Postexposure Prophylaxis (PEP) Protects Against Rabies
Protective measures, known as postexposure prophylaxis or PEP, are the only proven way to avoid the onset of rabies. There are 3 parts to this process. All of them are necessary.1,2
Cleanse the Wound
It makes sense that any animal bite or wound, no matter whether there’s a risk of rabies exposure or not, should be treated as a serious injury. Your doctor may want to check for nerve or tendon damage. Wounds should be cleaned by flushing with soap and water. An iodine solution can be used to minimize the risk of infection. Care should be taken to avoid any additional damage to surrounding skin or tissue. A tetanus vaccine should also be considered as part of standard wound care.1
Treat With Human Rabies Immune Globulin (HRIG)1,3,4
This important step needs to be administered quickly before the rabies virus can take hold.
An HRIG like HyperRAB® (rabies immune globulin [human]) provides critical, immediate protection. It’s given to individuals who have not been previously vaccinated.
HRIG + Vaccine
The most common adverse reactions in >5% of patients during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, gas, nasal congestion, and oropharyngeal pain.5
The HRIG is usually administered at the same time as the first dose of the vaccine but can be given up to 7 days later. Although vaccines can protect for years, they may take weeks to become effective. An HRIG like HyperRAB allows the vaccine time to establish active immunity.1,4
HyperRAB is made from plasma from human donors who have larger than normal amounts of antibodies and is injected into the body at the wound site. If the wound is small or in a difficult part of the body to reach, your doctor will inject as much as feasible at the wound site, then administer the rest at another location, like your upper arm.1,4
Complete a Series of Vaccine Injections
In addition to the HRIG, which provides immediate protection, a vaccine is administered to build active, long-lasting immunity. The rabies vaccine is usually given as a series of 4 shots.4
- The first dose of vaccine should be administered as soon as possible after rabies exposure1
- The date of the first dose is considered day 0 of the series. Additional shots will be given on days 3, 7, and 14 after the first vaccination1,4
- In cases where a person has a weak or compromised immune system, there may be a 5th shot on day 284
- Adults and older children will be given their injections in the upper arm (the deltoid muscle)4
- Young children may receive vaccine injections in the thigh4
Stopping Postexposure Prophylaxis (PEP)
If the animal that caused the wound was captured, and diagnostic testing on the animal proves it was not rabid, then the postexposure prophylaxis measures may be stopped.1
Learn More About Rabies
There Is No Rabies Treatment
Once you have symptoms, it’s almost certainly fatal.1
But You Can Prevent Rabies6,7
If you have been exposed, get postexposure prophylaxis treatment right away.
Important Safety Information for HyperRAB® (rabies immune globulin [human])
Indication and Usage
HYPERRAB® (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.
Limitations of Use
Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis. Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.
Important Safety Information
For infiltration and intramuscular use only.
Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.
HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.
The most common adverse reactions in >5% of subjects during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.
Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.
Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio, or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.
Please see full Prescribing Information for HYPERRAB.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088
References
- Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention—United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28.
- Nigg AJ, Walker PL. Overview, prevention, and treatment of rabies. Pharmacotherapy. 2009;29(10):1182-1195.
- World Health Organization (WHO). Rabies. WHO website. Accessed March 12, 2022. https://www.who.int/news-room/fact-sheets/detail/rabies.
- Rupprecht CE, Briggs D, Brown CM, et al; Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010;59(RR-2):1-9.
- HyperRAB (rabies immune globulin [human]) Prescribing Information. Grifols.
- Kaur M, Garg R, Singh S, Bhatnagar R. Rabies vaccines: where do we stand, where are we heading? Expert Rev Vaccines. 2015;14(3):369-381.
- Crowcroft NS, Thampi N. The prevention and management of rabies. BMJ. 2015;350:g7827.