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ACIP recommends reducing rabies PEP from five doses to four

The Advisory Committee on Immunization Practices has recommended reducing the rabies postexposure prophyhlaxis schedule from five doses to four, following a lengthy discussion at the CDC in Atlanta this morning.

Charles Rupprecht, VMD, MS, PhD, chief of the CDC’s rabies program, presented epidemiologic surveillance data from 1980 to the present, which showed no cases of rabies due to absence of the administration of a fifth dose. Other studies in animals have shown similar results, with many studies demonstrating a full protective effect after only three doses. Rupprecht said his office began looking at the data after some shortages in the vaccine supply were reported in late 2007.

“Compliance has not been 100% with rabies vaccine,” Rupprecht said. “One study of human postexposure prophylaxis concluded that about 13% of people did not complete the full schedule,” with no subsequent treatment failures.

One committee member, H. Cody Meissner, MD, who is a professor of pediatrics at Tufts University School of Medicine in Boston, Massachusetts, expressed concern about the revised recommendations conflicting with the package insert for both the approved Novartis and Sanofi products and the AAP’s recently-issued 2009 Red Book.

“This may cause a great deal of confusion for pediatricians,” Meissner said. However, other committee members noted that other ACIP recommendations conflict with package inserts, and that a strong guidance from the committee disseminated to public health providers would likely ease confusion.

Representatives from the manufacturers in attendance at the meeting stressed that the ACIP’s recommendations would conflict with the package insert, and if they are consulted by physicians on vaccine use, they would continue to recommend the five-dose schedule as directed by the package. – by Colleen Zacharyczuk