Ask the Experts
Rabies
General information - rabies
Who should be offered pre-exposure rabies vaccination?
Preexposure vaccination should be offered to persons in high-risk groups, such as veterinarians, animal handlers, rabies researchers, and certain laboratory workers. Pre-exposure vaccination also should be considered for other persons whose activities bring them into frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other species at risk for having rabies. In addition, some international travelers might be candidates for pre-exposure vaccination if they are likely to come in contact with animals in areas where dog or other animal rabies is enzootic and immediate access to appropriate medical care, including rabies vaccine and immune globulin, might be limited.
An updated ACIP statement on rabies was released in May 2008. What were new in the recommendations?
The most recent rabies ACIP statement ("Human Rabies Prevention-United States, 2008, Recommendations of the Advisory Committee on Immunization Practices") was published in MMWR on May 23, 2008. It updates the 1999 recommendations and reflects the status of rabies and antirabies biologics in the United States. There are no substantial changes to the recommended approach for rabies postexposure or pre-exposure prophylaxis. To view the complete recommendations, go to www.cdc.gov/mmwr/PDF/rr/rr5703.pdf
I understand that ACIP now recommend fewer doses of vaccine be given to certain post-exposure situations. Can you tell me more?
In June of 2009, ACIP voted to eliminate the fifth dose of vaccine given post-exposure to previously unvaccinated persons with no immunosuppression. This decision was based upon evidence that immunity would not be compromised, a need to conserve vaccine supplies, and the benefit to the patient's health as well as economics by minimizing the number of visits and vaccine doses required. To view the provisional recommendations, go to www.cdc.gov/vaccines/recs/provisional/downloads/rabies-July2009-508.pdf
If a bat is found in a room and the occupants are uncertain if direct contact has occurred (e.g., a baby is sleeping, a mentally disabled person is present), do you need to give postexposure prophylaxis?
Unless rabies can be ruled out by diagnostic testing of the bat, rabies postexposure prophylaxis (PEP) is recommended. Because the details of these recommendations are fairly complex and depend on various factors, consultation with state and local health departments should be sought.
Reviewed on 7/09
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