Half Price Rabies Shots...

Do I have your attention now? That's right half price!

When we first considered rabies vaccinations back in 2010, the cost per shot was $60 Canadian. We both needed 3 shots each for a total of $360. Because this was all out of pocket expenses (and we had other vaccinations to pay for) we decided against it.  On this trip there is more of a need for rabies prevention—we will be visiting monkey temples and Kathmandu has a high instance of rabies—so we wanted more info about risks.

The shocker was the cost...$220 per shot, 3 shots per person for a total of  $1320 (plus taxes)

After some discussions with the travel nurse we had a better understanding of what our options were. A few important considerations were:

• Rabies is always fatal in humans if not treated
• Signs of infection in humans only appears once its too late to treat
• Pre-exposure rabies vaccination will give you rabies antibodies (pretty much) for life
• When it comes to rabies vaccinations, there are two type of vaccine:
• rabies vaccine (expensive but fairly easy to acquire)
• rabies immune globulin (very, very expensive and difficult to acquire)

1. If you get bit or scratched by a rabid animal and you have no rabies antibodies, you need 1 shot of  rabies immune globulin AND then a series of four shots of  rabies vaccine. If you happen to be in an area where immune globulin is not available you're in trouble!
2. If you have rabies antibodies and then get bit, you would only need 3 rabies vaccine shots. No need for the expensive, hard to find globulin.

Armed with this knowledge we decided to take the plunge. As almost an afterthought, our travel nurse made a suggestion that we might want to consider a vaccination method that is not widely used in Canada but is globally accepted as safe and effective.

Instead of injecting one full vial of vaccine intramuscularly  (IM) we could share a vial and each have half injected intradermally (ID). This would reduce our entire cost by half. The caveat...there is a 5% chance that we won't develop enough antibobies and we may need a single, full dose if the 3 half doses didn't take. We decided to take a week to research and discuss.

The rabies vaccine we were going to be using was RabAvert. From the RabAvert drug insert::

RabAvert MUST NOT BE USED SUBCUTANEOUSLY OR INTRADERMALLY.
RabAvert must be injected intramuscularly. For adults, the deltoid area is the preferred site of immunization; for small children and infants, administration into the anterolateral zone of the thigh is preferred. The use of the gluteal region should be avoided, since administration in this area may result in lower neutralizing antibody titers (1).

From the Public Health Agency of Canada web site:

While intramuscular (IM) administration of rabies vaccine is the gold standard, the World Health Organization (WHO) considers the intradermal (ID) regimen an acceptable alternative as it uses less vaccine to produce a comparable degree of protection against rabies.In a number of countries throughout the world, ID administration has become standard practice. Although not recommended by the manufacturer in Canada, ID vaccination with rabies cell culture vaccines is an economical and widely accepted alternative to IM vaccination and uses one-tenth of the IM dose.


We decided to go ahead with ID method—95% success rate sounds good to us. Even if we both failed, we would still save money. The only caveat would be if we don't get our blood test results back before we left. We were taking a chance that we may not be fully protected on the trip.

This will be the first time that this Primacy travel clinic has administered rabies vaccine using the ID method, so special permission was needed by the clinic doctor. We're officially guinea pigs!