Rabies

Travelers to endemic areas, veterinarians, animal handlers, cave explorers, laboratory workers.

Pregnancy: Safe — must be given for post-exposure prophylaxis (PEP).

Rabies vaccine is an inactivated cell-culture vaccine and is safe during pregnancy.

• Post-exposure prophylaxis (PEP): NO contraindications exist — rabies PEP must be administered regardless of pregnancy, gestational age, or any other condition. Rabies is nearly 100% fatal once symptomatic.

• Pre-exposure prophylaxis: safe to administer during pregnancy when occupational or travel risk warrants it.

• WHO: pregnancy is not a contraindication for either PrEP or PEP.

• No teratogenic effects observed in published case series.

Breastfeeding: Safe — no restrictions.

Rabies vaccine is inactivated and completely safe during breastfeeding. PEP must never be withheld or delayed for any reason, including breastfeeding. No modification to breastfeeding required.

Pediatric use:

• No minimum age restriction — rabies vaccine can be given to infants if needed for PEP.

• Children are at higher risk of animal bites (especially from dogs) and may not report exposures.

• WHO intradermal regimen (0.1 mL ID) approved for children — reduces cost significantly.

• Pre-exposure: recommended for children with prolonged travel to rabies-endemic areas (especially if staying in rural settings).

• Same dose as adults: 0.5 mL or 1.0 mL IM depending on formulation.

Geriatric use:

• No specific age-related contraindications. Standard dose and schedule apply.

• Immunocompromised elderly patients may have a reduced antibody response — check antibody titer (≥0.5 IU/mL) after pre-exposure vaccination or PEP completion.

• PEP must never be withheld based on age.