What is the pre-exposure prophylaxis (PrEP) schedule for rabies vaccine?

In May 2022, CDC published new ACIP recommendations reducing the primary PrEP rabies vaccination series from 3 doses to 2 doses (administered intramuscularly on days 0 and 7) for all people at elevated risk for exposure to rabies. This was done based on strong evidence that the 2-dose schedule would provide the same protection as the previously recommended 3-dose primary series for up to three years. The less costly 2-dose schedule conserves rabies vaccine supplies, which have been subject to national shortages at times, and may increase adherence with PrEP recommendations.

Five categories of risk were created based upon variables including elevated risk of unusual, unrecognized, or recognized exposures and whether elevated risk is sustained over time, or not. For individuals in risk categories 1–3 (all with sustained elevated risk expected to last more than 3 years after the primary series), ACIP recommends periodic rabies vaccine antibody titer checks at different intervals, and/or booster vaccination. See the table on pages 622–623 of the MMWR published on May 6, 2022, (www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7118a2-H.pdf) for each risk category’s antibody titer and/or booster dose recommendations for sustained pre-exposure prophylaxis over time.