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Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe

⚠ This medicine appears to have been discontinued

The electronic medicines compendium (emc) no longer publishes a Summary of Product Characteristics for this product, which usually means it is no longer marketed in the UK. The patient leaflet below is kept for reference, but the product may not be available.

If you were prescribed this medicine, other products containing Rabies virus (inactivated, strain flury lep) may still be available. Do not stop your treatment — ask your pharmacist or GP what to use instead.

Active substance: Rabies virus (inactivated, strain flury lep)
Source: electronic medicines compendium (emc)
Official leaflet: Read the PIL on emc

What it is and what it is used for

FOR

What Rabipur is Rabipur is a vaccine containing rabies virus that has been killed. After administration of the vaccine, the immune system (the body's natural defence system) forms antibodies to rabies viruses. These antibodies protect from infections or diseases by the virus that causes rabies. None of the components of the vaccine can cause rabies. What Rabipur is used for Rabipur can be used in individuals of all ages. Rabipur can be used to prevent rabies:

  • before possible risk of exposure to rabies virus (pre-exposure prophylaxis). or
  • after suspected or proven exposure to rabies virus (post-exposure prophylaxis). Rabies is an infection that can be transmitted when a person is bitten, scratched or even just licked by an infected animal, particularly when the skin is already injured. Even contact with animal traps that were licked or bitten by infected animals can cause infections in humans. 2.

WHAT YOU NEED TO KNOW BEFORE YOU/YOUR CHILD RECEIVES RABIPUR

You/Your child must not receive Rabipur before possible risk of exposure to the rabies virus if you/your child:

  • Have/has a history of having a severe allergic reaction to the active substance or any ingredient of the vaccine listed in section 6.
  • Have/has an acute disease requiring treatment. Because of the seriousness of rabies infection, Rabipur can be given to anyone if they have been exposed to rabies, even those who are pregnant. 1

Severe allergic reactions (hypersensitivity) If you or your child is known to be at risk of a severe allergic reaction to the vaccine or to any of the ingredients, you/your child may be given a different vaccine against rabies that does not contain these ingredients. If there is no alternative vaccine available, your doctor or nurse will discuss the risks of vaccination and rabies virus infection with you before you or your child receives the vaccine. Warnings and precautions In case of acute disease requiring treatment, vaccination is usually postponed until at least 2 weeks after recovery. The presence of a minor infection should not require postponement of the vaccination, but talk to your doctor or nurse first. Tell your doctor or nurse before you or your child receives Rabipur for post exposure prophylaxis if you/your child:

  • Have/has a severe allergy to egg or egg products (for symptoms see section 4 of this leaflet). Rabipur contains residues of chicken proteins left over from the manufacturing process.
  • Have/has a severe allergy to the antibiotics neomycin, chlortetracycline, or amphotericin B. These antibiotics may be present in very small amounts in the vaccine.
  • Have/has a severe allergy to polygeline. Fainting can occur following, or even before, any needle injection, therefore tell the doctor or nurse if you fainted with a previous injection. Cases of very rare but severe conditions affecting the nervous system have been reported following the receipt of Rabipur vaccine. See section 4. Anti-inflammatory medicines (steroids), often used to treat these conditions, may interfere with the effectiveness of the vaccine (see below, other medicines and Rabipur). Your doctor or nurse will decide how to proceed in this circumstance. As with all vaccines, Rabipur may not fully protect all people who are vaccinated. The vaccine should not be given into the buttocks, under the skin or into a blood vessel. Other medicines and Rabipur Tell your doctor or nurse if you are /your child is taking, have/has recently taken, or plan to take any other medicines, even those not prescribed. Unless your doctor tells you otherwise, you/your child should continue to take all prescribed medicines as usual. If you or your child already has a poor immune system or is already taking medicines that reduce the body's immunity to infections, Rabipur can still be given but you/your child may not be as well protected as other people. In this case, your/your child's doctor may decide to carry out blood tests after the vaccine administration, to check if the body has produced enough antibodies to the virus. If necessary, you/your child will be given extra doses of the vaccine (see section 3 of this leaflet). Rabipur can be given at the same time as other inactivated vaccines. A different injection site will be used for each type of vaccine. You/Your child may also need to be given an injection of antibodies against rabies (called "rabies immunoglobulin") if you or your child have not been fully vaccinated against rabies and it is very likely that you or your child has been infected with the virus. If so, the rabies immunoglobulin injection (given only once and usually with the first dose of the vaccine) and the vaccine will be given in different parts of the body. Pregnancy and breast-feeding If you are pregnant or breastfeeding, if you think you may be pregnant, or are planning to have a baby, you should still be given rabies vaccine if you have had, or are likely to have had, contact with the virus. You can also be vaccinated with Rabipur during pregnancy or while breastfeeding and before exposure to the virus, if the risk of contact with the virus is thought to be considerable. In this instance, your doctor will discuss the risks of vaccination and rabies infection with you and advise on the best timing of Rabipur vaccination. Driving and using machines: 2

