Rabies Pre-exposure Prophylaxis

Most people in the United States have a low risk of encountering an animal with rabies. However, a small subset of people have a higher level of risk, like those who work directly with animals that could have rabies, or those who travel to parts of the world where rabies is common and access to medical care is limited. These people should receive rabies pre-exposure vaccination (PrEV), a series of rabies vaccine doses given before exposure to the rabies virus.

The Advisory Committee on Immunization Practices (ACIP) develops U.S. recommendations about how and when to use vaccines to prevent disease in the United States, including how to prevent rabies in people. ACIP updated rabies vaccine recommendations in May 2022, which are summarized below:

Updates to the ACIP recommendations to prevent human rabies, 2022

• A 2-dose PrEV schedule has replaced the 3-dose PrEV schedule to protect people from rabies for up to 3 years. Options for maintaining protection beyond 3 years are also described.
• Risk categories have been redefined into 5 risk groups.
• The minimum acceptable laboratory value (antibody titer) used to determine whether rabies vaccine booster doses are needed was revised and standardized.
• Many people for whom serial titers were recommended every 2 years now require only a one-time titer (and booster if below a certain level) OR a one-time booster.

Clinical guidance for administering PrEV to people with weakened immune systems has been outlined and includes recommendations to confirm that the vaccine was effective.