What if I receive treatment outside the United States?

Postexposure therapy outside the United States may include materials not used in the U.S. such as purified vero cell rabies vaccine (Verorab ™, Imovax – Rabies vero ™, TRC Verorab ™), purified duck embryo vaccine (Lyssavac N ™), or different formulations of PCEC (Rabipur ®) or HDCV (Rabivac ™).

If these materials have been used, it might be necessary to provide additional therapy when the patient returns to the United States. State or local health departments should be contacted for specific advice in such cases. If titers are obtained, specimens collected 2-4 weeks after preexposure or postexposure prophylaxis would be considered adequate if they completely neutralize challenge virus at a 1:5 serum dilution by the RFFIT.

Purified equine rabies immune globulin (ERIG) has been used effectively in developing countries where HRIG might not have be available. The incidence of adverse reactions has been low (0.8%-6.0%), and most of those that occurred were minor. In addition, unpurified anti-rabies serum of equine origin might still be used in some countries where neither HRIG nor ERIG are available. The use of this anti-rabies serum is associated with higher rates of serious adverse reactions, including anaphylaxis.

Although no postexposure vaccine failures have occurred in the United States since cell culture vaccines have been routinely used, failures have occurred abroad when some deviation was made from the recommended postexposure prophylaxis protocol or when less than the currently recommended amount of RIG was administered. Specifically, patients who contracted rabies after postexposure prophylaxis did not have their wounds cleansed with soap and water, did not receive their rabies vaccine injections in the deltoid area (i.e., vaccine was administered in the gluteal area), or did not receive RIG around the wound site.

For more information also see the international WHO guidelines for rabies postexposure treatment.