NOTE:
#  One-week, 2-site ID regimen (Institut Pasteur du Cambodge regimen); duration of the entire PEP course: 7 days.
$ Two-week, 1-site IM regimen (4-dose modified Essen regimen); duration of entire PEP course: between 14 and 28 days.
*  Individuals with documented evidence of previous PrEP, or at least 2 previous administrations of rabies vaccine as PEP are considered previously immunised and benefit from an abridged PEP without RIG in case of exposure.

Contraindications and Adverse Effects

1. Individuals with a history of severe hypersensitivity to any of the components or to excipients listed by the vaccine manufacturer should receive an alternative rabies vaccine product for PrEP.
2. There is no contraindication to PEP and PrEP, including for infants, pregnant and lactating women, HIV-infected and other immunocompromised individuals and those receiving with chloroquine or hydroxychloroquine treatment. Where possible, PrEP should be completed before chloroquine or hydroxychloroquine treatment is initiated.
3. Reported adverse events include transient minor local erythema (0.5–1%), induration (3–11%), and tenderness (14–29%).

To date, the most frequently reported adverse events for rabies received by the National Pharmaceutical Regulatory Agency (NPRA) is pruritus, rash and fever.

Unlike nerve-tissue derived rabies vaccines that can induce severe adverse reactions and is no longer recommended by WHO, cell culture and embryonated egg-based vaccines (CCEEVs) are safe and well-tolerated. Minor and transient local adverse reaction such as erythema, pain and/or swelling may occur at the site of injection in 35–45% of recipients. Mild systemic adverse events such as transient fever, headache, dizziness and gastrointestinal symptoms, have been reported in 5–15% of recipients.

Evidence for Effectiveness
Modern CCEEVs are highly immunogenic. They induce a prompt and strong vaccine-induced neutralising antibody response against the G protein of RABV. A minimum serum antibody concentration of 0.5 IU/mL is widely used and recommended by WHO as a measure of adequate seroconversion following vaccination. The antibody titre is reached by day 7–14 of a PEP regimen, with or without simultaneous administration of RIG in most individuals, regardless of their age or nutritional status.

Whilst PEP using modern CCEEVs is known to be highly effective, it does not necessarily confer 100% protection against the development of human rabies infection. Delay in seeking PEP, inadequate wound care, unnoticed wounds, direct neural inoculation, use of ineffective rabies vaccine, improper vaccine administration (e.g., subcutaneous injection) or non-adherence to vaccination schedule and poor quality vaccine (non-WHO prequalified or cold-chain quality issue) are several important causes of PEP failure in humans.