The Australian Immunisation Handbook 10th Edition 2013

Pre-exposure prophylaxis for rabies virus and other lyssaviruses (including ABLV)
PreP with rabies vaccine is recommended for:
• persons liable to receive bites or scratches from bats (this includes bat
handlers, veterinarians, wildlife officers and others who come into direct
contact with bats) in any country, including Australia
• travellers and expatriates who will be spending time in rabies-enzootic areas;
PreP should occur following a risk assessment that takes into consideration
the likelihood of interaction with animals and access to emergency medical
attention
• persons working with terrestrial animals in rabies-enzootic areas
• research laboratory personnel working with any live lyssaviruses.
Parents travelling with children to rabies-enzootic areas should consider PreP for
younger children, as many children, if bitten by dogs, are often bitten on the face
and hands because they are at an optimal height for such contact.
Serological testing to confirm seroconversion is only necessary in certain
circumstances (see ‘Serological testing following rabies vaccination’ below). 22
PreP simplifies the management of a subsequent exposure because fewer doses
of vaccine are needed and because rabies immunoglobulin (RIG) is not required
(see ‘Post-exposure prophylaxis for rabies virus and other lyssavirus (including
ABLV) exposures’ below). This is particularly important as RIG (human or
equine) is often difficult to obtain in many developing countries and its safety
may not be guaranteed.
Pre-exposure prophylaxis administered via the intradermal route
Intradermal PreP is not recommended because, although initial antibody titres
may be higher, titres at 14 days are lower and wane more rapidly after ID
administration of rabies vaccine than after either IM or SC administration. There
may also be a slow initial immune response following exposure to rabies virus
in those given ID rabies vaccine. 42-44 For these reasons, it is strongly recommended
that the IM route (IM or SC if HDCV is used) be used for pre-exposure prophylaxis. (See
also 4.16.7 Dosage and administration above.)
However, if ID rabies PreP is considered (using a dose of 0.1 mL on days 0, 7 and
28) it is essential that:
• it is given by vaccine providers with not only expertise in, but also regular
practice of, the ID technique
• it is not administered to anyone who is immunocompromised
• it is not administered to persons taking either chloroquine or other
antimalarials structurally related to chloroquine (e.g. mefloquine), at either
the time of, or within a month following, vaccination45 • any remaining vaccine is discarded at the end of the session during which the
vial is opened (8 hours)
PART 4 VACCINE-PREVENTABLE DISEASES 359
4.16 RABIES AND OTHER
LYSSAVIRUSES (INCLUDING
AUSTRALIAN BAT LYSSAVIRUS)