Some of the adverse effects described in section 4 of this leaflet may affect the ability to drive and use machines. Rabipur contains: Less than 23 mg of sodium per dose, and is therefore essentially 'sodium-free'. 3.

How to take it

RABIPUR

Rabipur will be given to you/your child by a doctor or nurse who has been trained to give vaccines. Treatment that may be needed to manage very serious types of allergic reactions that can occur after receipt of the vaccine should be available (see section 4 of this leaflet). The vaccine should be given to you/your child in a clinic or surgery that has the necessary equipment to treat these reactions. Instructions intended for doctors and medical personnel for reconstituting the vaccine can be found at the end of this leaflet. The recommended dose for adults and children of any age is one millilitre (1.0 ml) per injection. Your doctor will decide how many doses you/your child should receive; this will depend on whether you/ your child are/is being given Rabipur before or after any possible contact with the virus. The vaccine is given as an injection into a muscle (usually in the upper arm, or in small children, into the muscle of the thigh). BEFORE ANY POSSIBLE CONTACT WITH THE VIRUS If you have/your child has never had any rabies vaccine before:

  • you need to have 3 doses in the first instance. The first dose is given at the first visit, the second dose is given 7 days later and the third dose 21 or 28 days after the first dose.
  • if you are an adult between 18 and 65 years of age needing a rapid protection, Rabipur can also be given to you as a total of three doses over 7 days. The first dose is given at the first visit, the second dose is given 3 days later and the third dose 4 days after the second dose.
  • alternatively, if you are an individual with a normal immune response, Rabipur can be given to you as two doses over 7 days. The first dose is given at the first visit and the second dose is given 7 days later. If you/your child miss an appointment for an injection, you should arrange to have it as soon as possible after the due date. The need for boosters depends on the risk of contact with rabies virus. Your doctor will consult the official recommendations on rabies vaccination and will tell you when a booster is needed. If you are at continuous high risk of infection, your doctor may also ask you to have regular blood tests to measure the amount of antibody against rabies in your blood so that boosters can be given as soon as needed. Experience shows that booster doses are generally required every 2-5 years. AFTER SUSPECTED OR PROVEN CONTACT WITH THE VIRUS

Vaccinated people If you have/your child has already been fully vaccinated against rabies and/or have received boosters, and have been in contact with a rabid or suspected rabid animal, you/ your child usually need 2 more doses of vaccine (1.0 ml each). The first dose is given as soon as possible after the contact, and the second is given 3 days later. Unvaccinated people If you/your child have/has not been vaccinated before or received inadequate basic immunisation, either 4 or 5 doses (1.0 ml each) will be given according to one of the following schedules: 3

