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Immunizations - travel vaccinations - Management
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Definition
- Rabies is an acute viral infection, caused by a rhabdovirus, that is nearly always fatal. Transmission is usually in saliva via the bite of an infected animal.
When is rabies vaccine (pre-exposure) indicated?
- The following travellers should be offered pre-exposure immunization:
- People living in, or travelling for more than 1 month to, rabies-enzootic areas (e.g. jungle habitat) where there is no access to reliable, prompt, safe medical care.
- People travelling for less than 1 month to enzootic areas but who may be exposed to rabies because of their activities, or those who would have limited access to post-exposure medical care.
- People who are working abroad with, or in close contact with, animals (e.g. veterinarians, zoologists).
In depth
When is post-exposure rabies vaccination indicated?
- Refer immediately, for expert advice on risk assessment and management, anyone who has been exposed to rabies (even if the person has been fully immunized). This should be obtained from:
- Health Protection Agency Centre for Infection (020 8200 6868).
- Health Protection Scotland (0141 300 1100).
- Public Health Laboratory, Belfast City Hospital (028 9032 9241).
- Post-exposure vaccination (i.e. after a bite or scratch has occurred) depends on the immunization status of the person, the level of risk in the country, and the nature of the exposure.
In depth
What type of rabies vaccine is available?
- Two inactivated rabies vaccines are available in the United Kingdom: Rabies Vaccine BP and Rabipur®.
In depth
What schedule is used for rabies vaccine (pre-exposure)?
- A primary course of immunization should be completed prior to departure.
Table 1. Schedule for rabies (pre-exposure) vaccination.
Vaccine | Schedule | Length of protection | Age range |
|---|
Rabies Vaccine BP | 3 doses: Day 0, 7, and 28. | Booster dose every 2–3 years if at continued risk. | No minimum age stated in SPC. However, vaccine should be considered for children from the age of approximately 1 year. |
2 doses, given at least 4 weeks apart, are likely to confer protection.* | Booster dose at 6 months if required. |
Rabipur® | 3 doses: Day 0, 7, and 21 or 28. | Booster doses every 2–5 years if at continued risk. | Can be given from any age. |
* The two dose schedule is suggested as an option in this vaccine datasheet, but is omitted in the Department of Health recommendations. Persons who have not had a three dose of a pre exposure schedule should be treated as unvaccinated if presenting for post exposure treatment. |
In depth
What are the adverse effects of rabies vaccine?
- Local reactions may occur such as redness, swelling, or pain at the site of injection within 24–48 hours of administration. Systemic reactions are rare.
In depth
Prescriptions
Rabies vaccine
Age from 2 months onwards
Rabipur vaccine powder and solvent for solution for injection 1ml vials
Give 1ml by intramuscular injection. For primary immunization give three doses on days 0, 7, and 28.
Supply 1 1ml vial+diluent.
Age from 1 year onwards
Rabies vaccine BP (Sanofi Pasteur MSD)
Rabies vaccine powder and solvent for solution for injection 1ml vials
Give 1ml by intramuscular injection. For primary immunization give three doses on days 0, 7, and 28.
Supply 1 1ml vial.
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