5.4.3 What do we need to know about products for human rabies prophylaxis?

Where can I find the vaccine?
Vaccine may be available at a specific anti-rabies clinic, in an emergency health clinic, or at a hospital.

Why do I need two different types of product for PEP [1]?
You need two products because one product provides passive immunity and the other provides active immunity.

You receive passive immunity through RIG [2]. RIG is a product containing antibodies produced specifically against rabies virus, and begins to destroy the virus immediately when it is administered into wounds inflicted by rabid animals.

You receive active immunity by being vaccinated with rabies vaccine. Rabies vaccine causes your body to produce its own antibodies to protect you against the rabies virus. It takes 7 to 14 days for your body to produce its own antibody after receiving rabies vaccine and therefore by injecting RIG into and around the wound areas, your body will have more protection against rabies.

RIG is not available where I live, is there an alternative?
There is no alternative to RIG. It is generally available in larger cities. If there is a delay in finding RIG, you should begin the vaccination series immediately and seek RIG elsewhere if possible. You can receive RIG up to 7 days after your PEP series was initiated.

What is the difference between ERIG [3] and HRIG [4]?
ERIG is equine RIG and is produced in horses.
HRIG is human RIG and is produced in humans.
Both products contain antibodies specifically made against rabies virus. Both products are produced by vaccinating horses (ERIG) or humans (HRIG) and harvesting their plasma which contains antibodies against rabies virus.
The dose of ERIG is twice as high (40 IU [5]/Kg of body weight) as the dose needed if you receive HRIG (20 IU/Kg of body weight).

What is the difference between CCV [6] and NTV [7]?
NTVs are usually crude vaccines made by infecting sheep or goats with rabies virus and harvesting their brain tissue to produce vaccine. The course of vaccination is long and painful, and not always effective. A more purified NTV is produced in the brain tissue of infected mice. Side effects are more often reported in persons who receive NTVs than in those who receive CCVs. The side effects from NTVs can be very serious including paralysis, whereas side effects of CTVs are extremely rare and only very minor.
CCVs are produced in primary or continuous cell lines, and are highly purified and among the most efficacious vaccines in the world. The course of vaccination is shorter. Side effects most commonly reported are similar to other vaccines including: pain at the site of injection, headache, fatigue, induration etc. Very seldom more serious adverse reactions to CTVs have been reported including Guillain Barré Syndrome described here.

WHO [8] strongly advocates the use of CCVs (click here for the list of WHO pre-qualified vaccines) and recommends complete discontinuation of the production and use of NTVs, as stated here.

I started my PEP with one brand of CCV but need to continue with another brand, is that safe?
It is best to continue with the same brand of CCV if possible, however if this is not possible, substitution with another WHO pre-qualified rabies vaccine is acceptable.

I have been vaccinated previously with a CCV, how long does my vaccine (immunity) last?
Modern CCVs are highly immunogenic (i.e. capable of inducing antibody production). Immunity usually lasts for 5 years, but this may vary depending on the vaccine used. Testing for antibodies may be used if available to check whether boostering is necessary. If you have received a CCV previously and are subsequently exposed to rabies, you will need two boosters only, one on day 0 and one on day 3.

[1Post-exposure prophylaxis

[2Rabies Immunoglobulin

[3Equine Rabies Immunoglobulin

[4Human Rabies Immunoglobulin

[5International Unit

[6Cell-culture Vaccine

[7Nerve Tissue-based Vaccine

[8World Health Organization


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Version 1 - Last updated November 2012