  • If an immunisation schedule of 4 doses is used, the first 2 vaccine doses are given as soon as possible after the contact on day 0 and then single doses are given 7 and 21 days after the first dose.
  • An alternative 4 doses schedule can be adopted as well for healthy people who are known to have a good immune response; the first vaccine dose given as soon as possible after the contact on day 0 and the others given on days 3, 7 and 14 after the first dose.
  • If an immunisation schedule of 5 doses is used, the first vaccine dose is given as soon as possible after the contact on day 0 and the others are given on days 3, 7, 14 and 28 after the first dose. After any possible contact with rabies virus, your doctor will consider the risk of infection according to the type of contact you have/your child has had. For example, if you have been bitten or scratched by an animal that could have the virus, or have been in contact with bats, you are at much greater risk of rabies infection than someone who has been licked but has no break in the skin. People with a compromised immune system (poor immunity to infection) If you have/your child has an increased risk of rabies infection because your immune system is not working properly, you/your child will need five or six doses (each of 1.0 ml) of rabies vaccine after contact with a rabid or suspected rabid animal. Vaccination is given in combination with local treatment of the wound and rabies immunoglobulin. If six doses are used, the first two are given as soon as possible after the contact, and then single doses are given on days 3, 7, 14 and 28 after the first dose. If five doses are used, the first dose is given as soon as possible after the contact, and the others are given on days 3, 7, 14 and 28 after the first dose. It may also be necessary for you/your child to have blood tests to measure the amount of antibody to rabies virus in your/your child's blood so that extra doses of vaccine can be given if needed. Your doctor will explain what needs to be done and will tell you when to attend for extra tests or doses. 4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Serious allergic reactions involving the whole body, sometimes associated with shock (dangerously low blood pressure)* can occur following Rabipur vaccination. Appropriate medical treatment and supervision should always be readily available in case of a rare severe allergic reaction to the vaccine. Talk to a doctor straight away if they happen. The most common side effects reported with the use of Rabipur were pain at the injection site, mainly pain due to the injection, or hardness of the skin at the site of injection. These reactions are very common (occurring in more than 1 in 10 persons). Most injection site reactions were not severe and resolved within 24 to 48 hours after injection. Other side effects include: Very common (these may affect more than 1 in 10 people) Headache Dizziness Rash General discomfort Fatigue Weakness Fever Common (these may affect up to 1 in 10 people) Swollen glands Decreased appetite Nausea 4

Vomiting Diarrhoea Stomach pain/discomfort Hives Muscles pain Joint pain Rare (these may affect up to 1 in 1,000 people) Allergic reactions Pins and needles or tingling sensations Sweating Chills Very rare (these may affect up to 1 in 10,000 people) Inflammation of the brain, nerve disturbances that can cause weakness, inability to move or loss of feeling in some parts of the body* Fainting, unsteadiness with dizziness* Serious allergic reaction which causes swelling of the face or throat* *Description of adverse reactions from spontaneous reporting Additional side effects in children Frequency, type and severity of adverse reactions in children are expected to be the same as in adults. Reporting of side effects If you or your child get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine. 5.

How to store it

RABIPUR

Keep this vaccine out of the sight and reach of children. Store protected from light in a refrigerator (at 2°C to 8°C). Do not freeze. Keep the vial and the syringe in the outer carton in order to protect from light. Do not use this vaccine after the expiry date which is stated on the outer carton. The expiry date refers to the last day of the month. Do not throw away any vaccine via wastewater. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment. 6.

Contents of the pack and other information

What Rabipur contains The active substance in the vaccine is rabies virus (inactivated, strain Flury LEP) 27.9 IU. This has been produced on purified chick embryo cells (PCEC). The other ingredients are: trometamol, sodium chloride, disodium edetate, potassium-L-glutamate, polygeline, sucrose and water for injections. Chicken proteins (e.g., ovalbumin), human serum albumin, neomycin, chlortetracycline, amphotericin B are present as residues. What Rabipur looks like and contents of the pack Rabipur is a white freeze-dried powder to be reconstituted with the clear colourless solvent. The reconstituted vaccine is clear to slightly opalescent and colourless to slightly pink. Rabipur is supplied in packs containing: 5

–

1 vial of the powder, 1 disposable pre-filled syringe o either with white tamper evident seal cap of sterile diluent o or with transparent screw cap of sterile diluent and 2 identical needles (25 gauge, 25 mm) – one for reconstitution and one for injection.

