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Preexposure Vaccinations

People who work with rabies in laboratory settings and animal control and wildlife officers are just a few of the people who should consider rabies preexposure vaccinations.

If you are traveling to a country where rabies is widespread, you should consult your doctor about the possibility of receiving preexposure vaccination against rabies.

Consider preexposure vaccination if:

  1. Your planned activity will bring you into contact with wild or domestic animals, for example if you are a biologist, veterinarian, or agriculture specialist working with animals.
  2. You will be visiting remote areas where medical care is difficult to obtain or may be delayed, for example, hiking through remote villages where dogs are common.
  3. Your stay is longer than 1 month in an area where dog rabies is common. The longer your stay, the greater the chance of an encounter with an animal.

Although preexposure vaccination does not eliminate the need for additional therapy after a rabies exposure, it simplifies management by eliminating the need for rabies immune globulin and decreasing the number of doses of vaccine needed. This is of particular importance for persons at high risk for exposure to rabies in areas where immunizing products might not be available or where lesser quality biologics might be used which would place the exposed person at increased risk for adverse events.

Preexposure prophylaxis may also protect people whose postexposure therapy is delayed and provide protection to people who are at risk for unapparent exposures to rabies.

Rabies Preexposure Prophylaxis Guide
Risk CategoryNature of RiskTypical PopulationPreexposure Recommendations
ContinuousVirus present continuously, often in high concentrations. Specific exposures likely to go unrecognized. Bite, nonbite, or aerosol exposure.Rabies research laboratory workers; rabies biologics production workers.Primary course. Serologic testing every 6 months; booster vaccination if antibody titer is below acceptable level.
FrequentExposure usually episodic, with source recognized, but exposure also might be unrecognized. Bite, nonbite, or aerosol exposure.Rabies diagnostic lab workers, spelunkers, veterinarians and staff, and animal-control and wildlife workers in rabies-enzootic areas. All persons who frequently handle bats.Primary course. Serologic testing every 2 years; booster vaccination if antibody titer is below acceptable level.
InfrequentExposure nearly always episodic with source recognized. Bite or nonbite exposure.Veterinarians and terrestrial animal-control workers in areas where rabies is uncommon to rare. Veterinary students. Travelers visiting areas where rabies is enzootic and immediate access to appropriate medical care including biologics is limited.Primary course. No serologic testing or booster vaccination.
Rare (population at large)Exposure always episodic with source recognized. Bite or nonbite exposure.U.S. population at large, including persons in rabies-epizootic areas.No vaccination necessary.

Primary vaccination

Three 1.0-mL injections of HDCV or PCEC vaccine should be administered intramuscularly (deltoid area) -- one injection per day on days 0, 7, and 21 or 28. Vaccine preparations for intradermal administration are no longer available in the United States.

Booster doses

Continuous risk

People who work with rabies virus in research laboratories or vaccine production facilities are at the highest risk for unapparent exposures. Such persons should have a serum sample tested for rabies antibody every six months. Intramuscular booster doses of vaccine should be administered to maintain a serum titer corresponding to at least complete neutralization at a 1:5 serum dilution by the RFFIT.

Frequent risk

This group includes other laboratory workers such as those performing rabies diagnostic testing, spelunkers, veterinarians and staff, and animal-control and wildlife officers in areas where animal rabies is enzootic. The frequent-risk category also includes persons who frequently handle bats, regardless of location in the Unites States. Persons in the frequent risk group should have a serum sample tested for rabies antibody every 2 years; if the titer is less than complete neutralization at a 1:5 serum dilution by the RFFIT, the person also should receive a single booster dose of vaccine.

Infrequent risk

Veterinarians, veterinary students, and terrestrial animal-control and wildlife officers working in areas where rabies is uncommon to rare (infrequent exposure group) and at-risk international travelers fall into this category and do not routine preexposure booster doses of vaccine after completion of primary preexposure vaccination.

Rabies vaccines and immunoglobulin available in the United States
TypeNameRouteIndications
Human Diploid Cell Vaccine (HDCV)Imovax® RabiesIntramuscularPreexposure or Postexposure
Purified Chick Embryo Cell Vaccine (PCEC)RabAvert®IntramuscularPreexposure or Postexposure
 
 
 
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