Source: CDC
February 24, 2021
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ACIP shortens recommendation for rabies PrEP to two-dose schedule

Source: CDC
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The CDC’s Advisory Committee on Immunization Practices voted Wednesday to shorten the recommendation for rabies PrEP to a two-dose vaccine schedule, aligning with international guidance.

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 changing the recommendation to:

ACIP recommends a 2-dose (0, 7 days) intramuscular rabies vaccine series in immunocompetent persons [at least] 18 years of age for whom rabies vaccine PrEP is indicated.

The committee then voted unanimously to approve a second proposed recommendation for a booster dose of vaccine to be given after the initial two-dose PrEP series for people who are at risk for 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 a titer check, for immunocompetent persons [at least] 18 years of age who have sustained and elevated risk for only recognized rabies exposures. The booster dose should be administered no sooner than day 21 but no later than 3 years after the 2-dose PrEP series.

Rabies PrEP is recommended only for people at an increased risk for exposure compared with the general population, including people who work with research-grade concentrations of the virus or who are traveling internationally to areas where rabies is commonly spread by dogs.

Data have shown that a two-dose schedule is noninferior to a three-dose schedule for rabies PrEP, and a two-dose schedule is also recommended by WHO.

Rabies is almost always fatal once symptoms appear. Cases rarely occur in the United States these days and are mostly caused by bats — the result of a slow and steady decline of infections caused by dog bites. Globally, however, 40% of rabies cases occur among children and are mostly the result of dog bites, according to WHO.

Rabies PrEP does not negate the need for rabies post-exposure prophylaxis (PEP) for people who have been exposed but is an important part of preventing infections in the U.S., the ACIP’s rabies work group noted.

The work group did not propose any updated recommendations for rabies PEP, which the CDC says should include human rabies immune globulin and a series of four doses of rabies vaccine given on days 0, 3, 7 and 14.