Implications of These Updates
More persons who are recommended to receive rabies PrEP might be vaccinated because the 2-dose series recommended in these updates is associated with lower out-of-pocket costs and takes less time to complete. Persons with only short-term (≤3 years) risk for rabies (risk category 4) require no additional titer or booster doses, and last-minute travelers who previously were not vaccinated because the 3-dose series required ≥21 days might now be vaccinated because only 1 week is needed to complete the 2-dose primary series.
The updates might also facilitate improved adherence to evidence-based ACIP recommendations. As previously mentioned, in the past, some persons recommended to have serial titers checked did not adhere to those recommendations; with this update, many such persons now have the option of a one-time titer check or a one-time booster dose (i.e., a one-time action with two options for accomplishing it). As described in the EtR framework, some persons might prefer the titer option because of the potentially lower cost if a booster is not indicated (i.e., titer is ≥0.5 IU/mL); others might prefer the convenience of proceeding directly to a booster dose. The wide interval during which the titer or booster options can be taken might defray up-front costs and allow persons more time to determine whether they expect risk for rabies >3 years. Appointments for the titer check or booster dose can be scheduled at the time of the 2-dose primary series to ensure adherence to the recommendations.
Persons who received the 3-dose PrEP schedule recommended by ACIP in the past and whose activities place them within risk category 3 require no further titer checks or booster doses; the last vaccine dose they receive as part of the 3-dose series is equivalent to the option provided in these updates for a booster dose during day 21 to year 3. However, frequency of serial titer checks (risk categories 1 and 2) is unchanged, regardless of whether the 2-dose or 3-dose primary series was received by a person.
A consequence of the updated minimum acceptable rabies antibody titer (0.5 IU/mL) is that when titers are checked, more persons might require a booster dose than with the previous minimum acceptable rabies antibody titer level. ACIP concluded that the benefits of the new acceptable titer outweighed this theoretical concern.
Morbidity and Mortality Weekly Report. 2022;71(18):619-627. © 2022 Centers for Disease Control and Prevention (CDC)