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WORLD RABIES DAY 2018:
ACIP GUIDELINES FOR HUMAN RABIES PREVENTION
The Advisory Committee on Immunization Practices (ACIP) Guidelines for human rabies prevention provide detailed information about administering post-exposure prophylaxis (PEP), including the proper use of rabies vaccine and human rabies immune globulin (HRIG).1 The 2008 guidelines were the first revision since 1999 and provide updated information on the epidemiology of rabies in the United States, the effectiveness and efficacy of rabies biologics, and treatment considerations for various patient scenarios.2 In 2010, ACIP published an update to its rabies vaccine dosing schedule that reduces the doses from 5 to 4 for most cases.3
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MORE CLINICAL PEARLS FROM THE ACIP GUIDELINES2,3
Rationale for prophylaxis. The Committee stresses that administration of PEP is a matter of medical urgency, and treatment should not be delayed. The decision to initiate rabies PEP should include an assessment of exposure type, local animal rabies epidemiology, the animal species involved, and an evaluation of the incident.
Treatment of bite wounds. Starting with immediate, thorough cleansing of all wounds with soap and water, the recommendations offer further guidance on vaccine and HRIG administration in vaccinated and unvaccinated patients.
Rabies immune globulin and vaccine. The antibody response from the rabies vaccine can take 7 to 10 days to develop, and administering HRIG at the time of the first vaccine dose provides rapid, passive immunity.
Effectiveness and immunogenicity of PEP. A summary of the evidence provides information about effective administration of rabies vaccine and HRIG in several patient and bite scenarios.
References: 1. Centers for Disease Control and Prevention. About ACIP. https://www.cdc.gov/vaccines/acip/about.html. Updated August 16, 2012. Accessed July 10, 2018. 2. Centers for Disease Control and Prevention. Human rabies prevention—United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2008;57(RR-3):1-28. 3. Centers for Disease Control and Prevention. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2010;59(RR-2):1-9.