Rabies

ACIP updates rabies pre-exposure prophylaxis guidelines

The US Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) have updated their rabies pre-exposure prophylaxis (PrEP) guidelines. PrEP is recommended in certain people who are at high risk for rabies exposure.

Fewer doses are now required in the primary vaccination schedule. ACIP recommends a two-dose intramuscular rabies vaccination series to replace the previously recommended three-dose schedule. Doses should be administered on days 0 and 7. As a consequence of this update, more people who are recommended to receive rabies PrEP might now be vaccinated because the two-dose series is associated with a lower cost and takes less time to complete.

The minimum acceptable rabies antibody titer, used to determine whether rabies vaccination booster doses are required, has been increased to 0.5 IU/mL. Historically, the minimum antibody titer recommended was 0.1 to 0.3 IU/mL. Therefore, when titers are checked, more people may require a booster dose than with the previous titer cut-off.

Recommendations for PrEP depend on the level of a person’s risk for being exposed to rabies. These risk categories have been redefined into 5 risk groups. Many people for whom serial titers were previously recommended every 2 years now require only a one-time titer (and booster if the titer is below a certain level), or a one-time booster. This means less frequent or no antibody titer checks for some risk groups.

Worldwide, approximately 59,000 human rabies deaths occur each year. In the US, 52 cases of human rabies were diagnosed between 2000 to 2020, 28 of which were indigenously acquired.

See Management: prevention

Original source of update