Rabies Pre-Exposure Prophylaxis Regimen
Animal Bites and Rabies Risk:
A Guide for Health Professionals

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Rabies Pre-Exposure Prophylaxis Regimen
Who should receive rabies pre-exposure prophylaxis?
Pre-exposure rabies vaccination series
Rapid Fluorescent Foci Inhibition Test (RFFIT)
Laboratories offering RFFIT rabies antibody titer testing

Rabies Pre-Exposure Prophylaxis Regimen

Pre-exposure vaccination against rabies simplifies the rabies post-exposure treatment, and it may protect in cases of unrecognized rabies exposure or when post-exposure treatment is delayed. It does not eliminate the need for appropriate treatment following a known rabies virus exposure.

Who should receive rabies pre-exposure prophylaxis?

Individuals are placed into one of five risk categories when determining their need for PrEV. Category 1 is the highest risk and 5 is the lowest and the categories were based on recognized versus unrecognized exposures. Serial titer checks are unnecessary for people who will have recognized exposures because an exposure will prompt an evaluation for PEP. Risk categories may change for a person over their lifetime.

A 2-dose PrEV schedule has replaced the 3-dose PrEV schedule. The primary vaccination series is now two doses on Days 0 and 7 and then depending on the person’s risk category they may require nothing additional, or they may require a 1-time booster, a 1-time titer check, or serial titer checks. Table 5: Rabies recommendations for pre-exposure vaccinated (PrEV) persons (PDF)

Pre-exposure rabies vaccination series

• Two 1 mL doses of rabies vaccine are given IM, one injection per day, on days 0, 7, in the deltoid area of adults or in the anterolateral thigh of young children.
• Human diploid cell vaccine (HDVC) or purified chick embryo cell vaccine (PCEC) may be used, although it is recommended that the vaccine series be initiated and completed with the same vaccine product.
• No HRIG should be given.
• Five risk categories determine the need for a one-time booster or periodic titer checks..

Rapid Fluorescent Foci Inhibition Test (RFFIT)

• The RFFIT(ref 7) is the only recommended test for determining virus neutralizing antibody levels against the rabies virus. Other available titer tests (including the ELISA test) are not recommended for this purpose.
  • The ACIP (ref 1) recommends that a single booster rabies vaccination be given when the titer falls below <0.5 IU/mL by the rapid fluorescent focus inhibition test (RFFIT), a virus neutralization test.

Commercial Laboratories offering RFFIT rabies antibody titer testing

Both require 2.0 mL serum.

Rabies Laboratory
Kansas State University
1800 Denison Ave
Manhattan, KS 66506
785-532-5650

Testing at KSU may also be requested through Quest Labs 
as Rabies Vaccine Response End Point Titer (order # 5789)

Atlanta Health Associates
309 Pirkle Rd, Suite D-300
Cummings, GA 30040
1-800-717-5612
 

RFFIT testing may be available to order through clinical reference laboratories. 
Please review your lab’s test catalog.