Rabies Vaccine Safety During Pregnancy
The rabies vaccine is definitively safe to administer during pregnancy for both post-exposure prophylaxis (PEP) and pre-exposure prophylaxis when there is substantial risk of exposure, and pregnancy should never be considered a contraindication to rabies vaccination. 1, 2
Post-Exposure Prophylaxis: Always Administer
For any pregnant woman with potential rabies exposure, immediately administer complete post-exposure prophylaxis without hesitation, as the consequences of inadequately treated rabies exposure (nearly 100% fatal) far outweigh any theoretical risks. 1, 2
Evidence of Safety
No increased incidence of abortion, premature births, or fetal abnormalities has been documented with rabies vaccination during pregnancy. 1, 2
The largest prospective study of 202 pregnant Thai women who received tissue culture-derived rabies vaccine and rabies immune globulin showed adverse reaction rates similar to non-pregnant patients, with all mothers and infants remaining healthy. 3
A study of 29 pregnant women vaccinated with purified vero cell rabies vaccine found no adverse side effects, normal intrauterine growth, satisfactory pregnancy outcomes, and no congenital anomalies in any infants during one-year follow-up. 4
Among 21 pregnant patients receiving purified Vero cell rabies vaccine, only mild transient side effects occurred (15% reported myalgia, malaise, erythema, swelling, urticarial rashes, mild lymphadenopathy), with no congenital malformations detected and all infants well after one year. 5
A 2019 systematic review concluded that available data indicate administering rabies vaccines during pregnancy is safe and effective. 6
Pre-Exposure Prophylaxis: Indicated When Risk is Substantial
Pre-exposure prophylaxis may be indicated during pregnancy if there is substantial risk of exposure to rabies, such as for veterinarians, animal handlers, laboratory workers, or travelers to rabies-endemic areas. 1, 2
The safety demonstrated in post-exposure studies (which involve actual exposures and higher-risk scenarios) supports the use of rabies vaccine before exposure for pregnant women at high risk. 1, 2
The inactivated virus platform used in rabies vaccines is inherently safer in pregnancy compared to live attenuated vaccines. 1, 2
Vaccination Protocol: No Modifications Needed
Administer the standard vaccination schedule to pregnant women with no special dosing adjustments. 2
For post-exposure prophylaxis, use the standard 4-dose series on days 0,3,7, and 14, plus rabies immune globulin (20 IU/kg) for WHO category III exposures. 7
For pre-exposure prophylaxis, administer three 1.0-mL injections intramuscularly in the deltoid area on days 0,7, and 21 or 28. 8
Rabies Immune Globulin Safety
Rabies immune globulin should be administered to pregnant women when indicated, as pregnancy is not considered a contraindication to post-exposure prophylaxis. 9
The FDA label for rabies immune globulin states that limited data indicate fetal abnormalities have not been associated with rabies vaccination, and if there is substantial risk of exposure, pre-exposure prophylaxis may also be indicated during pregnancy. 9
Critical Clinical Context
Rabies has nearly 100% mortality once clinical symptoms develop, making prevention absolutely critical regardless of pregnancy status. 2, 7
The decision-making algorithm is straightforward: For post-exposure situations, always administer complete prophylaxis; for pre-exposure situations, assess the likelihood of exposure and vaccinate if risk is substantial. 2, 8
Common Pitfalls to Avoid
Never delay or withhold rabies post-exposure prophylaxis due to pregnancy concerns—this is the most dangerous error. 3
Do not confuse rabies vaccine (inactivated, safe in pregnancy) with live attenuated vaccines that are contraindicated in pregnancy. 1
Do not assume that mild adverse reactions (myalgia, injection site reactions) represent a safety concern—these are common, transient, and require no treatment. 5