The Australian Immunisation Handbook 10th Edition 2013

Although data are limited on the effectiveness of rabies vaccine and HRIG as PEP
against infection with lyssaviruses other than classical rabies virus, the available
animal data and clinical experience support their use. 19,24-29
Post-exposure prophylaxis of persons who have been previously vaccinated
Wound management must still be carried out irrespective of prior rabies
vaccination.
Persons who have evidence of a previous completed recommended PreP or PEP
regimen, or who have a previously documented adequate VNAb titre, require a
total of 2 doses of rabies vaccine (see Figure 4.16.1 or Figure 4.16.2). This includes
immunocompromised individuals; however, VNAb levels should be checked
after the 2nd dose to ensure they are adequate (see ‘Serological testing following
rabies vaccination’ below).
Note: PreP or PEP vaccine administered via the ID route is not considered
appropriate previous vaccination unless documentation of an adequate VNAb
titre is available (see ‘Serological testing following rabies vaccination’ below).
HRIG is not required and should not be administered, as its use may suppress
the level of anamnestic response and circulating VNAb.
In cases where a person’s vaccination status is uncertain because the
documentation of a full course of rabies vaccine is not available, the full PEP
regimen should be administered.
Post-exposure prophylaxis commenced overseas
Australians travelling overseas who are exposed to a potentially rabid animal
(including bats from any country) may be given PEP using vaccines and
schedules not used in Australia. In very rare circumstances, if an older nerve
tissue-derived rabies vaccine has been administered, any doses given should be
disregarded (see Table 4.16.2). However, it is most likely that a person vaccinated
overseas will have received a cell culture-derived vaccine (see ‘Interchangeability
of rabies vaccines’ in 4.16.7 Dosage and administration above). 22,34 If a person
has received a cell culture-derived vaccine abroad, it is recommended that the
standard post-exposure prophylaxis regimen be continued in Australia with
either HDCV or PCECV.
WHO-approved post-exposure rabies vaccination regimens include:
• Zagreb (2 doses on day 0, doses on days 7 and 21: annotated as 2-0-1-1)
• Essen (doses given on days 0, 3, 7, 14 and 28 (or 30): annotated as 1-1-1-1-1)
• Modified Essen (doses given on days 0, 3, 7 and 14: annotated as 1-1-1-1).
If the PEP was started overseas but HRIG or equine RIG was not given, and the
person presents in Australia within 7 days of commencing PEP, HRIG should be
given as soon as is practicable (and within 7 days of the 1st rabies vaccine dose).
If the person presents in Australia 8 days or more after commencing PEP, then
HRIG should not be administered and the appropriate number of remaining
doses of rabies vaccine administered.
PART 4 VACCINE-PREVENTABLE DISEASES 363
4.16 RABIES AND OTHER
LYSSAVIRUSES (INCLUDING
AUSTRALIAN BAT LYSSAVIRUS)