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About Rabies About

About Rabies

Even though rabies has been around for more than 4000 years, it still remains one of the deadliest diseases in the world.1 After the onset of symptoms, there is no effective treatment, and only a handful of people worldwide have ever recovered from it. Human infections usually occur as a result of being bitten by an infected animal.2

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Rabies virus

The rabies virus, from the saliva of an infected animal deposited in the wound site, enters muscle cells, replicates, then rapidly travels within axons to the central nervous system, resulting in fatal encephalitis. A remarkable aspect of the rabies virus that adds to its lethality is its ability to evade host immune mechanisms.1, 2

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Explanation of the different types of exposure that could cause rabies.

Animals at high risk for rabies in the US5:

Animals at high risk for rabies in the US; bats, raccoons, foxes, skunks, dogs, cats and cattle.

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Bats flying

Rabies is essentially7,8:

Rabies disease essential data; 100% preventable, 0% treatable and 100% fatal

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Postexposure Prophylaxis for Rabies

Approximately 55,000 people report coming in contact with potentially rabid animals and receive rabies postexposure prophylaxis (PEP) each year.6

If PEP has been initiated and appropriate laboratory diagnostic testing (eg, the direct fluorescent antibody test) indicates that the animal that caused the exposure was not rabid, PEP may be discontinued.2

Be sure to follow the CDC PEP schedule10:

Steps to follow after coming in contact with potentially rabid animals by the Centers for Disease Control and Prevention (CDC)

CDC, Centers for Disease Control and Prevention; HDCV, human diploid cell vaccine; PCECV, purified chick embryo cell vaccine.
‡Inject full dose around and into the wound (if possible). For remaining volume (or if there is no wound), inject HRIG in the deltoid area opposite of the vaccine injection.11
§Inject full dose in the deltoid area opposite of the HRIG injection or wound.11

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If patients are exposed to an animal bite, they are also at risk for tetanus—check tetanus vaccination history when treating for rabies.12  

Find out more information about tetanus immune globulin.
Find out more information about tetanus vaccination.

recommendations-guidelines

For more information, recommendations, and guidelines, visit the CDC Advisory Committee on Immunization Practices (ACIP).

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Rabies vaccines can take weeks to build efficacy—HRIGs such as HyperRAB provide immediate protection11,13,14

  • The most commonly encountered causes of PEP management failures are when HRIG is not used at all, it is injected only IM and not into wound(s), or not all bite wound(s) are injected15
  • The virus may continue to spread and replicate without HRIG16,17

Provide immediate protection after exposure to rabies10,13,18:

  • HRIG can be given up to 7 days after the first dose of rabies vaccine10
  • Patients who are immunocompromised should be given a fifth dose of the rabies vaccine on day 2810

isi-hyperrab

Important Safety Information for HyperRAB® (rabies immune globulin [human])

Indication and Usage

HYPERRAB® (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.

Limitations of Use 

Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine.

For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis.

Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

Important Safety Information

For infiltration and intramuscular use only.

Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reactions in >5% of subjects during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.

Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.

Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio, or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.  

Please see full Prescribing Information for HYPERRAB.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.


About Rabies references

References:

  1. Schnell MJ, McGettigan JP, Wirblich C, Papaneri A. The cell biology of rabies virus: using stealth to reach the brain. Nat Rev Microbiol. 2010;8(1):51-61.
  2. Manning SE, Rupprecht CE, Fishbein D, et al; Advisory Committee on Immunization Practices Centers for Disease Control and Prevention (CDC). Human rabies prevention—United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28.
  3. Centers for Disease Control and Prevention (CDC). Learning about bats and rabies. CDC website. https://www.cdc.gov/rabies/bats/education/index.html. Updated April 22, 2011. Accessed July 1, 2019.
  4. World Health Organization (WHO). Rabies. WHO website. https://www.who.int/news-room/fact-sheets/detail/rabies. Updated September 27, 2019. Accessed December 4, 2019.
  5. Birhane MG, Cleaton JM, Monroe BP, et al. Rabies surveillance in the United States during 2015. J Am Vet Med Assoc. 2017;250(10):1117-1130.
  6. Pieracci EG, Pearson CM, Wallace RM, et al. Vital signs: trends in human rabies deaths and exposures—United States, 1938-2018. MMWR Morb Mortal Wkly Rep. 2019;68(23):524-528.
  7. Crowcroft NS, Thampi N. The prevention and management of rabies. BMJ. 2015;350:g7827.
  8. Noah DL, Drenzek CL, Smith JS, et al. Epidemiology of human rabies in the United States, 1980 to 1996. Ann Intern Med. 1998;128(11):922-930.
  9. Centers for Disease Control and Prevention (CDC). Recovery of a patient from clinical rabies—California, 2011. MMWR Morb Mortal Wkly Rep. 2012;61(4):61-65.
  10. Rupprecht CE, Briggs D, Brown CM, et al; Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010;59(RR-2):1-9.
  11. HyperRAB (rabies immune globulin [human]) Prescribing Information. Grifols.
  12. Baddour LM, Harper M. Patient education: animal bites (beyond the basics). UpToDate website. https://www.uptodate.com/contents/animal-and-human-bites-beyond-the-basics. Updated August 27, 2019. Accessed December 4, 2019.
  13. Baxter D. Active and passive immunity, vaccine types, excipients and licensing. Occup Med (Lond). 2007;57(8):552-556.
  14. Centers for Disease Control and Prevention (CDC). Principles of vaccination. CDC website. http://cdc.gov/vaccines/pubs/pinkbook/downloads/prinvac.pdf. Accessed June 26, 2019.
  15. Wilde H. Failures of post-exposure rabies prophylaxis. Vaccine. 2007;25(44):7605-7609.
  16. World Health Organization (WHO). WHO expert consultation on rabies. Second report. World Health Organ Tech Rep Ser. 2013;(982):1-139, back cover.
  17. Nigg AJ, Walker PL. Overview, prevention, and treatment of rabies. Pharmacotherapy. 2009;29(10):1182-1195.
  18. Siegrist CA. Vaccine immunology. In: Plotkin SA, Orenstein WA, Offit PA, eds. Vaccines. 6th ed. Philadelphia: Elsevier-Saunders; 2013:17-36.