CDC council says fewer postexposure rabies vaccine doses needed

Published on August 01, 2009
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A health advisory committee recommends four postexposure rabies vaccine doses, rather than five, for people without previous rabies vaccinations.

The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention voted June 24 to recommend the reduction for naive patients. The 15-member committee provides advice and guidance to the Department of Health and Human Services and the CDC.

The CDC is recommending that state and local health departments and health care providers plan to implement the dosage recommendations after provisional guidelines are available, but delay implementing changes until after the formal updated recommendations are published in an upcoming issue of the CDC's Morbidity and Mortality Weekly Report. The report containing those changes is expected to be published within several months of the June 24 meeting.

An online Q-and-A page from the CDC states a panel of rabies experts reviewed rabies studies and literature on rabies pathogenesis, vaccine trials, animal studies, epidemiologic surveillance, and health economics prior to the committee's recommendation.

"The panel found significant evidence to suggest that four doses of vaccine elicit an immunological response equivalent to the five dose series," the CDC information states.

The committee recommends administration of postexposure prophylaxis on the day of exposure with subsequent doses three, seven, and 14 days later. The committee's 2008 recommendations also called for administration of a dose 28 days later.

The ACIP did not recommend any changes in the number or schedule of doses for previously immunized people.

Dr. Charles Rupprecht, chief of the CDC's rabies program, said the CDC has historically followed most of the committee's recommendations, and the ACIP's final recommendations related to the four-dose schedule would be published as an addendum to the 2008 recommendations.

Dr. Rupprecht said it does not appear manufacturers will try to change the dosage information currently in product inserts.

"We do not anticipate the vaccine manufacturers will be applying for a product insert change anytime soon," Dr. Rupprecht said.

Because of the discrepancy, the CDC began meeting with medical professionals at the end of June to answer questions and alleviate confusion.

Information from the CDC states the ACIP has previously made off-label recommendations for rabies vaccines.

"In the past, ACIP recommendations regarding intradermal administration of rabies vaccine in the United States preceded changes to vaccine labeling and licensing," the CDC information states.

The ACIP's provisional guidelines will be available on the committee's Web site.

Information about rabies vaccines is available here and in a Q-and-A page. The most recent CDC Morbidity and Mortality Weekly Report is here.