Marketing Authorisation Holder and Manufacturer Marketing Authorisation Holder: Bavarian Nordic A/S Philip Heymans Alle 3 2900 Hellerup Denmark Manufacturer: GSK Vaccines GmbH Emil-von-Behring-Str. 76 35041 Marburg – Germany

Bavarian Nordic A/S Hejreskovvej 10A 3490 Kvistgaard – Denmark

Other formats: To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge:

0800 198 5000 (UK Only) Please be ready to give the following information: Product name Rabipur Reference number 40365/0004 This is a service provided by the Royal National Institute of Blind People. This leaflet was last revised in April 2026. Trade marks are owned by Bavarian Nordic A/S

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The following information is intended for healthcare professionals only: There are two types of pre-filled syringes which are differentiated by their type of cap. Both types of syringes are equipped with a backstop which facilitates injection handling and administration. In addition, the backstop reduces the opening diameter of the syringe body and simultaneously enlarges the finger flange with ergonomically shaped wings. This prevents the plunger stopper from being inadvertently pulled out of the syringe. Before preparing Rabipur for administration, identify the pre-filled syringe in your pack (either with white tamper evident seal cap or with transparent screw cap) and follow the instructions of the relevant pre-filled syringe contained in the pack. Instruction for use of Rabipur disposable pre-filled syringe:

Pre-filled syringe with white tamper evident seal cap:

Step 1: With one hand, hold the syringe with the cap pointing upward. Be sure to hold the syringe by the white textured holding ring (D).

Step 2: With the other hand, grasp the cap (A) and firmly rock it back and forth to break its connection to the holding ring (D). Do not twist or turn the cap.

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Step 3: Lift up to remove the cap (A) and the attached gray tip cap (B). Be careful not to touch the sterile syringe tip (C).

Needle application (these instructions apply to both provided needles): Step 1: Twist to remove the cap (H) from one of the two identical needles. This will be the needle used for reconstitution. Do not remove the plastic cover (G).

Step 2: With one hand, firmly hold syringe (E) by white textured holding ring (D). With your other hand, insert this needle (F) and twist clockwise until it locks into place. Once the needle is locked, remove its plastic cover (G). The syringe (E) is now ready for use.

Pre-filled syringe with transparent screw cap:

Step 1: With one hand, hold the syringe with the cap pointing upward. Be sure to hold the syringe by the transparent textured holding ring (D). Unscrew the cap (A) by twisting it counterclockwise.

Needle application (these instructions apply to both provided needles): 8

Step 1: Twist to remove the cap (H) from one of the two identical needles. This will be the needle used for reconstitution. Do not remove the plastic cover (G).

Step 2: With one hand, firmly hold syringe (E) by transparent textured holding ring (D). With your other hand, insert this needle (F) and twist clockwise until slight resistance is felt. Once the needle is locked, remove its plastic cover (G). The syringe (E) is now ready for use.

Instructions for reconstituting Rabipur with the use of pre-filled syringe: The vaccine should be visually inspected both before and after reconstitution for any foreign particulate matter and or change in physical appearance. The vaccine must not be used if any change in the appearance of the vaccine has taken place. The reconstituted vaccine is clear to slightly opalescent and colourless to slightly pink. The powder for solution should be reconstituted using the solvent for solution supplied and carefully agitated prior to injection. The reconstituted vaccine should be used immediately. The vial of vaccine contains negative pressure. After reconstitution of the vaccine, it is recommended to unscrew the syringe from the needle to eliminate the negative pressure. After that, the vaccine can be easily withdrawn from the vial. It is not recommended to induce excess pressure, since over-pressurization will create the problems in withdrawing the proper amount of the vaccine. The length of the needle will not reach to the bottom of the vial, so please invert the vial and pull back the needle close to the stopper. This will allow the full amount of vaccine solution to be withdrawn from the vial. After completing the reconstitution of the vaccine, remove the cap from the second needle (as explained in step 1 for the needles) and replace the needle used for reconstitution with the second needle, to be used for administration. Do not use the same needle for reconstitution and administration.

