Rabies
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Rhabdoviridae
picture of rabies

Rabies is a preventable viral disease of mammals most often transmitted through the bite of a rabid animal. The vast majority of rabies cases reported to the Centers for Disease Control and Prevention (CDC) each year occur in wild animals like raccoons, skunks, bats, and foxes.

The rabies virus infects the central nervous system, ultimately causing disease in the brain and death. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, anxiety, confusion, slight or partial paralysis, excitation, hallucinations, agitation, hypersalivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms.

A person bitten by an animal that might have rabies should be treated immediately with rabies vaccine and rabies immune globulin. Once symptoms of rabies develop, treatment is effective only in extremely rare cases.      

About the Vaccine

There are currently two rabies vaccines available for use in the United States. Both are inactivated vaccines.

Rabies Vaccines Licensed for Use in the U.S.

Product: Imovax® (Rabies)
Manufacturer: Sanofi Pasteur
Year licensed: 1980
Product Insert

Product: RabAvert® (Rabies)
Manufacturer: Novartis Vaccines
Year licensed: 1997
Product Insert

Indications Contraindications and precautions

Pre-Exposure

  • People who are at high risk of exposure to rabies, such as veterinarians, animal handlers, certain laboratory workers.
  • People whose activities bring them into frequent contact with rabies virus or with possibly rabid animals.
  • International travelers who are likely to come into contact with animals in parts of the world where rabies is common.

Post-Exposure

  • People who have been exposed to rabies.
  • People who have been bitten by an animal or had contact with a bat that may be likely have rabies (in cases where the animal cannot be tested for rabies).

Pre-Exposure

  • People who have had a severe allergic reaction to a previous dose of rabies vaccine or a rabies vaccine component.*
  • People who are moderately or severely ill should wait until recovery before receiving any vaccine. Minor illnesses, such as a cold, are not a contraindication.
  • Women who are pregnant.*
  • People who are immune compromised due to disease, treatment, or medication.

Post-Exposure

  • There are no known specific contraindications to rabies vaccine in the event of an exposure. Consult an allergist or immunologist if an allergy is present.
* Consult with healthcare provider regarding pre-exposure use.
Circumstance Dose/Route Routine Administration Schedule
Pre-exposure Dose: 1 ml

Route: Intramuscular
3 doses on days 0, 7, and 21-28.
Post-exposure with pre-exposure vaccine given previously Dose: 1 ml

Route: Intramuscular
2 doses on days 0 and 3.
Post-exposure without any pre-exposure vaccine given Dose: 1 ml

Route: Intramuscular
4 doses on days 0, 3, 7, and 14. Note: Persons with immune suppression need a 5th dose on day 28. Also give Rabies Immune Globulin (RIG) to anyone who has not received pre-exposure rabies vaccine.     
Rabies Side Effects
  • Soreness, redness, swelling, or itching at the injection site (30% to 74% of people).
  • Headache, nausea, abdominal pain, muscle aches, dizziness (5% to 40% of people).
  • Severe allergic reaction (very rare).
Product Name Supplied Storage and Handling
Imovax
Sanofi Pasteur
1 mL single dose vial with diluent (1 set per package). Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Diluent can be stored in the refrigerator or at room temperature.
RabAvert
Novartis Vaccines
1 mL single dose vial with diluent (1 set per package). Store refrigerated between 2° to 8°C (35° to 46°F). Do not freeze. Diluent can be stored in the refrigerator or at room temperature.     
In August 2011, a male U.S. Army soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety, and dysphagia was admitted to an emergency department (ED) in New York for suspected rabies. Rabies virus antigens were detected in a nuchal skin biopsy, rabies virus antibodies in serum and cerebrospinal fluid (CSF), and rabies viral RNA in saliva and CSF specimens by state and CDC rabies laboratories. An Afghanistan canine rabies virus variant was identified.
National Association of State Public Health Veterinarians, Inc. as published in the
Recommendations of the Advisory Committee on Immunization Practices
Recommendations of the Advisory Committee on Immunization Practices
National Association of State Public Health Veterinarians, Inc. as published in the
Revised Directions for Use of 2 mL Prefilled Syringe
Information Paper
MILVAX Agency Listserv
Package Insert - Immune Globulin
Package Insert - Vaccine
Package Insert - Vaccine
Package Insert - Immune Globulin
Package Insert - Immune Globulin
Rabies Information
Talecris 28 Feb 08
HyperRAB™ S/D, Rabies Immune Globulin (Human)
MMQC-12-1541 07 Sep 12
SANOFI PASTEUR / NOVARTIS / IMOVAX RABIES VACCINE / IMOGAM RABIES-HT RABIES IMMUNE GLOBULIN (HUMAN) / INFORMATION
Video: Rabies, Episode 4Rabies, Episode 4 (12:56) 26 Sep 11
A BoonDOCS Video
BoonDOCS Video
Vaccine Information Statement
Author(s): CDC
Publication: MMWR Dispatch Vol. 53 / April 2, 2004
Subject: Vaccine-Safety
Disease: 
Rabies