New Rabies Post-Exposure Prophylaxis Recommendations

Posted on August 1, 2009

The Advisory Committee on Immunization Practices voted unanimously to change recommendations for human rabies post-exposure prophylaxis.  This committee makes recommendations to the CDC which, in turn, makes recommendations to physicians.  The new recommendation states that within 14 days of exposure, 4 injections (in the arm or thigh) over 28 days are sufficient to prevent development of rabies.  This reduces the previous recommendation of five and the historical nightmare which was at least 14 shots in the abdomen.  The new recommendations are based on improvements to vaccines and data showing that of the thousands of people who have not completed the 5 shot series, none have developed rabies.

The vaccine package insert will continue to recommend a 5 shot series which will make the new government guidance an “off-label” recommendation.  As far as what veterinarians should know and the importance of the new recommendations for board exams, it is not a veterinarian’s role to make specific recommendations for the treatment of any human exposed to rabies although some clients may ask.  Veterinarians play a critical role in recognizing and diagnosing rabies in animals and informing humans about rabies exposure.  Additionally, there are few careers that have a higher risk of exposure to rabies than veterinarians so it behooves them to know about human treatment and prevention.