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Frequently asked questions about Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe

How do I take Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe?

Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe comes as injection containing 27.9iu. Always follow the dose your doctor or pharmacist has given you, and read the leaflet that comes with the medicine.

What is the active substance in Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe?

The active substance in Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe is rabies virus (inactivated, strain flury lep).

Where does this information come from?

This leaflet reproduces the patient information leaflet approved for Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe, as published on the electronic medicines compendium (emc). The version printed inside your medicine’s packaging is the one that applies to you.

Can I get Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe without a prescription?

Whether a medicine is available over the counter or on prescription only depends on its licence. Check the leaflet, or ask your pharmacist — they can tell you straight away.

About this leaflet

The text above reproduces the patient information leaflet approved for this medicine, restructured for easier reading.

Medical disclaimer: This page is for information only and does not replace advice from your doctor or pharmacist. Always read the leaflet supplied with your medicine. If you are unwell, call NHS 111; in an emergency, call 999.

Medicines with the same active substance: Rabies virus (inactivated, strain flury lep) (1 medicine)
See every medicine containing this substance, or browse the full A–Z of active substances.
⚕For healthcare professionals — Summary of Product Characteristics (SmPC)Full SmPC: dosage, interactions, contraindications, warnings+
Technical information intended for healthcare professionals (doctors and pharmacists). The Summary of Product Characteristics (SmPC) is the official document approved by the MHRA/EMA. It does not replace the patient leaflet or a doctor’s advice.

4.1. Therapeutic indications

Rabipur is indicated for active immunisation against rabies in individuals of all ages. (see sections 4.2 and 5.1)

Rabipur should be used in accordance with official recommendations.

4.2. Posology and method of administration

Posology

The recommended dose for both primary immunisation and boosters is 1.0 ml.

Pre-exposure prophylaxis

Primary immunisation

The primary pre-exposure immunisation course consists of three doses administered according to the conventional or rapid regimen, as shown in Table 1.

Table 1 Primary immunisation regimens

Conventional regimen

Rapid Regimen*

1st dose

Day 0

Day 0

2nd dose

Day 7

Day 3

3rd dose

Day 21 (or 28)

Day 7

*The rapid regimen should only be considered for adults aged 18-65 years not able to complete the conventional pre-exposure prophylaxis regimen within 21 or 28 days before protection is required.

Alternatively, in immunocompetent individuals, a one-week regimen with 2 doses can be used: at D0 and at D7.

Booster doses

Booster doses are generally recommended every 2-5 years. Timing for booster after vaccination with rapid regimen has not yet been established (see section 5.1). Serological testing for the presence of antibody ≥ 0.5 IU/ml to assess the need for booster doses should be conducted in accordance with official recommendations.

Rabipur may be used to boost individuals previously immunised with any human diploid cell rabies vaccine.

Post-exposure prophylaxis

Post-exposure prophylaxis should commence as soon as possible after exposure.

Table 2 summarises recommendations for post-exposure prophylaxis, including immunization, according to the type of exposure.

Table 2: Recommended post-exposure prophylaxis according to type of exposure

Category of exposure

Type of exposure to a domestic or wild a) animal suspected or confirmed to be rabid, or animal unavailable for testing

Recommended post-exposure prophylaxis

I

Touching or feeding animals

Licks on intact skin

Contact of intact skin with secretions or excretions of a rabid animal or human case

None, if reliable case history is available.

II

Nibbling of uncovered skin

Minor scratches or abrasions without bleeding

Administer vaccine immediately b)

Stop treatment if animal remains healthy throughout an observation period of 10 days c) or is proven to be negative for rabies by a reliable laboratory using appropriate diagnostic techniques.

