Vaccine, Rabies (Human) in Pregnancy and Breastfeeding

Risk Factor: CM
Class: Serums, toxoids, and vaccines / Vaccines

Contents of this page:
Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Rabies vaccine (human) is an inactivated virus vaccine (1,2). Animal reproduction studies have not been conducted with the vaccine.

Because rabies is nearly 100% fatal if contracted, the vaccine should be given for postexposure prophylaxis (1,2). Fetal risk from the vaccine is unknown, but indications for prophylaxis are not altered by pregnancy (1). Three reports described the use of rabies vaccine (human) during pregnancy (3,4 and 5). Passive immunity was found in one newborn (titer >1:50) but was lost by 1 year of age (3). No adverse effects from the vaccine were noted in the newborn. The mother had not delivered at the time of the report in the second case (4).

A 1990 brief report described the use of rabies vaccine in 16 pregnant women, 15 using the human diploid cell vaccine and 1 receiving the purified chick embryo cell product (5). In 15 cases the stage of pregnancy was known: nine 1st trimester, three 2nd trimester, and three 3rd trimester. Two women had spontaneous abortions, but the causes were probably not vaccine related. The remaining pregnancy outcomes were 12 full-term healthy newborns, 1 premature delivery at 36 weeks' gestation, and 1 newborn with grand-mal seizures on the 2nd day. In the latter case, no antirabies antibodies were detectable in the infant's serum, indicating that the condition was not vaccine related (5).

In two reports, duck embryocultured vaccine was used during pregnancy (6,7). In 1974 a report appeared describing the use of rabies vaccine (duck embryo) in a woman in her 7th month of pregnancy (6). She was given a 21-day treatment course of the vaccine. She subsequently delivered a healthy term male infant who was developing normally at 9 months of age. The second case was described in 1975 involving a woman exposed to rabies at 35 weeks' gestation (7). She was treated with a 14-day course of vaccine (duck embryo) followed by three booster injections. She gave birth at 39 weeks' gestation to a healthy male infant. Cord blood rabies neutralizing antibody titer was 1:30, indicative of passive immunity, compared with a titer of 1:70 in maternal serum. Titers in the infant fell to 1:5 at 3 weeks of age, then to <1:5 at 6 weeks. Development was normal at 9 months of age.

A 1989 report from Thailand described the use of purified Vero cell rabies vaccine for postexposure vaccination in 21 pregnant women (8). Equine rabies immune globulin was also administered to 12 of the women with severe exposures. One patient aborted 3 days after her first rabies vaccination, but she had noted vaginal bleeding on the day of rabies exposure. No congenital malformations were observed and none of the mothers or their infants developed rabies after a 1-year follow-up (8).

In a subsequent prospective study, the above researchers administered the purified Vero cell rabies vaccine (5-dose regimen) after exposure to 202 pregnant women (9). Some of these women also received a single dose of rabies immune globulin (human or equine). Follow-up of 1 year or greater was conducted in 190 patients; 12 patients were lost to follow-up following postexposure treatment. No increase in maternal (spontaneous abortion, hypertension, placenta previa, or gestational diabetes) or fetal (stillbirth, minor birth defect, or low birth weight) complications was observed in comparison with a control group of nonvaccinated, nonexposed women. The one minor congenital defect observed in the treated group was a type of club foot (talipes equinovalgus).

Breast Feeding Summary

No data are available.

