What are the CDC and WHO recommendations for rabies vaccination?

Updated: Jun 21, 2019
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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CDC and WHO recommend 2 doses of cell-culture vaccine administered intramuscularly or intradermally on days 0 and 3 for preexposure "booster" prophylaxis. [19]

In the United States, the CDC recommends rabies postexposure prophylaxis only with intramuscular (IM) cell-cultured vaccines; intradermal (ID) formulations are not approved by the US Food and Drug Administration (FDA) for use in the United States.

Outside the United States, in areas where cost and vaccine supply are limiting factors, alternatives to the IM regimens may be more feasible. In addition, rabies vaccination may be the norm in some countries where rabies is endemic, and anamnestic response may permit effective alternative dosing. In 1998, the World Health Organization (WHO) released guidelines for ID use of human diploid cell vaccine (HDCV), purified chick embryo cell vaccine, and purified duck embryo cell vaccine. [36] The WHO published updated postexposure prophylaxis guidelines that included ID regimens often used outside the United States. [37]

Booster immunization is indicated for individuals at continuous or frequent risk of rabies, who should undergo periodic rabies antibody testing and who have serum rabies titer of less than 1:5 dilution based on RFFIT results.

An NAb titer greater than or equal to 0.5 IU/mL (or complete neutralization at a serum dilution of 1:5) is considered an acceptable antibody response for protection against rabies.

Passive immunization consists of the administration of human rabies immunoglobulin (HRIG) pooled from the sera of immunized human donors.

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