Postexposure Treatment for Rabies

Q&A

What is rabies?
Rabies is a disease that affects the central nervous system and is transmitted by coming into contact with the saliva of an infected animal.1

How is it contracted?
Rabies can be contracted if you are bitten, scratched, or come into contact with infected saliva from a wild animal, especially raccoons (which are the most common carriers of rabies). Skunks, bats, and foxes, as well as some domestic animals, such as dogs, can also transmit the disease.2,3

What are the symptoms?
Those suffering from rabies will experience symptoms that resemble the flu, such as fatigue, headaches, fever, and general feeling of illness. These symptoms will usually be followed by more serious symptoms such as overproduction of saliva, confusion, hallucinations, and slight or partial paralysis. Rabies, once contracted, is almost always fatal.4,5

How can I prevent rabies?
As soon as the incident with the animal has taken place, go directly to the hospital, and if possible, every effort should be made to capture the animal without risking another bite. If you are unable to capture the animal, proceed directly to the hospital.6

What is a rabies immune globulin and why isn't a vaccine enough?
A rabies immune globulin is a treatment that contains high levels of rabies antibodies. An immune globulin works much faster than a vaccine, but does not last as long. Because of the potentially life-threatening nature of rabies, doctors will give you a rabies immune globulin shot like HyperRAB and a vaccine to make sure you get the comprehensive care you need.6,7

QUICK FACTS

  • If left untreated, rabies is essentially 100% fatal8
  • According to the CDC, the most common carriers of rabies in the United States are raccoons3
  • According to the CDC, wound cleansing and administration of a rabies immune globulin, such as HyperRAB, as soon as possible after potential contact with an animal may prevent the onset of rabies8
  • Once the signs and symptoms of rabies start to appear, there is no treatment, and the disease is almost always fatal4

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.


References:

  1. Centers for Disease Control and Prevention (CDC). What materials can spread rabies? CDC website. http://www.cdc.gov/rabies/exposure/materials.html. Updated April 22, 2011. Accessed May 12, 2016.
  2. Centers for Disease Control and Prevention (CDC). How is rabies transmitted? CDC website. http://www.cdc.gov/rabies/transmission/index.html. Updated April 22, 2011. Accessed May 12, 2016.
  3. Dyer JL, Yager P, Orciari L, et al. Rabies surveillance in the United States during 2013. J Am Vet Med Assoc. 2014;245(10):1111-1123.
  4. Crowcroft NS, Thampi N. The prevention and management of rabies. BMJ. 2015;350:g7827.
  5. Centers for Disease Control and Prevention (CDC). What are the signs and symptoms of rabies? CDC website. http://www.cdc.gov/rabies/symptoms/index.html. Updated February 15, 2012. Accessed May 12, 2016.
  6. Centers for Disease Control and Prevention (CDC). What care will I receive? CDC website. http://www.cdc.gov/rabies/medical_care/index.html. Updated March 23, 2016. Accessed May 12, 2016.
  7. HyperRAB® S/D (rabies immune globulin [human]) Prescribing Information. Grifols.
  8. Centers for Disease Control. Human rabies prevention — United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR03);1-28.