A rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the latent period after exposure to prevent the disease. Transmission of rabies virus to humans typically occurs through a bite or scratch from an infectious animal, but exposure can occur through indirect contact with the saliva from an infectious individual. Doses are usually given by injection into the skin or muscle. After exposure, the vaccination is typically used along with rabies immunoglobulin. It is recommended that those who are at high risk of exposure be vaccinated before potential exposure. Rabies vaccines are effective in humans and other animals, and vaccinating dogs is very effective in preventing the spread of rabies to humans. A long-lasting immunity to the virus develops after a full course of treatment. Rabies vaccines may be used safely by all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site, and 5 to 15 percent of people may experience fever, headaches, or nausea. After exposure to rabies, there is no contraindication to its use, because the untreated virus is virtually 100% fatal. The first rabies vaccine was introduced in 1885 and was followed by an improved version in 1908. Over 29 million people worldwide receive human rabies vaccine annually. It is on the World Health Organization's List of Essential Medicines.
Medical uses
Before exposure The World Health Organization (WHO) recommends vaccinating those who are at high risk of the disease, such as children who live in areas where it is common. Other groups may include veterinarians, researchers, or people planning to travel to regions where rabies is common. Three doses of the vaccine are given over a one-month period on days zero, seven, and either twenty-one or twenty-eight.
After exposure Before the administering of the vaccines and RIG, it is necessary to first clean the wound. This should be done by washing for at least 15 minutes with water and soap, and using a virucidal agent such as povidone-iodine to irrigate the wound. For individuals who have been potentially exposed to the virus, four doses over two weeks are recommended, as well as an injection of rabies immunoglobulin with the first dose. This is known as post-exposure vaccination. For people who have previously been vaccinated, only two doses of the rabies vaccine are required. However, vaccination after exposure is neither a treatment nor a cure for rabies; it can only prevent the development of rabies in a person if given before the virus reaches the brain. Because the rabies virus has a relatively long incubation period, post-exposure vaccinations are typically highly effective.
Additional doses Immunity following a course of doses is typically long lasting, and additional doses are usually not needed unless the person has a high risk of contracting the virus. Those at risk may have tests done to measure the amount of rabies antibodies in the blood, and then get rabies boosters as needed. Following administration of a booster dose, one 2002 study found 97% of immunocompetent individuals demonstrated protective levels of neutralizing antibodies after ten years. A 2021 study found that in patients who had received PrEP rabies vaccines in the form of 2 doses or 3-doses 10-24 years ago, rabies immunological memory was reactivated in all patients within 7 days after a single intramuscular booster immunization. The WHO recommends that patients who had received at least 2 doses of PrEP in the past be given after exposure either of the following three approved protocols of rabies vaccine booster administration: 1-site ID on days 0 and 3; or 4-sites ID on day 0; or 1-site IM on days 0 and 3. RIG should not be given to patients who had undergone PrEP.
Immunization plan People potentially exposed to rabies should discuss with a medical professional about risk assessment, namely the risk that the animal might be rabid, and about options for treatment, including about possible drug interactions, such as immunosuppressive medications. RIG (which provides immediate temporary passive immunity) should be given on the same day with the first rabies vaccine injection, or, if this is not possible, within a week after the first rabies vaccine.However, RIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose. RIG should not be given if more than a week has elapsed from the first dose of vaccine, after the second dose of vaccine or to people who are already partially immunized (such as people who had received PrEP) because this can interfere with their already existing antibodies. If a dog, cat or ferret is still alive and healthy (as certified by a professional) after 10 days from the exposure, then it could not have been infectious at the time of the exposure. However, in countries where rabies is common, the possibility of keeping the animal under observation should not lead to delay in the beginning of the treatment, because human rabies symptoms can occur as early as 7 days, and once symptoms have started the treatment is no longer effective. Instead, post-exposure prophylaxis should be started immediately after exposure, and it can subsequently be discontinued after 10 days, with the existing treatment functioning as PrEP for future exposure.
Safety Rabies vaccines are safe in all age groups. About 35 to 45 percent of people develop a brief period of redness and pain at the injection site, and 5 to 15 percent of people may experience fever, headaches, or nausea. Because of the certain fatality of the virus, receiving the vaccine is always advisable. Vaccines made from nerve tissue are used in a few countries, mainly in Asia and Latin America, but are less effective and have greater side effects. Their use is thus not recommended by the World Health Organization.
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