Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies

Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies
Recommendations of the Advisory Committee on Immunization Practices


This report summarizes new recommendation and updates previous recommendations of the Advisory Committee on Immunization Practices (ACIP) for postexposure prophylaxis (PEP) to prevent human rabies. Previously, ACIP recommended a 5-dose rabies vaccination regimen with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV). These new recommendations reduce the number of vaccine doses to four. ACIP recommendations for the use of rabies immune globulin (RIG) remain unchanged. For persons who previously received a complete vaccination series (pre- or postexposure prophylaxis) with a cell-culture vaccine or who previously had a documented adequate rabies virus-neutralizing antibody titer following vaccination with noncell-culture vaccine, the recommendation for a 2-dose PEP vaccination series has not changed. Similarly, the number of doses recommended for persons with altered immunocompetence has not changed; for such persons, PEP should continue to comprise a 5-dose vaccination regimen with 1 dose of RIG. Recommendations for preexposure prophylaxis also remain unchanged, with 3 doses of vaccine administered on days 0, 7, and 21 or 28. Prompt rabies PEP combining wound care, infiltration of RIG into and around the wound, and multiple doses of rabies cell culture vaccine continue to be highly effective in preventing human rabies.


Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies
Recommendations of the Advisory Committee on Immunization Practices
Recommendations and Reports
March 19, 2010 / 59(02);1-9


Prepared by
Charles E. Rupprecht, VMD, PhD1

Deborah Briggs, PhD2

Catherine M. Brown, DVM3

Richard Franka, DVM, PhD1

Samuel L. Katz, MD4

Harry D Kerr, MD5

Susan M. Lett, MD3

Robin Levis, PhD6

Martin I. Meltzer, PhD1

William Schaffner, MD7

Paul R.Cieslak, MD8

1National Center for Emerging and Zoonotic Infectious Diseases (proposed), CDC

2Kansas State University, Manhattan, Kansas

3Massachusetts Department of Public Health, Jamaica Plain, Massachusetts

4Duke University Medical Center, Durham, North Carolina

5American College of Emergency Physicians, Dallas, Texas

6Food and Drug Administration, Washington, District of Columbia

7Vanderbilt University School of Medicine, Nashville, Tennessee

8Oregon Department of Public Health, Corvallis, Oregon

The material in this report originated in the National Center for Emerging and Zoonotic Infectious Diseases (proposed), Lonnie King, DVM, Director.

Corresponding preparer: Charles E. Rupprecht, VMD, PhD, National Center for Emerging and Zoonotic Infectious Diseases (proposed), 1600 Clifton Road, N.E., MS G-33, Atlanta, GA 30333. Telephone: 404-639-1050; Fax: 404-639-1564; E-mail: cyr5@cdc.gov.


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