Rabies vaccination

Rabies is a fatal disease. This disease can be prevented by vaccination.

When should you get vaccinated?

Rabies vaccines can be administered in two ways:

• Before exposure, also known as pre-exposure prophylaxis (PrEP) vaccination. This schedule prepares your immune system, but does not yet offer full protection against the disease.
• After potential exposure, also known as post-exposure prophylaxis (PEP). This course of vaccination prevents the disease from developing and must be started as soon as possible after the risk has occurred.

Anyone who has previously received a rabies PrEP vaccination and is subsequently exposed must still receive a PEP vaccination after each new exposure. However, the response to this PEP vaccination is faster and more effective. Furthermore, the PEP vaccination schedule is shorter for people who have received rabies PrEP vaccination.

In general, rabies PrEP vaccination is recommended for:

• people travelling to countries where rabies occurs in dogs. In such cases, this is noted in the relevant country fact sheet. This risk score can help you make your choice.
• people who come into regular contact with bats (e.g. animal rescue centres).

Which vaccines?

In Belgium, two rabies vaccines are available: Rabipur® and Verorab®. Both vaccines can be administered intramuscularly (IM) or intradermally (ID) and are interchangeable within the same schedules.

Vaccination schedule

• Rabies PrEP vaccination:
  • 2 doses ID or IM with a minimum 7-day interval
  • for people with a weakened immune system: 3 doses IM on days 0, 7 and 21
• Rabies PEP vaccination
  • for people who have previously received a rabies PrEP vaccination and have normal immunity: 2 doses IM with a 3-day interval
  • for people without prior PrEP, or people with compromised immunity, and depending on the injury:
    • 4 doses: double dose on day 0, 1 dose on day 7, 1 dose on day 21
    • or 5 doses: 1 dose on day 0, day 3, day 7, day 14 and day 21, in combination with immunoglobulins at the start. 
    •  for people who have been exposed to a bat but have no visible injuries (e.g. waking up to find a bat in their bedroom), the PrEP vaccination schedule is recommended.

Side effects:

The vaccine is generally well tolerated. Pain at the injection site, headache, flu-like symptoms and swollen lymph nodes may occur.

Additional information for doctors

https://artsen.wanda.be/en/a-z-index/rabies

https://artsen.wanda.be/en/a-z-index/rabies-post-exposure-prophylaxis-pep