February 24, 2021
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The CDC’s Advisory Committee on Immunization Practices on Wednesday voted to shorten the recommendation for rabies PrEP to a two-dose vaccination schedule, in line with international guidelines.
The current schedule for Rabies PrEP is three doses of vaccine given intramuscularly on days 0, 7 and 21 or 28. In a 14: 1 vote, the committee approved an amendment to the recommendation:
ACIP recommends a 2-dose (0.7 day) intramuscular rabies vaccine series for immunocompetent individuals [at least] 18 years old for whom PrEP is indicated for rabies vaccine.
The committee then unanimously approved a second proposed recommendation for a booster dose of the vaccine to be given after the first two-dose series of PrEP for people who are at risk of rabies exposure beyond 3 years – for example, veterinarians, veterinary assistants, Animal handlers, veterinary students and travelers:
ACIP recommends an intramuscular booster dose of rabies vaccine as an alternative to titer testing for immunocompetent individuals [at least] 18 years old who have an increased and increased risk for only recognized rabies exposures. The booster dose should be administered on the 21st day at the earliest, but no later than 3 years after the 2-dose PrEP series.
Rabies PrEP is only recommended for people who are at increased risk of exposure compared to the general population, including those working with research-grade concentrations of the virus or those who travel internationally to areas where rabies is often transmitted by dogs.
Data have shown that a two-dose regimen is not inferior to a three-dose regimen for rabies PrEP, and a two-dose regimen is also recommended by the WHO.
Rabies is almost always fatal when symptoms occur. Cases are rare these days in the United States and are primarily caused by bats – the result of a slow and steady decline in infections caused by dog bites. Globally, however, 40% of rabies cases occur in children and are mainly due to dog bites, according to the WHO.
Rabies PrEP does not negate the need for rabies post-exposure prophylaxis (PEP) for exposed people, but it is an important part of infection prevention in the USA, according to the ACIP rabies working group.
The working group did not propose updated recommendations for rabies PEP, which the CDC said should include human rabies immunoglobulin and a series of four doses of rabies vaccine given on days 0, 3, 7 and 14.
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