Is rabies (Rabies) vaccine indicated for pregnant women?

Rabies Vaccine in Pregnancy

Pregnancy is not considered a contraindication to rabies vaccination for both post-exposure prophylaxis and pre-exposure prophylaxis when there is substantial risk of exposure. 1

Post-Exposure Prophylaxis

• The rabies inactivated virus vaccine should be administered to pregnant women following potential rabies exposure, as the consequences of inadequately treated rabies exposure (nearly 100% fatal) far outweigh any theoretical risks 1
• No increased incidence of abortion, premature births, or fetal abnormalities has been associated with rabies vaccination during pregnancy 1
• Studies of pregnant women receiving post-exposure prophylaxis have shown:
  • No significant adverse effects on pregnancy outcomes 2, 3, 4
  • Adequate rabies neutralizing antibody titers well above the minimum protective level 2
  • Normal intrauterine growth and development 2

Pre-Exposure Prophylaxis

• Pre-exposure prophylaxis may also be indicated during pregnancy if there is substantial risk of exposure to rabies 1
• The safety demonstrated in post-exposure studies supports the use of rabies vaccine before exposure for pregnant women at high risk 1
• The inactivated virus platform used in rabies vaccines is considered safer in pregnancy compared to live attenuated vaccines 1

Clinical Considerations

• Rabies immune globulin (RIG) can also be administered during pregnancy when indicated as part of post-exposure prophylaxis 5, 6
• When administering rabies vaccine to pregnant women:
  • Monitor for standard adverse reactions which are typically mild and transient 3
  • No special dosing adjustments are needed 1
  • The standard vaccination schedule should be followed 1

Important Caveats

• The decision to administer pre-exposure prophylaxis should consider the likelihood of exposure to rabies 1
• Rabies has nearly 100% mortality once clinical symptoms develop, making prevention critical 1
• Mother-to-child transmission of rabies is possible but rare 7
• For babies born to mothers with suspected rabies, post-exposure prophylaxis including RIG should be administered to the infant as soon as possible 7

Algorithm for Decision-Making

1. For post-exposure situations:

   • Always administer complete post-exposure prophylaxis regardless of pregnancy status 1
   • Follow standard protocols including wound cleaning, rabies vaccine, and rabies immune globulin when indicated 1

2. For pre-exposure prophylaxis:

   • Assess risk of exposure (veterinarians, laboratory workers handling rabies virus, travelers to high-risk areas) 1
   • If risk is substantial, administer pre-exposure vaccination despite pregnancy 1
   • If risk is low or can be postponed, consider delaying until after pregnancy 1