On June 2, 2022, the West Virginia Bureau for Public Health sent Health Advisory #197 to health care providers, hospitals and other health care facilities. The advisory summed up new national advice on rabies preexposure prophylaxis (PrEP).
Rabies is a viral infection that a person usually gets from the bite of a rabid animal. It is almost always fatal once symptoms start, so prevention is critical. Most people have a low risk. People who work with animals that can carry rabies, and travelers to areas where rabies is common, have a higher risk.
PrEP is a series of rabies vaccine doses given before any exposure. It does not remove the need for post-exposure care (PEP) after a bite. But it reduces the number of vaccine doses needed after an exposure, and it removes the need for rabies immunoglobulin.
What changed in May 2022
The CDC’s Advisory Committee on Immunization Practices (ACIP) updated its rabies advice in May 2022. The state advisory listed these changes:
- A 2-dose PrEP series replaced the 3-dose series.
- There are now 5 risk groups, each with its own advice.
- The minimum antibody level (titer) used to decide on a booster dose was revised.
- Many people who needed a titer check every 2 years now need only a one-time titer check or a one-time booster.
- There is clinical guidance for people with weak immune systems and for people who miss the schedule.
The five risk groups
- Group 1 (highest risk): people who work with live or concentrated rabies virus in labs. 2 doses on days 0 and 7, and a titer check every 6 months.
- Group 2: people who often handle bats, enter places with many bats such as caves, or do animal necropsies. 2 doses on days 0 and 7, and a titer check every 2 years.
- Group 3: people who will be at higher risk from mammals other than bats for more than 3 years after PrEP. This includes most veterinarians, veterinary technicians, animal control officers, wildlife biologists, rehabilitators, trappers and cave explorers, and some travelers. 2 doses on days 0 and 7, plus a one-time titer check 1 to 3 years later, or a 1-dose booster between 3 weeks and 3 years later.
- Group 4: the same people as Group 3, but at higher risk for 3 years or less after PrEP. 2 doses on days 0 and 7.
- Group 5 (lowest risk): the general population. No PrEP.
See also epidemiology and other health advisories.
This guidance is from June 2022. It is kept here as a record and is not current advice. Check current guidance from the CDC or your doctor.