Travellers

Travel Health Information Sheets

Rabies Vaccine Information

Indications for use of vaccine

The need for pre-exposure rabies vaccine includes an assessment of:

  • The incidence of rabies in the destination countries
  • The availability and quality of anti rabies vaccine and rabies immune globulin (RIG)
  • The planned activities of the traveller
  • The duration of stay
  • The possibility of unrecognised or unreported exposure (e.g. in young children)

Rabies pre-exposure vaccine should be considered for

  • Those travelling for a month or more in enzootic areas.
  • Persons who will be travelling for less than a month in enzootic areas, but who may be exposed because of their travel activities.
  • Those at occupational risk e.g. vets, animal handlers, laboratory workers who handle the virus

Other specific indications for vaccination can be found in Immunisation against Infectious Disease

The rationale for receiving pre-exposure vaccine is that it will give the individual time to reach medical treatment, in the event of an animal bite or scratch; or possibly protect an individual who has an unapparent exposure. Prompt medical assistance is advised in the case of any potential rabies exposure, even if a pre-exposure course has been completed.

Those who have received a pre-exposure course of rabies vaccine will only require two further doses of vaccine post-exposure, rather than the full course of five vaccines. In addition, RIG will not be required in country; RIG is frequently difficult to locate. Travellers should be advised to perform first aid treatment on a wound and to seek medical advice as soon as possible.

Availability of vaccine

There are two rabies vaccines licensed for use in the UK, both of which are inactivated.

Details of these and manufacturers can be found in the summary table: Availability of Rabies vaccine (will open in new window)

It is good practice to continue a course of rabies with the same brand of vaccine. However, should this not be possible the vaccines may be used interchangeably.

Intradermal route of administration

The intradermal route is not licensed in the UK for any rabies vaccine. The ID route should not be used with Purified Chick Cell Vaccine (Rabipur). If practitioners decide to use the intradermal route, the Human Diploid Cell Vaccine (Rabies Vaccine BP) should be administered. Concurrent use of chloroquine is a contraindication to intradermal rabies vaccine.

Travellers who receive the intradermal rabies vaccine should be advised that in the event of a possible rabies exposure, they may be considered by the treating doctor to be incompletely immunised, and consequently advised to complete a full post exposure vaccine course. RIG is however, unnecessary in this situation.

Animal handlers and immune compromised persons should always receive intramuscular doses of rabies vaccine.

Interrupted courses

If there are time constraints to the full pre-exposure course, the traveller should be advised to complete the course at the destination if at all possible.

The first two doses of vaccine are likely to prime the immune system. It is important that travellers are aware that in the event of a possible exposure, they may require a full post exposure course of vaccine. RIG should not however, be necessary.

Studies suggest that a primary course of three rabies vaccines does not need to be repeated regardless of the interval between it and subsequent reinforcing doses.

Contraindications

  • Acute febrile or other infectious illness
  • Allergy to any constituent of the vaccine
  • Individuals who develop symptoms suggestive of hypersensitivity after vaccination should not receive further doses.
  • Rabipur vaccine is propagated on chick cell embryo, and is therefore contraindicated by egg allergy.

Adverse events

Adverse events to rabies vaccine tend to be mild and transient and include itching, pain, and erythema at the injection site. Less commonly fever, malaise, headaches, dizziness and urticaria can occur. An immune-complex reaction of urticaria, pruritis and malaise may occur in about 6% of persons receiving booster doses of the Human Diploid Cell Vaccine.

Post exposure prophylaxis

Advice regarding post exposure prophylaxis should be sought from the HPA Virus Reference Division, Colindale on 020 8200 6868.

If they are not available, the duty doctor at HPA CDSC should be consulted.