Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Rabies Vaccine

by Krisha McCoy, MS
What Is Rabies?

Rabies is an infection caused by a virus. This virus is almost always fatal unless it is treated before symptoms appear. It affects the central nervous system.

People usually get rabies through a bite or scratch from an infected animal. Wild animals in the US that commonly carry the virus include bats, raccoons, skunks, foxes, and coyotes. Dogs, cats, and other domestic animals can also carry the disease. The rabies virus is found in the saliva, brain, or nervous tissue of infected animals. In the US, rabies in humans is rare, though it is more common in other countries.

Rabies symptoms include:

  • Erratic, excited, or bizarre behavior
  • Flu-like symptoms, such as headache, fever, fatigue, and nausea
  • Increased production of thick saliva
  • Pain, tingling, or itching at the site of the bite wound or other site of viral entry
  • Painful spasms and contractions of the throat when exposed to water
  • Paralysis
  • Stiff muscles

Symptoms may not appear for weeks, or even years, after a bite.

If an animal has bitten you, wash the wound with soap and water right away. Call your doctor or go to the emergency room.

What Is the Rabies Vaccine?

The vaccine is made from killed rabies virus. It is given by injection.

Who Should Get Vaccinated and When?

There are two reasons for rabies vaccines:

  • Preventive vaccination
  • Vaccination after exposure
Preventive Vaccination

This is for people at high risk of exposure to rabies, such as:

  • People who explore caves
  • Rabies laboratory workers
  • Travelers who may come in contact with rabid animals
  • Veterinarians and animal handlers

The preventive vaccine is given in three doses. The second dose is given seven days after the first, and the third is given 21 or 28 days after the first. People who may be repeatedly exposed to the virus should be periodically tested for immunity. Booster doses may be needed.

Vaccination After Exposure

This is given to anyone who has been bitten by an animal or was otherwise exposed to rabies. This regimen includes 4-5 doses of rabies vaccine. One dose is given right away, and four more doses on the third, seventh, fourteenth, and twenty-eighth days. Also, a shot of rabies-specific immune globulin (RIG) should be given along with the first dose. For people who have been vaccinated before, two doses are given. One dose is given right away and another on the third day. RIG is not needed for people who have already had the vaccine.

What Are the Risks Associated With the Rabies Vaccine?

Like any vaccine, the rabies vaccine can cause serious problems, such as severe allergic reactions. The risk of serious harm or death is extremely small.

The most commonly reported problems include:

  • Abdominal pain
  • Dizziness
  • Fever
  • Headache
  • Hives
  • Muscle aches
  • Nausea
  • Pain in the joints
  • Soreness, redness, swelling, or itching around the injection site

Rarely, an illness resembling Guillain-Barre syndrome and other nervous system disorders have been reported in association with the vaccine.

Who Should Not Get Vaccinated?

Talk with your doctor before being vaccinated if you:

  • Have a weakened immune system due to disease, drug use, or cancer
  • Are moderately or severely ill—Wait until you recover to get the preventive vaccine. If you have been exposed to rabies, you should get the vaccine right away.
  • Had a life-threatening allergic reaction to a previous dose of rabies vaccine or one of its components
What Other Ways Can Rabies Be Prevented Besides Vaccination?

Here are some ways to prevent rabies:

  • Avoid contact with wild animals.
  • Do not touch any wild animal, even if it appears to be dead.
  • Report strangely acting or sick animals to animal control authorities.
  • Seal basement, porch, and attic openings. This will prevent an animal from getting into your home.
  • Vaccinate house pets.

Rabies symptoms in animals may include:

  • Disorientation (eg, nocturnal animals such as a bat or fox appearing in daylight)
  • Erratic behavior (often overly aggressive or vicious)
What Happens in the Event of an Outbreak?

In the event of an outbreak, authorities will identify and control the source of the outbreak. They will increase their surveillance of wild and domestic animals. Steps will be taken to increase animal rabies vaccination rates and provide safety education to the public.

Last reviewed: November 2011 by Lawrence Frisch, MD, MPH.

References:
  • Malerczyk C, Detora L, Gniel D. Imported human rabies cases in Europe, the United States, and Japan, 1990 to 2010. J Travel Med. 2011;18(6):402-407.
  • McGettigan JP. Experimental rabies vaccines for humans. Expert Rev Vaccines. 2010;9(10):1177-1186.
  • Rabies. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated December 2008. Accessed March 3, 2008.
  • Rabies. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/rabies/ . Accessed February 2, 2007.
  • Treatment of wounds. US Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/rabies/exposure/postexposure.html . Updated September 3, 2007. Accessed November 16, 2009.
  • 3/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies. MMWR Morb Mortal Wkly Rep. 2010;59(2):1.