Pre-exposure vaccination is given by 3 doses of inactivated rabies vaccine on days 0,7,21 or 28 as standard primary series. Active immunity develops after the third dose, therefore pre-exposure vaccination should be started one month before travelling. Those who wish to take anti-malaria (chloroquine) should preferably be given vaccine intramuscularly because concurrent use of these drugs may affect the antibody response to intradermal vaccination.
Pre-exposure vaccination is recommended for prolonged trip to endemic areas, particularly for visits to remote rural regions without medical facilities, or people who will travel even for a short period in rabies infected areas if their activities may involve some special risk (hiking, cycling, trekking and animal handling). It should be noted that pre-exposure immunisation does not eliminate the need for post-exposure immunisation. Travellers should therefore seek local medical opinion if bitten by animals abroad even when they had already received a course of pre-exposure immunisation.
Pain, reddness, and swelling or itching at the injection sites have been reported among 30 - 70 % of recipients. Systemic reactions such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported among 5-40% of recipients. Anaphylactic shock and Guillain-Barre Syndrome have been reported very rarely.
Pregnant women and persons with hypersensitivity to neomycin should not be vaccinated unless there is a high risk of the disease or for post-exposure treatment. Persons who are immunosuppressed by disease or medication should defer pre-exposure vaccination because the immune response may not be adequate in such persons, and consider avoiding risky activities afore-mentioned.