From the Guidelines
The Rabies vaccine is associated with local reactions such as pain at the injection site, redness, swelling, and induration, which occur in 11%--57% of recipients.
Common Side Effects
- Local pain at the injection site, reported in 2%--23% of vaccinees 1
- Systemic reactions, reported in 0--31% of vaccine recipients 1 ### Rare Side Effects
- Neurologic adverse events, such as Guillain-Barré syndrome, have been reported in rare cases, but causality has not been established 2
- Anaphylactic or neuroparalytic reactions are rare, but pose a serious dilemma for the patient and the attending physician 3, 4 ### Management of Adverse Reactions Advice and assistance on the management of serious adverse reactions for persons receiving rabies vaccines can be sought from the state or local health department or CDC 3, 4. It is essential to carefully consider a patient's risk for acquiring rabies before deciding to discontinue vaccination 3, 4.
From the FDA Drug Label
ADVERSE REACTIONS Once initiated, rabies prophylaxis should not be interrupted or discontinued because of local or mild systemic adverse reactions to rabies vaccine. Usually such reactions can be successfully managed with anti-inflammatory, antihistaminic, and antipyretic agents. (11) Reactions after vaccination with HDCV have been observed (13) In a study using five doses of HDCV, local reactions such as pain, erythema, swelling or itching at the injection site were reported in about 25% of recipients of HDCV, and mild systemic reactions such as headache, nausea, abdominal pain, muscle aches, and dizziness were reported in about 20% of recipients (8) Data from post-marketing experience The following additional adverse events have been identified during postapproval use of Imovax Rabies vaccine Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to Imovax Rabies vaccine exposure Blood and Lymphatic System Disorders Lymphadenopathy Immune System Disorders Anaphylactic reaction, serum sickness type reaction, dermatitis allergic, pruritus (itching), edema Nervous System Disorders Paresthesia, neuropathy, convulsion, encephalitis, syncope Gastrointestinal Disorders Vomiting, diarrhea Musculoskeletal and Connective Tissue Disorders Arthralgia General Disorders and Administration Site Conditions Asthenia, malaise, fever and chills (shivering), injection site hematoma Respiratory, Thoracic, and Mediastinal Disorders Wheezing, dyspnea WARNINGS Do not inject the vaccine into the gluteal area as administration in this area may result in lower neutralizing antibody titers. (11) Serum sickness type reactions have been reported in persons receiving booster doses of rabies vaccine for pre-exposure prophylaxis. The reaction is characterized by onset approximately 2 to 21 days post-booster, presents with a generalized urticaria, and may also include arthralgia, arthritis, angioedema, nausea, vomiting, fever, and malaise None of the reported reactions were life-threatening. This has been reported in up to 7% of persons receiving booster vaccination. (13) Rare cases of neurologic illness resembling Guillain-Barré syndrome, (14) (15) a transient neuroparalytic illness, that resolved without sequelae in 12 weeks and a focal subacute central nervous system disorder temporally associated with HDCV, have been reported (16)
The side effects of the Rabies vaccine include:
- Local reactions: pain, erythema, swelling, or itching at the injection site (reported in about 25% of recipients)
- Mild systemic reactions: headache, nausea, abdominal pain, muscle aches, and dizziness (reported in about 20% of recipients)
- Serious systemic reactions: anaphylactic reaction, serum sickness type reaction, dermatitis allergic, pruritus (itching), edema
- Neurologic disorders: paresthesia, neuropathy, convulsion, encephalitis, syncope
- Gastrointestinal disorders: vomiting, diarrhea
- Musculoskeletal and connective tissue disorders: arthralgia
- General disorders and administration site conditions: asthenia, malaise, fever and chills (shivering), injection site hematoma
- Respiratory, thoracic, and mediastinal disorders: wheezing, dyspnea
- Serum sickness type reactions (reported in up to 7% of persons receiving booster vaccination)
- Neurologic illness resembling Guillain-Barré syndrome (rare cases reported) [5] [6]
From the Research
Side Effects of the Rabies Vaccine
The side effects of the rabies vaccine can vary depending on the type of vaccine and the individual receiving it. Some common side effects include:
- Headache 7, 8
- Pain at the site of administration 7
- Arthralgia (joint pain) 7, 8
- Fatigue 8
- Malaise (general feeling of being unwell) 8
- Dizziness 8
- Chills 8
- Fever 7, 8
- Nausea 8
- Diarrhea 8
- Vomiting 7, 8
- Paraesthesias (abnormal sensations such as tingling or numbness) 8
- Myalgias (muscle pain) 8
Neurological Complications
In some cases, the rabies vaccine can cause more serious neurological complications, such as:
- Meningoradiculitis (inflammation of the membranes surrounding the brain and spinal cord) 9
- Meningomyeloradiculitis (inflammation of the membranes surrounding the brain, spinal cord, and nerve roots) 9
- Meningomyelitis (inflammation of the membranes surrounding the brain and spinal cord) 9
- Myelitis (inflammation of the spinal cord) 9
- Peripheral neuropathy (damage to the nerves outside the brain and spinal cord) 9
Factors Affecting Side Effects
The incidence of side effects can be affected by various factors, including:
- Age: Side effects were more common in certain age groups, such as fever and vomiting in children under 15 years old 7
- Sex: Female patients were more likely to experience side effects than male patients 7
- Chronic illness: Patients with chronic illnesses were more likely to experience side effects, such as headache and arthralgia 7
- Vaccine type: The type of vaccine used can affect the incidence of side effects, with some vaccines causing more side effects than others 7