Postexposure Prophylaxis Treatment for Rabies

Between 16,000 and 39,000 people report coming in contact with potentially rabid animals and receive rabies postexposure prophylaxis each year.1

According to the Centers for Disease Control and Prevention (CDC), rabies is almost always fatal, but it is almost 100% preventable with the comprehensive treatment that can only be provided by a rabies immune globulin, such as HyperRAB® S/D (rabies immune globulin [human]), in conjunction with a vaccine.2

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

Vaccines can take weeks to build efficacy, but HyperRAB S/D provides immediate protection. This allows the vaccine the time needed to establish active immunity; giving your patients the critical protection they need now.3

Immediate Protection

HyperRAB S/D contains high titers of rabies antibodies for postexposure prophylaxis (PEP), providing rapid immune protection. Along with appropriate wound cleansing, a human rabies immune globulin such as HyperRAB S/D is recommended by the CDC and World Health Organization (WHO) to be administered at the same time as the rabies vaccine in previously unvaccinated persons, immediately following a transdermal bite or scratch by an animal suspected of being rabid.2,4

For unvaccinated individuals, the combination of human rabies immune globulin and vaccine is recommended for both bite and nonbite exposures, regardless of the time interval between exposure and initiation of PEP. If PEP has been initiated and appropriate laboratory diagnostic testing (ie, the direct fluorescent antibody test) indicates that the animal that caused the exposure was not rabid, PEP may be discontinued.2

General Guidelines (previously unvaccinated adults and children)

  • The recommended dose for HyperRAB S/D is 20 IU/kg (0.133 mL/kg) of body weight, given preferably at the time of first vaccine. If vaccine is not available, treat with HyperRAB S/D immediately
  • HyperRAB S/D should be administered as promptly as possible after exposure, but can be administered up to the eighth day after the first dose of vaccine is given
  • HyperRAB S/D and vaccine should never be administered in the gluteal area


Safety Is a Priority

  • HyperRAB S/D is mercury (thimerosal) free and latex free5
  • HyperRAB S/D has Food and Drug Administration (FDA) labeling for removal of pathogenic prions that may cause transmissible spongiform encephalopathies in humans5
    • Studies of the HyperRAB manufacturing process demonstrated that TSE clearance is achieved during the Pooled Plasma to Effluent III Fraction Process (6.7 log10). These studies provide reasonable assurance that low levels of CJD/vCJD agent infectivity, if present in the starting material, would be removed
  • HyperRAB S/D provides tamper-evident packaging
  • HyperRAB S/D is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent that can cause disease. There is also the possibility that unknown infectious agents may be present in such products

Dosing Recommendations

The recommended dose for HyperRAB S/D is 20 IU/kg (0.133 mL/kg) of body weight given at time of first vaccine dose. It may also be given up to the eighth day after the first dose of vaccine.5

Product Information

HyperRAB S/D Product Information

Rabies vaccine and HyperRAB® S/D (rabies immune globulin [human]) should be given to all persons suspected of exposure to rabies with one exception: persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. HyperRAB S/D should be administered as promptly as possible after exposure, but can be administered up to the eighth day after the first dose of vaccine is given.

HyperRAB S/D should be given with caution to patients with a history of prior systemic allergic reactions following the administration of human immunoglobulin preparations.

The attending physician who wishes to administer HyperRAB S/D to persons with isolated immunoglobulin A (IgA) deficiency must weigh the benefits of immunization against the potential risks of hypersensitivity reactions. Such persons have increased potential for developing antibodies to IgA and could have anaphylactic reactions to subsequent administration of blood products that contain IgA.

As with all preparations administered by the intramuscular route, bleeding complications may be encountered in patients with thrombocytopenia or other bleeding disorders.

Soreness at the site of injection and mild temperature elevations may be observed at times. Sensitization to repeated injections has occurred occasionally in immunoglobulin-deficient patients. Angioneurotic edema, skin rash, nephrotic syndrome, and anaphylactic shock have rarely been reported after intramuscular injection so that a causal relationship between immunoglobulin and these reactions is not clear.

Administration of live virus vaccines (e.g., MMR) should be deferred for approximately 3 months after rabies immune globulin (human) administration.

HyperRAB S/D is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent that can cause disease. There is also the possibility that unknown infectious agents may be present in such products.

Please see HyperRAB S/D full Prescribing Information for complete prescribing details.

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.


References:

  1. Centers for Disease Control and Prevention (CDC). Rabies vaccine: what you need to know. CDC website. http://www.cdc.gov/vaccines/hcp/vis/vis-statements/rabies.pdf. Published October 6, 2009. Accessed March 25, 2016.
  2. Centers for Disease Control and Prevention. Human rabies prevention — United States, 2015: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2008;57(RR03):1-26,28.
  3. Baxter D. Active and passive immunity, vaccine types, excipients and licensing. Occup Med (Lond). 2007;57(8):552-556.
  4. World Health Organization (WHO). Rabies. Current strategies for human rabies pre and post-exposure prophylaxis. WHO website. http://www.who.int/rabies/human/postexp/en/#. Updated 2016. Accessed April 11, 2016.
  5. HyperRAB® S/D (rabies immune globulin [human]) prescribing information. Grifols Therapeutics Inc. September 2012.