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Rabies immune globulin and vaccine

Alfred DeMaria, Jr, MD
Section Editors
Martin S Hirsch, MD
Sheldon L Kaplan, MD
Deputy Editor
Jennifer Mitty, MD, MPH


More than 3.3 billion people worldwide live in areas where rabies is enzootic. Human mortality from rabies is estimated to range from 26,400 to 61,000 deaths per year. Most cases occur in Africa and Asia and result primarily from canine reservoirs [1]. In the United States, there has been an average of two fatal human rabies cases annually since 1980, the majority associated with exposure to bats.

Rabies is virtually always fatal, but infection can be prevented with proper wound care and postexposure prophylaxis. Although the incidence of human rabies is very low in the United States, approximately 16,000 to 39,000 cases with contact to potentially rabid animals receive rabies postexposure prophylaxis annually [2]. The annual expenditure for rabies in Africa and Asia has been estimated to be $584 million, and globally, $6 billion in direct costs and lost productivity; the cost of postexposure prophylaxis with rabies immune globulin and vaccine accounts for a significant proportion of this expenditure [1,3].

The safety, efficacy, and administration of rabies immune globulin and rabies vaccine will be reviewed here. Clinical decision-making regarding the necessity for rabies prophylaxis can be complex. This issue and the clinical presentation, diagnosis, and care of the patient with suspected rabies are discussed elsewhere. (See "When to use rabies prophylaxis" and "Clinical manifestations and diagnosis of rabies".)


The general principles guiding rabies prophylaxis, as derived from the Advisory Committee on Immunization Practices (ACIP) guidelines of the United States Centers for Disease Control and Prevention (CDC) [2], are discussed below. The full set of guidelines can be accessed at: http://www.cdc.gov/mmwr/pdf/rr/rr57e507.pdf (with updated vaccine schedule recommendations at http://www.cdc.gov/mmwr/pdf/rr/rr5902.pdf).

Timing of prophylaxis — Rabies postexposure prophylaxis is an urgent medical intervention and should begin as soon as possible after the presumed exposure.

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Literature review current through: Nov 2017. | This topic last updated: Nov 18, 2015.
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