The Australian Immunisation Handbook 10th Edition 2013

to 2 years, depending on the risk of exposure, to assess the need for booster
vaccination (see ‘Booster doses’ above).
4.16.9 Pregnancy and breastfeeding
Rabies vaccine and HRIG are recommended in pregnant or breastfeeding women
following a potential exposure to rabies virus, ABLV or another bat lyssavirus64,65 (see 4.16.8 Recommendations above and 3.3 Groups with special vaccination
requirements, Table 3.3.1 Recommendations for vaccination in pregnancy).
4.16.10 Contraindications
There are no absolute contraindications to use of either rabies vaccine or HRIG as
post-exposure prophylaxis in persons with a potential exposure to rabies or other
lyssaviruses, including ABLV. This is because rabies disease is almost always
lethal.
Persons with an anaphylactic sensitivity to eggs, or to egg proteins, should not
receive PCECV. HDCV should be used instead.
See also 4.16.11 Adverse events below.
4.16.11 Adverse events
Cell culture-derived vaccines are generally well tolerated. In a large study, the
following adverse events were reported after administration of HDCV to adults:
sore arm (in 15 to 25% of vaccine recipients), headache (in 5 to 8%), malaise,
nausea or both (in 2 to 5%), and allergic oedema (in 0.1%). 66 Similar adverse event
profiles have been reported for the PCECV; these reactions occur at the same
rates in children. 22,23,67-72
Although anaphylactic reactions are rare (approximately 1 per 10 000
vaccinations) following administration of HDCV, approximately 6% of persons
receiving booster doses may experience allergic reactions. The reactions typically
occur 2 to 21 days after a booster dose, and are characterised by generalised
urticaria, sometimes with arthralgia, arthritis, oedema, nausea, vomiting, fever
and malaise. 66 These reactions are not life-threatening; they have been attributed
to the presence of β-propiolactone-altered human albumin in the implicated
vaccines. 66
HRIG has an excellent safety profile and, in general, no chance of immediate
hypersensitivity reactions as is more often the case with some equine sources of
rabies immunoglobulin. 22
Management of adverse events
Once initiated, rabies post-exposure prophylaxis should not be interrupted or
discontinued because of local reactions or mild systemic reactions. Such reactions
can usually be managed with simple analgesics.
Because rabies disease is almost always lethal, the recommended vaccination
regimens, in particular the PEP regimen, should be continued even if a significant
370 The Australian Immunisation Handbook 10th edition