Is the rabies (Rabies) vaccine safe to administer during pregnancy?

Rabies Vaccine Safety in Pregnancy

Rabies vaccine should be administered to pregnant women both for post-exposure prophylaxis and pre-exposure prophylaxis when there is substantial risk, as pregnancy is not a contraindication to rabies vaccination. 1

Post-Exposure Prophylaxis: Always Administer

For any pregnant woman with potential rabies exposure, complete post-exposure prophylaxis must be given immediately regardless of pregnancy status. 1 The rationale is straightforward:

• Rabies has nearly 100% mortality once clinical symptoms develop, making the consequences of inadequately treated exposure far more dangerous than any theoretical vaccine risks 2, 1
• No increased incidence of abortion, premature births, or fetal abnormalities has been associated with rabies vaccination during pregnancy 1
• Large-scale safety data from 202 pregnant Thai women who received post-exposure treatment showed adverse reaction rates similar to non-pregnant patients, with no congenital malformations detected 3
• A study of 21 pregnant women receiving post-exposure vaccination found only mild, transient side effects (15% reported myalgia, malaise, injection site reactions), with all infants healthy at one-year follow-up 4

Pre-Exposure Prophylaxis: Indicated for Substantial Risk

Pre-exposure prophylaxis may be administered during pregnancy if there is substantial risk of rabies exposure. 2, 1 This includes:

• Pregnant women working in veterinary medicine, animal control, or rabies laboratories 1
• Those traveling to rabies-endemic areas with anticipated animal contact 1
• The inactivated virus platform used in rabies vaccines is inherently safer in pregnancy compared to live attenuated vaccines 1

Vaccination Protocol

No special dosing adjustments or schedule modifications are needed for pregnant women—follow the standard vaccination protocol. 1 This includes:

• Standard intramuscular administration at the recommended intervals 1
• Rabies immunoglobulin should be given for WHO category III exposures, though the FDA label notes it should only be given "if clearly needed" during pregnancy 5
• Complete the full vaccine series; do not discontinue due to pregnancy status 2

Critical Pitfall to Avoid

The most dangerous error is withholding or delaying rabies post-exposure prophylaxis due to pregnancy concerns. 3 A 2015-2016 investigation in Vietnam documented six deaths among pregnant and breastfeeding women who feared vaccine risks to their fetus or child and consequently avoided post-exposure prophylaxis after dog bites—all six patients died from rabies 6. This underscores that vaccine hesitancy in pregnancy is far more dangerous than the vaccine itself.

Special Considerations for Immunosuppression

If the pregnant patient is on corticosteroids or other immunosuppressive medications:

• Do not withhold post-exposure prophylaxis 2
• Obtain serum antibody testing to ensure adequate immune response has developed 2
• Immunosuppressive agents should not be administered during post-exposure therapy unless essential for other medical conditions 2