Rabies PEP use surges as CDC warns against preventable administration errors

Clinical takeaway: Promptly assess suspected rabies exposures with public health authorities, provide immediate wound care, and select postexposure prophylaxis (PEP) according to the patient’s vaccination and immune status.

Since July 2026, multiple US jurisdictions have reported increases in exposure to rabid or potentially rabid animals. From July through August, CDC received 17% more rabies-related inquiries than during the same period in 2025. Pharmacy data through September 2 showed year-over-year increases of 33% in rabies vaccine use and 76% in human rabies immune globulin (HRIG) use. No national shortage is currently reported.

Before initiating PEP, clinicians should verify that a meaningful exposure occurred, consider local animal epidemiology and testing or observation options, and consult public health authorities when needed. In general, PEP is unnecessary if the animal completes a 10-day observation period, tests negative, or health officials determine there is no rabies risk. Immediately wash wounds thoroughly with soap and water; irrigate with povidone-iodine when available, and delay wound closure until after HRIG infiltration.

For patients not previously vaccinated, administer HRIG once at 20 IU/kg, plus rabies vaccine 1 mL IM on days 0, 3, 7, and 14. Infiltrate as much HRIG as anatomically feasible into and around every wound; give any remainder IM at a site distant from vaccine. Verify the product concentration before converting the dose to milliliters. Do not mix HRIG and vaccine or administer them at the same anatomic site. If HRIG is unavailable, do not delay vaccination; HRIG may be given through day 7. Do not exceed 40 IU/kg when correcting an administration error, because excess HRIG may impair vaccine response.

Previously vaccinated patients should receive vaccine only on days 0 and 3—not HRIG. Give vaccine in the deltoid for adults and children older than 2 years; the anterolateral thigh is acceptable for younger children. Gluteal doses are invalid and must be repeated.

Immunocompromised patients require vaccine on days 0, 3, 7, 14, and 28, followed by serologic confirmation of response and prompt public health consultation. Review immunosuppressive medications and prior domestic or international rabies vaccination carefully. Schedule deviations of several days generally do not require restarting the series; seek public health guidance for longer delays or administration errors.

Source: Centers for Disease Control and Prevention (CDC). (2026 Sep 10) Health Alert Network (HAN). Nationwide Increase in Reported Human Rabies Exposures: Rabies Post-exposure Prophylaxis Administration