Health Advisory

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

To: Vermont Health Care Providers
From: Robert Johnson, State Public Health Veterinarian
Date: March 29, 2010

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The Advisory Committee on Immunization Practices (ACIP) has revised the recommendations for postexposure prophylaxis (PEP) to prevent human rabies from a five-dose rabies vaccination regimen to a four-dose regimen for immunocompetent people.

Previously, ACIP recommended a five-dose rabies vaccination regimen with human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV). The new recommendations reduce the number of vaccine doses to four. The reduction in doses recommended for PEP was based in part on evidence from rabies virus pathogenesis data, experimental animal work, clinical studies, and epidemiologic surveillance.

These studies indicated that four vaccine doses in combination with rabies immune globulin (RIG) elicited adequate immune responses, and that a fifth dose of vaccine did not contribute to more favorable outcomes. 

New ACIP Recommendations

Note: These new ACIP recommendations differ from current rabies vaccine label instructions, which still list the five-dose series for PEP. Alterations of current product labels for HDCV and PCEC are not anticipated by the producers of human rabies vaccines licensed in the United States.

To read this more about this recommendation, see MMWR RR-2, March 19, 2010 / 59(02);1-9: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm

For more information about rabies, see the Vermont Depart of Health’s website: http://healthvermont.gov/prevent/rabies/Rabies.aspx

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