National Center for Emerging and Zoonotic Infectious Diseases

Rabies Work Group Update

ACIP Meeting

June 24, 2021

Sharon Frey, MD, FACP, FIDSA

Chair, ACIP Rabies Work Group
Work Group Members

ACIP Members

Sharon Frey (chair)

Lynn Bahta

Liaison Representatives

AAFP- James Stevermer

NASPHV- Katie Brown and Sally Slavinski

NACCHO- Matt Zahn

AAP- Elizabeth Bennett

APhA- Karl Hess

NACI- Julie Emili, Linlu Zhao, and Rob 

Stirling

FDA- Paula Agger and Robin Levis

NIH- Eun-Chung Park

Invited Consultants

Subject Matter Expert- Deborah Briggs

Subject Matter Expert- Susan Moore

Travel medicine- David Shlim

Emergency Medicine – Greg Moran

APHL-Michael Pentella

CDC

Rabies Work Group lead – Agam Rao

Immunization Safety Office – Pedro Moro

Division of Global Migration and 

Quarantine- Kristina Angelo
Last ACIP meeting and continuing work group discussions 

 May presentations

– Rabies pre-exposure prophylaxis and children

• Antibody response to rabies vaccine in children of all ages is similar to that in adults

• WG’s preference is for PrEP recommendations for children to align with those of adults

– Post-exposure prophylaxis (PEP) background

• Components of rabies PEP for previously vaccinated and naïve persons

• Factors that should be considered before administering PEP (draft flowchart)

 Workgroup discussions

– Rabies immunoglobulin (RIG) products licensed since 2008 ACIP recommendations

– Data about changes to PEP schedule
WG’s goal for today

 PrEP

– Review the Evidence to Recommendations framework presented at the October 

ACIP meeting and summarized at the February ACIP meeting 

– ACIP votes on 2 recommendations for children; these were passed for persons ≥ 

18 years of age during February ACIP meeting

 PEP

– RIG: Background, 2 product licensed since 2008 ACIP recommendations, and 

WG’s consideration of recent changes to the WHO recommendations

– Data about changes to PEP series and WG’s preferences
Anticipated timeline

-Finished discussion about 

PrEP and children 

-Begin PEP presentations 

May 2021 June 2021 October 2021

-Present WG interpretation 

of data about RIG, PEP 

schedules

-Votes on PrEP and children

-PEP clinical guidance topics

E.g., management of 1) schedule 

deviations for PrEP and PEP and 

2) PEP initiated abroad
Today’s presentations*

 Rabies immune globulin

 Post-exposure prophylaxis schedule

 Rabies pre-exposure prophylaxis: Review of summarized EtR

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 Vote

*All presentations are provided by Dr. Agam Rao (CDC/NCEZID)
Today’s vote: Proposed recommendation #1

ACIP recommends a 2-dose [0, 7 days] intramuscular rabies vaccine series in 

immunocompetent persons <18 years of age for whom rabies vaccine preexposure prophylaxis (PrEP) is indicated.
Today’s vote: Proposed recommendation #2

ACIP recommends an intramuscular booster dose of rabies vaccine, as an 

alternative to a titer check, for immunocompetent persons <18 years of age 

who have sustained and elevated risk for only recognized rabies exposures 

(i.e., those in risk category #3 of rabies PrEP recommendations table). The 

booster dose should be administered no sooner than day 21 but no later than 

3 years after the 2-dose PrEP series.
1For questions about 

the disease 

biogeography of the 

region where an 

exposure occurred, 

please contact your 

local or state health 

department

2Bats are reservoirs 

for rabies in all US 

states except Hawaii

3Terrestrial mammals 

are non-bat species 

(e.g., racoons, skunks, 

livestock)
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Thank you!