Brand Name(s): Imovax^®, RabAvert^®

What is rabies?

Rabies is a serious disease. It is caused by a virus. Rabies is mainly a disease of animals. Humans get rabies when they are bitten by infected animals.

At first there might not be any symptoms. But weeks, or even years after a bite, rabies can cause pain, fatigue, headaches, fever, and irritability. These are followed by seizures, hallucinations, and paralysis. Rabies is almost always fatal.

Wild animals, especially bats, are the most common source of human rabies infection in the United States. Skunks, raccoons, dogs, and cats can also transmit the disease.

Human rabies is rare in the United States. There have been only 55 cases diagnosed since 1990. However, between 16,000 and 39,000 people are treated each year for possible exposure to rabies after animal bites. Also, rabies is far more common in other parts of the world, with about 40,000 to 70,000 rabies-related deaths each year. Bites from unvaccinated dogs cause most of these cases. Rabies vaccine can prevent rabies.

Rabies vaccine

Rabies vaccine is given to people at high risk of rabies to protect them if they are exposed. It can also prevent the disease if it is given to a person after they have been exposed.

Rabies vaccine is made from killed rabies virus. It cannot cause rabies.

Who should get rabies vaccine and when?

Preventive Vaccination (No Exposure):

• People at high risk of exposure to rabies, such as veterinarians, animal handlers, rabies laboratory workers, spelunkers, and rabies biologics production workers should be offered rabies vaccine.
• The vaccine should also be considered for: (1) people whose activities bring them into frequent contact with rabies virus or with possibly rabid animals, and (2) international travelers who are likely to come in contact with animals in parts of the world where rabies is common.
• The pre-exposure schedule for rabies vaccination is 3 doses, given at the following times: (1) Dose 1: As appropriate, (2) Dose 2: 7 days after Dose 1, and (3) Dose 3: 21 days or 28 days after Dose 1.
• For laboratory workers and others who may be repeatedly exposed to rabies virus, periodic testing for immunity is recommended, and booster doses should be given as needed. (Testing or booster doses are not recommended for travelers.) Ask your doctor for details.

Vaccination After an Exposure:

• Anyone who has been bitten by an animal, or who otherwise may have been exposed to rabies, should see a doctor immediately. The doctor will determine if they need to be vaccinated.
• A person who is exposed and has never been vaccinated against rabies should get 4 doses of rabies vaccine--one dose right away, and additional doses on the 3rd, 7th, and 14th days. They should also get another shot called Rabies Immune Globulin at the same time as the first dose.
• A person who has been previously vaccinated should get 2 doses of rabies vaccine--one right away and another on the 3rd day. Rabies Immune Globulin is not needed.

Tell your doctor if...

Talk with a doctor before getting rabies vaccine if you:

• ever had a serious (life-threatening) allergic reaction to a previous dose of rabies vaccine, or to any component of the vaccine; tell your doctor if you have any severe allergies.
• have a weakened immune system because of: HIV/AIDS or another disease that affects the immune system; treatment with drugs that affect the immune system, such as steroids; cancer, or cancer treatment with radiation or drugs.

If you have a minor illness, such as a cold, you can be vaccinated. If you are moderately or severely ill, you should probably wait until you recover before getting a routine (nonexposure) dose of rabies vaccine. If you have been exposed to rabies virus, you should get the vaccine regardless of any other illnesses you may have.

What are the risks from rabies vaccine?

A vaccine, like any medicine, is capable of causing serious problems, such as severe allergic reactions. The risk of a vaccine causing serious harm, or death, is extremely small. Serious problems from rabies vaccine are very rare.

Mild Problems:

• soreness, redness, swelling, or itching where the shot was given (30% to 74%)
• headache, nausea, abdominal pain, muscle aches, dizziness (5% to 40%)

Moderate Problems:

• hives, pain in the joints, fever (about 6% of booster doses)

Other nervous system disorders, such as Guillain-Barré Syndrome (GBS), have been reported after rabies vaccine, but this happens so rarely that it is not known whether they are related to the vaccine.

NOTE: Several brands of rabies vaccine are available in the United States, and reactions may vary between brands. Your provider can give you more information about a particular brand.

What if there is a moderate or severe reaction?

What should I look for?

• Any unusual condition, such as severe allergic reaction or a high fever. If a severe allergic reaction occurred, it would be within a few minutes to an hour after the shot. Signs of a serious allergic reaction can include difficulty breathing, hoarseness or wheezing, swelling of the throat, hives, paleness, weakness, a fast heart beat, or dizziness.

What should I do?

• Call a doctor, or get the person to a doctor right away.
• Tell your doctor what happened, the date and time it happened, and when the vaccination was given.
• Ask your provider to report the reaction by filing a Vaccine Adverse Event Reporting System (VAERS) form. Or you can file this report through the VAERS website at https://vaers.hhs.gov/index, or by calling 1-800-822-7967. VAERS does not provide medical advice.

How can I learn more?

• Ask your doctor or other health care provider. They can give you the vaccine package insert or suggest other sources of information.
• Call your local or state health department.
• Contact the Centers for Disease Control and Prevention (CDC): call 1-800-232-4636 (1-800-CDC-INFO) or visit the CDC's rabies website at https://www.cdc.gov/rabies/

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

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Selected Revisions: March 15, 2025.