What should I do with a patient exposed to rabies who received a 2-dose pre-exposure prophylaxis rabies vaccination series more than 3 years ago, but who has not had a titer or booster dose since?

In a situation where the person’s vaccination status is not aligned with current recommendations at the time of exposure, the person should receive the same postexposure prophylaxis (PEP) regimen as an unvaccinated person. This includes human rabies immune globulin (HRIG) and 4 doses of vaccine (days 0, 3, 7 and 14).

For details on this and other scenarios related to sustaining long term immunogenicity in recipients of the 2-dose rabies primary series, please refer to the figure on page 624 of the May 6, 2022, MMWR at www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7118a2-H.pdf.