III

Single or multiple transdermal bites d) or scratches, licks on broken skin.

Contamination of mucous membrane with saliva (i.e. licks). Exposure to bats e).

Administer rabies vaccine immediately, and rabies immunoglobulin, preferably as soon as possible after initiation of post-exposure prophylaxis. Rabies immunoglobulin can be injected up to 7 days after first vaccine dose administration.

Stop treatment if animal remains healthy throughout an observation period of 10 days or is proven to be negative for rabies by reliable laboratory using appropriate diagnostic techniques

a) Exposure to rodents, rabbits or hares does not routinely require rabies post-exposure prophylaxis.

b) If an apparently healthy dog or cat in, or from a low-risk area is placed under observation, treatment may be delayed.

c) This observation period applies only to dogs and cats. Except for threatened or endangered species, other domestic and wild animals suspected of being rabid should be euthanized and their tissues examined for the presence of rabies antigen by appropriate laboratory techniques.

d) Bites especially on the head, neck, face, hands and genitals are category III exposures because of the rich innervation of these areas.

e) Post-exposure prophylaxis should be considered when contact between a human and a bat has occurred, unless the exposed person can rule out a bite or scratch or exposure of a mucous membrane.

In-post-exposure prophylaxis of previously unvaccinated individuals, the vaccine should be administered according to Table 3.

Table 3: Post-exposure immunisation regimens for previously unvaccinated individuals

Essen regimen (5 doses)

Zagreb regimen (4 doses)

Reduced Essen regimen (4 doses)2

1st dose

Day 0

Day 0, 2 doses1

Day 0

2nd dose

Day 3

Day 3

3rd dose

Day 7

Day 7

Day 7

4th dose

Day 14

Day 21

Day 14

5th dose

Day 28

1one injection in each of the two deltoids or thigh sites

2 this shortened Essen regimen may be used as an alternative for healthy, immunocompetent individuals provided they receive wound care plus rabies immunoglobulin in category III as well as in category II exposures

In previously vaccinated individuals, post-exposure prophylaxis consists of two doses administered on days 0 and 3. Rabies immunoglobulin is not indicated in such cases.

Special populations

Immunocompromised individuals

Pre-exposure prophylaxis (PrEP)

The conventional 3-dose regimen should be followed. The rapid regimen and the one-week schedule with 2 doses on days 0 and 7 may be administered, if accompanied by serological testing at 2-4 weeks after the first rabies vaccine administration to assess whether an additional vaccine administration is needed. Consultation with an infectious disease specialist or an immunologist is advised.

Post-exposure prophylaxis (PEP)

In immunocompromised individuals with category II and III exposures, 5 doses should be given in combination with comprehensive wound management and local infiltration of rabies immunoglobulin as shown in Table 4.

Table 4: Post-exposure immunisation regimens for immunocompromised individuals

Essen regimen

Alternative to Essen

1st dose

Day 0

Day 0, 2 doses1

2nd dose

Day 3

Day 3

3rd dose

Day 7

Day 7

4th dose

Day 14

Day 14

5th dose

Day 28

Day 28

1 Two doses of vaccine may be given on day 0, that is, a single dose of 1.0 ml vaccine should be injected into the right deltoid and another single dose into the left deltoid muscle. In small children, one dose should be given into the anterolateral region of each thigh. This would result in a total of 6 doses.

When feasible, the rabies virus neutralising antibody response should be measured 2 to 4 weeks (preferably on day 14) following the start of vaccination to assess the possible need for an additional dose of the vaccine. Immunosuppressive agents should not be administered during postexposure therapy unless essential for the treatment of other conditions (see section 4.5).

Paediatric population

Paediatric individuals should receive the same dose as adults (1.0 ml).

Method of administration

Rabipur is for intramuscular administration only. For adults and children ≥ 2 years of age, the vaccine should be administered into the deltoid muscle. For children < 2 years, the anterolateral area of the thigh is recommended.

