Once initiated, rabies prophylaxis should not be interrupted or discontinued because of local or mild systemic adverse reactions to rabies vaccine. Usually such reactions can be successfully managed with anti-inflammatory and antipyretic agents (eg, aspirin).
Reactions after vaccination with HDCV are less common than with previously available vaccines.12, 16, 17 In a study using five doses of HDCV, local reactions, such as pain, erythema, and swelling or itching at the injection site were reported in about 25% of recipients of HDCV, and mild systemic reactions such as headache, nausea, abdominal pain, muscle aches and dizziness were reported in about 20% of recipients.8
Serious systemic anaphylactic or neuroparalytic reactions occurring during the administration of rabies vaccines pose a dilemma for the attending physician. A patient's risk of developing rabies must be carefully considered before deciding to discontinue vaccination. Moreover, the use of corticosteroids to treat life-threatening neuroparalytic reactions carries the risk of inhibiting the development of active immunity to rabies. It is especially important in these cases that the serum of the patient be tested for rabies antibodies. Advice and assistance on the management of serious adverse reactions in persons receiving rabies vaccines may be sought from the state health department.8
Read the Imovax (rabies vaccine) Side Effects Center for a complete guide to possible side effects »
Corticosteroids, other immunosuppressive agents, and immunosuppressive illnesses can interfere with the development of active immunity and predispose the patient to developing rabies. Immunosuppressive agents should not be administered during postexposure therapy, unless essential for the treatment of other conditions. When rabies postexposure prophylaxis is administered to persons receiving steroids or other immunosuppressive therapy, it is especially important that serum be tested for rabies antibody to ensure that an adequate response has developed.8
8. CDC. Recommendations of the Immunization Practices Advisory Committee (ACIP). Rabies Prevention—United States, 1984, MMWR 33: 393-402, 407-8 (1984).
12. Greenberg M, Childress J. Vaccination against rabies with duck-embryo and Semple vaccines. JAMA 173: 333-7 (1960).
16. CDC. Systemic allergic reactions following immunization with human diploid cell rabies vaccine. MMWR 33:185-7 (1984).
17. Rubin RH, Hattwick MAW, Jones S, Gregg MB, Schwartz VD. Adverse reactions to duck embryo rabies vaccine. Ann Intern Med 78: 643-9 (1973).
Last reviewed on RxList: 11/10/2008
This monograph has been modified to include the generic and brand name in many instances.
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