Rabies vaccine

How it works

It presents inactivated rabies virus antigen to the immune system, stimulating production of neutralising antibodies that provide active, durable protection against rabies infection.

Prescribing in practice

• After a significant exposure, prompt wound cleansing and a full vaccine course are essential, with rabies immunoglobulin added for unimmunised individuals, as rabies is almost invariably fatal once symptomatic.
• The number of doses and schedule differ between pre-exposure courses and post-exposure regimens and depend on prior immunisation and immune status per current guidance.
• It is administered by intramuscular injection and, for post-exposure prophylaxis, should never be withheld on account of pregnancy or breast-feeding.

Monitoring

Routine monitoring is not required, though antibody titre checks are used for certain occupationally exposed or immunosuppressed individuals.

Counselling the patient

• Complete every dose of the course on the dates given, as missing doses reduces protection.
• After any animal bite or scratch abroad, wash the wound thoroughly and seek medical advice at once.
• Tell the clinician if your immune system is weakened, as extra doses or antibody checks may be needed.

Evidence & guidelines

Rabies pre- and post-exposure vaccination schedules are set out in UK Health Security Agency (Green Book) and WHO guidance.