Rabies Vaccination

Rabies (synonyms: rabies; rage disease; lyssa) is a fatal infectious disease transmitted by the rabies virus. The disease is usually caused by a bite from an animal suffering from rabies (through infected saliva). Worldwide, dogs are the main carriers of the Rabies virus. There is a massive increase of dog rabies in China because most dogs, especially those in urban areas, are not vaccinated. Other animals can also transmit the rabies virus: foxes, cats, raccoons and skunks. Travelers to Asia must also be warned about temple monkeys. Bat rabies is also becoming more common around the world. In the U.S., these animals are so small that people don’t even realize they are being bitten. Rabies vaccination uses a vaccine consisting of inactivated rabies virus grown on HDC (human diploid cells) or chicken eggs. The following are the recommendations of the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute on rabies vaccination:

Indications (areas of application)

• B: Individuals with increased occupational risk:
  • Veterinarians, hunters, forestry personnel, and others handling animals in areas of recent wildlife rabies.
  • Persons with professional or other close contact with bats.
  • Laboratory personnel* with risk of exposure to rabies viruses.
• R: Travelers to regions with high rabies risk (e.g., from stray dogs).

* Laboratory personnel recommend a titer control – blood test for antibodies present – every six months (see below ), in order to quickly rule out possible deficiencies in effectiveness due to renewed vaccination. Legend

• B: Vaccinations due to an increased occupational risk, e.g., after risk assessment in accordance with the Occupational Health and Safety Act / Biological Substances Ordinance / Ordinance on Occupational Medical Precautions (ArbMedVV) and / or for the protection of third parties in the context of the occupational activity.
• R: Vaccinations due to travel

Contraindications

• There are no contraindications for vaccination after possible exposure to rabies with regard to the lethal outcome of manifest rabies.
• For prophylaxis (preventive vaccination), the following restrictions exist: Children, adolescents and adults with acute diseases requiring treatment should be vaccinated no earlier than 2 weeks after recovery.
• Persons with congenital or acquired immunodeficiencies, such as HIV infection, should be excluded from preventive vaccination, if applicable.

Implementation

• Basic immunization: in Germany, a precautionary vaccination with an inactivated virus at three times (0., 7th day, 21st day) is recommended.
• Individuals with continued risk of exposure should receive regular booster vaccination according to the manufacturer’s instructions.The following are recommendations for booster vaccination with Rabipur according to the SmPC:
  • “Bi-annual testing for neutralizing antibodies is generally recommended for those at increased risk of exposure (e.g., personnel in laboratories working with live rabies virus).
  • For persons at continuous risk of exposure (e.g., veterinarians and their assistants, foresters, hunters), serologic testing should generally be performed at least every two years; if deemed necessary depending on the level of risk, possibly at shorter intervals.
  • In the previously mentioned cases, a booster vaccination should be administered as soon as the antibody titer falls below 0.5 I.U./ml.
  • Alternatively, booster vaccinations can be administered at the officially recommended intervals without serologic control, depending on the risk. Experience shows that booster vaccinations are generally required every 2-5 years.

  Rabipur can be used for booster vaccinations after basic immunization with a human diploid cell culture rabies vaccine.”

Efficacy

• Reliable efficacy (almost 100%)
• Vaccination protection within 4 weeks after the start of basic immunization.
• Duration of vaccination protection at least 2-5 years

Possible side effects / vaccination reactions

• Local reactions such as redness and swelling around the injection site (25%).
• Arthritis – inflammation of the joints (6%).
• Arthropathies – non-inflammatory joint pain (6%).
• Angioedema – allergy-related swelling, especially around the lips.

Vaccination status – control of vaccination titers