Rabies immune globulin and vaccine
- Alfred DeMaria, Jr, MD
Alfred DeMaria, Jr, MD
- Medical Director, Bureau of Infectious Disease
- Massachusetts Department of Public Health and Laboratory Sciences
- Section Editors
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
More than 3.3 billion people worldwide live in areas where rabies is enzootic. Human mortality from rabies is estimated to range from 26,400 to 61,000 deaths per year. Most cases occur in Africa and Asia and result primarily from canine reservoirs . In the United States, there has been an average of two fatal human rabies cases annually since 1980, the majority associated with exposure to bats.
Rabies is virtually always fatal, but infection can be prevented with proper wound care and postexposure prophylaxis. Although the incidence of human rabies is very low in the United States, approximately 16,000 to 39,000 cases with contact to potentially rabid animals receive rabies postexposure prophylaxis annually . The annual expenditure for rabies in Africa and Asia has been estimated to be $584 million, and globally, $6 billion in direct costs and lost productivity; the cost of postexposure prophylaxis with rabies immune globulin and vaccine accounts for a significant proportion of this expenditure [1,3].
The safety, efficacy, and administration of rabies immune globulin and rabies vaccine will be reviewed here. Clinical decision-making regarding the necessity for rabies prophylaxis can be complex. This issue and the clinical presentation, diagnosis, and care of the patient with suspected rabies are discussed elsewhere. (See "When to use rabies prophylaxis" and "Clinical manifestations and diagnosis of rabies".)
The general principles guiding rabies prophylaxis, as derived from the Advisory Committee on Immunization Practices (ACIP) guidelines of the United States Centers for Disease Control and Prevention (CDC) , are discussed below. The full set of guidelines can be accessed at: http://www.cdc.gov/mmwr/pdf/rr/rr57e507.pdf (with updated vaccine schedule recommendations at http://www.cdc.gov/mmwr/pdf/rr/rr5902.pdf).
Timing of prophylaxis — Rabies postexposure prophylaxis is an urgent medical intervention and should begin as soon as possible after the presumed exposure.
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- GENERAL PRINCIPLES
- Timing of prophylaxis
- What to administer
- Wound care
- Other preventive care
- AVAILABLE PREPARATIONS FOR PROPHYLAXIS
- Rabies immune globulin
- - Outside of the US
- Rabies vaccines
- - Outside the US
- EFFICACY AND IMMUNOGENICITY
- Postexposure prophylaxis
- Preexposure prophylaxis
- SAFETY OF RABIES BIOLOGICS
- Rabies immunoglobulin (RIG)
- Human diploid cell vaccine (HDCV)
- Purified chick embryo cell vaccine (PCECV)
- DOSING SCHEDULES AND ROUTES OF ADMINISTRATION
- Rabies immune globulin
- Rabies vaccines
- - Preexposure prophylaxis
- - Postexposure prophylaxis for unvaccinated persons
- - Postexposure prophylaxis for previously vaccinated persons
- POST VACCINATION SEROLOGIC TESTING
- DELAYS IN IMMUNIZATION
- DEVIATIONS FROM IMMUNIZATION SCHEDULES
- SPECIAL CONSIDERATIONS
- Antimalarial prophylaxis
- VACCINE FAILURE
- FUTURE RESEARCH
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS