CDC Health Advisory: Nationwide Increase in Reported Human Rabies Exposures: Rabies Post-exposure Prophylaxis Administration

Rabies is a zoonotic viral disease that is nearly 100% fatal, but it is preventable when PEP is given appropriately before patient symptoms start. An infected animal can spread rabies to humans and other animals through bites, scratches, or oral secretions. Rabies primarily affects the central nervous system, leading to encephalitis and death if medical care is not received soon after exposure and before symptoms start. ACIP post-exposure prophylaxis to prevent human rabies recommendations outline rabies exposure assessment, wound care, vaccination, and immunoglobulin dosing. Following a potential rabies exposure, it is important for a health official familiar with animal rabies epidemiology to help assess exposure risk and determine if a patient might need PEP. Two rabies vaccines, Imovax^® (HDCV) and RabAvert^® (PCECV), and two HRIG products, KEDRAB™ and HyperRab™ , are licensed for use in people in the United States.

From July through August 2026, CDC received 17% more rabies-related inquiries than during the same period in 2025, including reports of mass exposure events (e.g., involving more than one person). During this time frame, CDC also received reports from at least eight state health departments of increased rabies PEP use, PEP administration errors, or both. Each year, an estimated 1.4 million people in the United States seek medical care after animal contact and undergo evaluation, and approximately 100,000 people receive rabies PEP following a potential exposure. According to weekly pharmacy data as of September 2, 2026, utilization for the two rabies vaccines and the two rabies immunoglobulins licensed in the United States has increased by an estimated 33% and 76%, respectively, compared with the same time period last year.

Although there is currently no shortage of human rabies vaccine or human rabies immunoglobulin in the United States, it is important for clinicians to administer PEP appropriately because errors in rabies risk assessment and PEP administration could result in unnecessary treatment (e.g., additional doses of vaccine or HRIG), potential adverse effects, and avoidable costs. A typical course of PEP can cost between $11,000 and $14,000 per person. Following rabies PEP administration guidance helps ensure that lifesaving vaccines are available for persons who need it and extraneous costs are avoided.

Correct rabies PEP administration depends on the patient's previous rabies vaccination status. For persons who have never been vaccinated against rabies, PEP should always include HRIG and vaccine. HRIG is administered once when PEP is initiated; if initially omitted, HRIG may be administered through the date of a patient's third vaccination dose (day 7). HRIG is infiltrated into and around all identifiable wounds to the extent anatomically feasible, and any remaining volume is administered intramuscularly at a site distant from the first vaccine dose. Rabies vaccine is administered intramuscularly in the deltoid area (for adults) or in the deltoid or anterolateral thigh (for children) on days 0, 3, 7, and 14. Persons who were previously vaccinated against rabies should receive vaccine on days 0 and 3 and should not receive HRIG. Rabies vaccine is not administered in the gluteal area. HRIG and the first vaccine dose are never administered in the same syringe or anatomical site. Other recommendations apply to persons with altered immunity.

Commonly reported errors in rabies PEP administration include:

• Administering rabies vaccine in the gluteal area.

• Failing to infiltrate HRIG into and around all identifiable wounds to the extent anatomically feasible.

• Administering HRIG and vaccine in the same syringe or anatomical site.

• Forgetting to give HRIG to someone who needs it.
• Administering HRIG to a person who was previously vaccinated against rabies.

• Misclassifying previous vaccination history or immune status, resulting in omitted or unnecessary biologics doses.

• Using an incorrect rabies vaccine schedule.

• Unnecessarily restarting the rabies vaccine series after a schedule deviation.