For instructions on reconstitution of the vaccine before administration, see section 6.6.

4.3. Contraindications

Pre-exposure prophylaxis (PrEP)

History of a severe hypersensitivity reaction to the active substance, to any of the excipients listed in section 6.1 or to any of the residues in section 2.

Vaccination should be postponed in individuals with a severe febrile illness (see section 4.4).

Post-exposure prophylaxis (PEP)

In view of the almost invariably fatal outcome of rabies, there is no contraindication to post-exposure prophylaxis.

4.4. Special warnings and precautions for use

A protective immune response may not be elicited in all vaccinees.

In case of acute diseases requiring treatment, patients should not be vaccinated until at least 2 weeks after recovery. The presence of a minor infection should not result in the deferral of vaccination.

Hypersensitivity reactions (PEP only)

Anaphylactic reactions including anaphylactic shock have occurred following Rabipur vaccination. As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine. Rabipur contains the excipient polygeline, residues of chicken proteins (e.g., ovalbumin), human serum albumin, and may contain traces of antibiotics (see section 2). In instances in which individuals have developed clinical symptoms of anaphylaxis such as generalised urticaria, upper airway (lip, tongue, throat, laryngeal or epiglottal) oedema, laryngeal spasm or bronchospasm, hypotension or shock, following exposure to any of these substances, the vaccination should only be administered by personnel with the capability and facilities to manage anaphylaxis post-vaccination.

Central nervous system effects

Encephalitis and Guillain-Barré syndrome have been temporally associated with the use of Rabipur (see section 4.8). A patient's risk of developing rabies must be carefully considered, before deciding to discontinue immunisation.

Route of administration

Rabies vaccine must not be given by intra-gluteal injection or subcutaneously, as the induction of an adequate immune response may be less reliable.

Unintentional intravascular injection may result in systemic reactions, including shock. Do not inject intravascularly.

Anxiety-related reactions

Anxiety-related reactions, including vasovagal reactions (syncope), hyperventilation or stress-related reactions, may occur in association with vaccination as a psychogenic response to the needle injection (see section 4.8). It is important that procedures are in place to avoid injury from fainting.

4.5. Interaction with other medicinal products and other forms of interaction

Immunosuppressive agents can interfere with the development of an adequate response to the rabies vaccine. Therefore, it is recommended that serological responses should be monitored in such subjects, and additional doses administered as necessary (see section 4.2).

The vaccine must not be mixed in the same syringe with other medicinal products. If rabies immunoglobulin is indicated in addition to Rabipur vaccine, it must be administered at an anatomical site distant to the vaccination.

Available clinical data support concomitant administration of Rabipur with inactivated Japanese encephalitis (JE) vaccine and conjugated MenACWY meningococcal vaccine in adult subjects; limited data are available in the paediatric population.

Almost all adult subjects achieved an adequate immune response (Rabies Viral Neutralizing Antibodies (RVNAs) ≥ 0.5 IU/ml) within 7 days after the end of a primary series of three injections of Rabipur when given concomitantly with inactivated JE vaccine according to either a rapid or the conventional PrEP schedule by the intramuscular route. From day 57 after vaccination a faster decline in immune response to rabies was observed in individuals vaccinated concomitantly with JE vaccine according to the rapid PrEP schedule compared with the concomitant conventional PrEP schedule and the rabies only conventional PrEP schedule. At day 366, percentages of subjects with RVNA concentration ≥0.5 IU/mL were 68%, 76%, and 80% for vaccine groups rabies/JE accelerated, rabies/JE conventional, and rabies conventional, respectively.

All adult subjects achieved an adequate immune response (RVNAs ≥ 0.5 IU/ml) within 28 days after the end of a primary series of three injections of Rabipur when given concomitantly with conjugated MenACWY vaccine according to the recommended conventional schedule by the intramuscular route.

Concomitant vaccines should always be administrated at separate injection sites and preferably contralateral limbs.