References

  1. American College of Obstetricians and Gynecologists. Immunization during pregnancy. Technical Bulletin. No. 160, October 1991.
  2. Amstey MS. Vaccination in pregnancy. Clin Obstet Gynaecol 1983;10:1322.
  3. Varner MW, McGuinness GA, Galask RP. Rabies vaccination in pregnancy. Am J Obstet Gynecol 1982;143:7178.
  4. Klietmann W, Domres B, Cox JH. Rabies post-exposure treatment and side-effects in man using HDC (MRC 5) vaccine. Dev Biol Stand 1978;40:10913.
  5. Fescharek R, Quast U, Dechert G. Postexposure rabies vaccination during pregnancy: experience from post-marketing surveillance with 16 patients. Vaccine 1990;8:40910.
  6. Cates W Jr. Treatment of rabies exposure during pregnancy. Obstet Gynecol 1974;44:8936.
  7. Spence MR, Davidson DE, Dill GS Jr, Boonthai P, Sagartz JW. Rabies exposure during pregnancy. Am J Obstet Gynecol 1975;123:6556.
  8. Chutivongse S, Wilde H. Postexposure rabies vaccination during pregnancy: experience with 21 patients. Vaccine 1989;7:5468.
  9. Chutivongse S, Wilde H, Benjavongkulchai M, Chomchey P, Punthawong S. Postexposure rabies vaccination during pregnancy: effect on 202 women and their infants. Clin Infect Dis 1995;20:81820.

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Questions and Answers

What are the Side Effects of VERORAB Anti Rabies Human Vaccine?, @topic title

I had to take rabies shots this past year after a cat bite.
I remember I was very sore and had muscle aches and a bit of nausea. I would describe it as mild flu like symptoms. I wrote an article if your interested. About half way thru it I discuss getting the shots and what that was like as well as some symptoms.

Cat Bite Results in Painful Rabies Injections as Precaution
http://www.associatedcontent.com/article...

how long does anti rabies vaccines for human last?, if ever i have already anti rabies vaccines, will i still have it if dogs bite me again?

You will still have to undergo the rabies treatment even if you have had the vaccines. I am undergoing treatment right now b/c the people of the dog that bit me didnt have proof of rabies shots. Rabies treatment is completley different than rabies vanninations. I have had over 20 shots injected in my wound. I also have to have 7 more series of shots. Remember to never get between two dogs and if you see a dog or animal acting strange stay away! Always get your dog vaccines for rabies and keep proof!

What happens if you discontiniue your rabies vaccine in the mid?, Can someone tell me what happens- if a stray dog bite to Human and the Human start taking vaccine in the next day in doubt that Dog might have infected with Rabies. In the mean while if the person discontinue the Vaccine in the mid. What will happen? Weather the person will be infected by Rabies within month /onset will be late may be in some years. What exactly will happen?

Regards,
Pramod

if you are in the middle of a series of preventative vaccinations-and it turned out that the dog that bit you did not have rabies-you could stop. but-better safe than sorry. continue the vaccinations. the ugliness from a person exposed to rabies would turn your stomach.

How long does rabies affect human body?, a dog bitted me one year this day to be exact... after a day, i felt dizzy and weak, i have already completed my vaccine and still feel dizzy till now.. anyone can help me about this? It is possible that rabies cause this dizzines? or there is other factors that affecting my dizziness.?

Since 1974, there have been no reported cases of treatment failure. If a person is not treated adequately, rabies is 100% fatal within 10 days of developing symptoms. It can lay dormant in the body for up to 3 months after the bite. If you are a year out from the bite, you won't have rabies. The dizziness isnot readily explainable by the bite or the vaccine this far out from the time of exposure. I'd get checked by your doctor for the real cause.

Should I get vaccinated for rabies?, I had the 5 series human rabies vaccine last summer after an exposure to a bat, my 5th shot was Sept 14th. Today I was out for a walk and was bit by a stray dog. Not real hard but enough to break the skin and draw blood. I'm not sure if the shots I received last summer are still protecting me or if I need to be boostered? Anybody with the experience of a 2nd possible rabies exposure after the shot series?

The fact that you received vaccine last summer means that you are already immune to the rabies virus!! Your immunity would last for years.
You don't need to be re-vaccinated.

Do rabies vaccines for animals protect humans too?, I've had to rephrase my question, but if your cat or dog has a rabies shot, could they still be a carrier and pass it on to humans?

The only way to get rabies is from direct contact with the saliva of an infected animal. If an infected animal bites you, or if you have a cut or scratch and the saliva from an infected animal gets into it, then you can contract the disease. If your pets have been vacinated for rabies, they will most likely never get the disease, so you should be safe.