Rabies vaccine !
Inactivated cell-culture vaccine. With wound washing and, in severe exposures, rabies immunoglobulin, it prevents a disease that is fatal once symptoms start.
Updated 2026-11-01
Also called: Human diploid cell vaccine (HDCV), Purified chick embryo cell vaccine (PCECV), Purified Vero cell vaccine
The figure shows the prefusion rabies glycoprotein trimer bound to a neutralising antibody; vaccine antibodies target this protein.
Mechanism of action
The virus travels along nerves to the brain; once it reaches the central nervous system and symptoms appear, rabies is fatal. Vaccination after exposure works because the incubation period gives time to build neutralising antibodies against glycoprotein G. In severe exposures, rabies immunoglobulin infiltrated into the wound gives immediate antibody cover until the vaccine's own antibodies appear.
- The wound is washed at once to remove virus
- Immunoglobulin in the wound neutralises virus locally (category III)
- The vaccine induces antibodies against glycoprotein G within days
- The virus is neutralised before it reaches the nervous system
Pharmacokinetics
- Onset and duration
- Active antibodies take days to appear; immunoglobulin covers that gap in severe exposures
Indications
- Post-exposure prophylaxis: WHO category II (minor scratches, nibbling) with vaccine; category III (transdermal bites, saliva on mucosa or broken skin, bat contact) with vaccine plus immunoglobulin
- Pre-exposure prophylaxis for people at high occupational risk (laboratory, animal control, wildlife work)
Adverse effects
Common
- Pain, redness and swelling at the injection site
- Headache, myalgia
Contraindications
- Pregnancy is not a contraindication to post-exposure prophylaxis
- After a previous allergic reaction, the decision is made by the treating team given that rabies is fatal
Key interactions
- Rabies immunoglobulin
- Complementary, but never in the same syringe or the same site as the vaccine, because it can neutralise it
- Previous rabies vaccination
- Previously vaccinated people do not receive immunoglobulin; they need only a short vaccine course
What is monitored
- Category of exposure and status of the animal
- Course completed on schedule
Administration and safety
- Intramuscular in the deltoid (anterolateral thigh in young children); never in the gluteal region
- Immunoglobulin goes into and around the wound, never in the same syringe or site as the vaccine
- Wash the wound with soap and water for at least 15 minutes as first aid
- Record the dates of each dose so the course is completed
Nursing care
- Wash the wound at once and thoroughly
- Classify the exposure (category I, II or III) and report it to surveillance
- Explain that post-exposure prophylaxis is urgent and must be completed
- Teach animal bite prevention and pet vaccination
Pregnancy and breastfeeding
Pregnancy is not a contraindication to post-exposure prophylaxis.
Test yourself
Think of the answer, then tap the question to see it.
Why can a vaccine given after the bite still prevent rabies?
The virus travels slowly along nerves; the incubation period gives time to make neutralising antibodies before it reaches the brain.
What does a WHO category III exposure need?
Wound washing, immediate vaccination and rabies immunoglobulin (or monoclonal antibodies) infiltrated into the wound.
Why is the vaccine not injected into the buttock or in the same site as immunoglobulin?
The gluteal region is never used (CDC), and immunoglobulin at the same site or in the same syringe can neutralise the vaccine.
Related drugs
← Back to the class: Viral vaccines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Rabies (World Health Organization, 2025); Rabies | CDC Yellow Book™ (Centers for Disease Control and Prevention, 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.