4.6. Fertility, pregnancy and lactation

Pregnancy

No cases of harm attributable to use of Rabipur during pregnancy have been observed.

Rabipur may be administered to pregnant women when post-exposure prophylaxis is required.

The vaccine may also be used for pre-exposure prophylaxis during pregnancy if it is considered that the potential benefit outweighs any possible risk to the fetus.

Breastfeeding

While it is not known whether Rabipur enters breast milk, no risk to the breast-feeding infant has been identified. Rabipur may be administered to breastfeeding women when post-exposure prophylaxis is required.

The vaccine may also be used for pre-exposure prophylaxis in breastfeeding women if it is considered that the potential benefit outweighs any possible risk to the infant.

Fertility

Non clinical reproductive and developmental toxicity studies have not been performed.

4.7. Effects on ability to drive and use machines

Some of the adverse effects described in section 4.8, may affect the ability to drive and use machines.

4.8. Undesirable effects

Summary of the safety profile

Anaphylactic reactions including anaphylactic shock that are very rare but clinically severe, and potentially lethal, systemic allergic reactions, can occur following Rabipur vaccination. Mild allergic reactions to Rabipur (i.e. hypersensitivity), including rashes (very common) and urticaria (common) may occur after vaccination. These reactions are usually mild in nature and typically resolve within a few days.

Very rare cases with symptoms of Encephalitis and Guillain-Barré Syndrome have been reported following Rabipur vaccination.

In clinical trials, the most commonly reported solicited adverse reactions were injection site pain (30-85%) or injection site induration (15-35%). Most injection site reactions were not severe and resolved within 24 to 48 hours.

Tabulated list of adverse reactions

Adverse reactions considered as being at least possibly related to vaccination have been categorised by frequency.

Frequencies are defined as follows:

Very common:

Common:

Uncommon:

Rare:

Very rare:

(≥1/10)

(≥1/100 to <1/10)

(≥1/1,000 to <1/100)

(≥1/10,000 to <1/1,000)

(<1/10,000)

Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness.

In addition to reports in clinical trials, worldwide voluntary reports of adverse reactions received for Rabipur since market introduction are included in the list. These reactions are reported voluntarily from a population of uncertain size and have been chosen for inclusion due to their seriousness, frequency of reporting, causal relationship to Rabipur, or a combination of these factors.

Table 5: Adverse reactions reported in clinical trials and in postmarketing surveillance

System Organ Class

Frequency

Adverse events

Blood and lymphatic system disorders

Common

Lymphadenopathy

Immune system disorders

Rare

Hypersensitivity

Very rare

Anaphylaxis including anaphylactic shock*

Metabolism and nutrition disorder

Common

Decreased appetite

Nervous system disorders

Very common

Headache, Dizziness

Rare

Paraesthesia

Very rare

Encephalitis*, Guillain-Barré syndrome*, Presyncope*, Syncope*, Vertigo*

Gastrointestinal disorders

Common

Nausea, Vomiting, Diarrhoea, Abdominal pain/ discomfort

Skin and subcutaneous tissue disorders

Very common

Rash

Common

Urticaria

Rare

Hyperhidrosis (sweating)

Very rare

Angioedema*

Musculoskeletal and connective tissue disorders

Common

Myalgia, Arthralgia

General disorder and administration site conditions

Very common

Injection site reactions, Malaise, Fatigue, Asthenia, Fever

Rare

Chills

*Additional adverse reactions from spontaneous reporting

Paediatric population

Frequency, type and severity of adverse reactions in children are expected to be the same as in adults.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

4.9. Overdose

No symptoms of overdose are known.

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Ask anything about Rabipur 27.9 iu/ vial Powder and solvent for solution for injection in pre-filled syringe. The assistant answers only from this leaflet — if the leaflet does not cover it, it will say so. It does not give medical advice.

Answers come from the patient leaflet published on the electronic medicines compendium (emc). They are not medical advice. Ask a pharmacist or your GP if you are unsure. For urgent help call NHS 111, or 999 in an emergency.

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