

Indications

Rabies vaccine is used to protect against rabies, a viral infection of the brain and nerves that is almost always fatal once symptoms begin. It is given after a possible exposure, such as a bite, scratch or lick on broken skin from a dog, cat, monkey, bat or other animal that may carry rabies (post-exposure prophylaxis). It is also given before any exposure to people at high risk, such as veterinarians, animal handlers, laboratory staff and some travellers (pre-exposure prophylaxis).

How It Works

The vaccine contains rabies virus that has been grown in cell culture and then inactivated (killed), so it cannot cause the disease. It trains the immune system to make protective antibodies that neutralise the virus before it reaches the nervous system. After a severe bite it is often given together with Rabies Immunoglobulin, which supplies ready-made antibodies for immediate protection while the vaccine starts to work.

Dosage and Administration

The vaccine is given by a doctor or nurse as an injection into the upper arm muscle or into the skin (intradermal), following the national schedule. The number of doses and the days on which they are given depend on whether it is for prevention before exposure or treatment after exposure, and on whether the person has been vaccinated before. After any animal bite, wash the wound well with soap and running water for about 15 minutes and go to a health centre the same day. Do not skip or delay any dose in the schedule.

Interactions

Medicines that weaken the immune system, such as high-dose Corticosteroids, anticancer drugs, Chloroquine and immunosuppressants used after transplant, may reduce the response to the vaccine; the doctor may check antibody levels or change the schedule. Rabies Immunoglobulin must not be mixed in the same syringe or injected at the same site as the vaccine. Tell the health worker about all medicines you take.

Contraindications

After a possible rabies exposure there is no reason to refuse the vaccine, because rabies is fatal. For vaccination before exposure, it should be postponed during a serious fever or acute illness and avoided in anyone who had a severe allergic reaction to a previous dose or to a component of the vaccine.

Side Effects

Common effects include pain, redness, swelling or itching where the injection was given, mild fever, headache, tiredness, muscle aches, dizziness and nausea. These usually settle within a day or two. Rarely, allergic reactions such as hives, joint pain or swelling can occur.

Get urgent medical help if you have difficulty breathing, swelling of the face or throat, a widespread rash, fainting, or weakness or numbness of the arms or legs after vaccination.

Pregnancy and Lactation

Pregnancy and breastfeeding are not reasons to delay vaccination after an exposure, because rabies is life threatening. The inactivated vaccine has not been shown to harm the baby. For vaccination before exposure during pregnancy, the doctor will weigh the actual risk of exposure.

Precautions and Warnings

Complete the full course on the scheduled days. Tell the health worker if you have a weak immune system, a bleeding disorder, or have had rabies vaccine before. Stay at the clinic for about 15 to 30 minutes after the injection in case of an allergic reaction. The vaccine does not replace proper wound washing and medical care after a bite.

Overdose

Overdose is unlikely because the vaccine is given by health professionals in measured doses. An extra dose is not expected to cause harm beyond the usual injection-site and general reactions.

Therapeutic Class

Vaccine (inactivated viral vaccine)

Storage

Store in a refrigerator at 2 to 8°C, do not freeze, and protect from light. It is usually kept and given at a health facility; follow the directions on the pack.