Rabies secondary prevention

Secondary Prevention
Prevention for travelers:

Pre-exposure vaccination with human diploid cell Rabies vaccine (HDCV), or purified chick embryo cell (PCEC) vaccine, may be recommended for international travelers based on the local incidence of rabies in the country to be visited, the availability of appropriate antirabies biologicals, and the intended activity and duration of stay of the traveler. Different schedules, alternative routes of administration, and other rabies vaccines besides HDCV and PCEC may be found abroad. Pre-exposure vaccination may be recommended for veterinarians, animal handlers, field biologists, spelunkers, missionaries, and certain laboratory workers. Pre-exposure vaccination does not eliminate the need for additional medical attention after a rabies exposure but simplifies postexposure prophylaxis in populations at risk by eliminating the need for rabies immune globulin (RIG) and by decreasing the number of doses of vaccine required. Pre-exposure vaccination is of particular importance for travelers at risk of exposure to rabies in countries where biologicals are in short supply and locally available rabies vaccines might carry a higher risk of adverse reactions. Pre-exposure vaccination may also provide some degree of protection when there is an unapparent or unrecognized exposure to rabies and when postexposure prophylaxis might be delayed. Planning is needed to ensure compliance in completion of the three pre-exposure vaccine doses, prior to commencing travel.

Travelers should be advised that any animal bite or scratch should receive prompt local treatment by thorough cleansing of the wound with copious amounts of soap and water (and povidone iodine, if available). This local treatment will substantially reduce the risk of rabies. Travelers who might have been exposed to rabies should be advised to always contact local health authorities immediately for advice about postexposure prophylaxis and should also contact their personal physician or state health department as soon as possible thereafter.

Equine rabies immune globulin (ERIG), or purified fractions of ERIG, has been used effectively in some developing countries where human rabies immune globulin (RIG) might not be available. If necessary, such heterologous products are preferable to no RIG administration in human rabies postexposure prophylaxis. The incidence of adverse reactions after the use of these products has been low (0.8%-6.0%), and most of those reactions were minor. However, such products are neither evaluated by U.S. standards nor regulated by the U.S. Food and Drug Administration, and their use cannot be unequivocally recommended at this time. In addition, unpurified antirabies serum of equine origin might still be used in some countries where neither human RIG nor ERIG is available. The use of this antirabies serum is associated with higher rates of serious adverse reactions, including anaphylaxis.

Adverse reactions

Travelers should be advised that they may experience local reactions after vaccination, such as pain, erythema, swelling, or itching at the injection site, or mild systemic reactions, such as headache, nausea, abdominal pain, muscle aches, and dizziness. Approximately 6% of persons receiving booster vaccinations with HDCV may experience an immune complex-like reaction characterized by urticaria, pruritus, and malaise. Once initiated, rabies postexposure prophylaxis should not be interrupted or discontinued because of local or mild systemic reactions to rabies vaccine.