Top 5 Takeaways

  1. Rabies Vaccination Recommendations Updated: A new 2-dose intramuscular rabies vaccination series on days 0 and 7 has replaced the previous 3-dose schedule, aimed at increasing adherence and reducing costs.
  2. Changes in Preexposure Prophylaxis (PrEP): The new guidance simplifies the post-exposure prophylaxis (PEP) regimen by eliminating the need for rabies immunoglobulin and reducing vaccine doses if an exposure occurs.
  3. Adjusted Rabies Antibody Titer Levels: The minimum acceptable rabies antibody titer has been raised to 0.5 international units per milliliter to align with global standards and enhance protective assurance.
  4. Special Populations and Clinical Guidance: The report provides specific recommendations for immunocompromised individuals and advises on coadministration of rabies vaccine with certain antimalarial drugs.
  5. Future Directions: Emphasis on further research to confirm the long-term immunogenicity of the 2-dose series and the efficacy of the vaccine among various risk groups.

Original Article Author and Citation

Corresponding Author

Agam K. Rao,

Suggested Citation

Rao AK, Briggs D, Moore SM, et al. Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022. MMWR Morb Mortal Wkly Rep 2022;71:619–627. DOI:


The Advisory Committee on Immunization Practices (ACIP) revised the rabies preexposure prophylaxis (PrEP) guidelines to improve adherence and coverage. The new 2-dose vaccination schedule is expected to facilitate easier and more affordable rabies prevention in the United States, especially among high-risk populations.


The ACIP conducted a systematic review of the evidence, deliberated on expert opinions, and analyzed data from recent years to recommend these changes. The decisions were influenced by a desire to improve public health outcomes and streamline preventive measures.


These changes aim to lower barriers to vaccination, reduce costs for at-risk individuals, and ensure a wider and more effective deployment of rabies PrEP. The new guidelines also take into account the evolving epidemiology of rabies and advances in vaccine technology.


The updates to the rabies vaccination guidelines by the ACIP reflect a significant step towards enhancing rabies prevention in the United States. The shift to a simpler vaccination regimen and updated titer levels underscores the ongoing efforts to adapt public health strategies to current challenges and scientific advancements.

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