Who should be offered pre-exposure prophylaxis (PrEP) with rabies vaccination?

In May 2022, CDC published updated ACIP recommendations for rabies PrEP based on risk categories. All people in categories 1-4 should receive a 2-dose primary PrEP rabies vaccine series. People in categories 1-3 require additional long-term follow-up with periodic antibody titer checks and/or booster doses, depending on the category. See the table on pages 622-623 of the MMWR publication for details: www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7118a2-H.pdf.

In brief, the risk categories are as follows:

• Risk category 1: elevated risk of unrecognized or recognized exposures, including unusual or high-risk exposures (e.g., laboratory or rabies vaccine production settings)
• Risk category 2: elevated risk, exposures typically recognized but may be unrecognized (e.g., people who frequently interact with bats or collect suspected rabies samples)
• Risk category 3: elevated risk, exposure nearly always recognized (e.g., veterinary workers, people who handle wildlife reservoir species, spelunkers [because of bats], and certain travelers who have increased risk and may have trouble obtaining safe post-exposure prophylaxis)
• Risk category 4: same type of risk as category 3, but risk period is time-limited (no more than 3 years)
• Risk category 5: low risk, typical person living in the United States (PrEP not recommended)