WASHINGTON, D.C. — The Centers for Disease Control and Prevention is warning clinicians and health departments about a nationwide rise in reported human rabies exposures and treatment errors after vaccine use jumped 33% and rabies immune globulin use climbed 76% from a year earlier.
The CDC issued a Health Alert Network advisory after multiple jurisdictions reported increases since July in people exposed to rabid or potentially rabid animals, including mass-exposure events. At least eight state health departments also reported increased use of rabies post-exposure prophylaxis, administration errors or both.
Rabies-related inquiries to the CDC increased 17% in July and August compared with the same period in 2025. Pharmacy data through Sept. 2 showed use of the two U.S.-licensed rabies vaccines increased an estimated 33%, while use of the two licensed human rabies immune globulin products rose 76%.
The increases have not produced a shortage of either vaccine or immune globulin. The CDC is urging clinicians to conduct risk assessments before administering post-exposure prophylaxis, or PEP, and to follow Advisory Committee on Immunization Practices recommendations to prevent unnecessary treatment and preserve supplies.
Rabies is nearly 100% fatal after symptoms develop but can be prevented when PEP is administered appropriately before symptoms begin. The virus can spread from infected animals through bites, scratches or oral secretions and attacks the central nervous system.
About 1.4 million people in the U.S. seek medical care each year after animal contact and undergo evaluation, while approximately 100,000 receive rabies PEP following a potential exposure.
The financial consequences of unnecessary treatment can be substantial. A typical course of rabies PEP costs between $11,000 and $14,000 per person, according to the CDC.
Treatment depends on whether a patient has previously been vaccinated against rabies. People who have never been vaccinated generally receive human rabies immune globulin, or HRIG, and four vaccine doses on days 0, 3, 7 and 14.
Previously vaccinated patients receive vaccine on days 0 and 3 and should not receive HRIG. Immunocompromised patients may require a five-dose vaccine series through day 28 and laboratory testing to confirm an adequate immune response.
The CDC identified several recurring treatment errors, including administering vaccine in the gluteal area, failing to infiltrate HRIG around identifiable wounds, giving HRIG and vaccine at the same anatomical site, using incorrect vaccine schedules and unnecessarily restarting a vaccine series after scheduling deviations.
Other reported problems include failing to provide HRIG when required, administering it to previously vaccinated patients and incorrectly classifying a patient’s vaccination history or immune status.
For patients who have not previously been vaccinated, HRIG should be administered when PEP begins and infiltrated into and around identifiable wounds when anatomically feasible. If initially omitted, it can be administered through the date of the third vaccine dose, or day 7.
The CDC advises clinicians not to delay vaccination when HRIG is unavailable. It also cautions that HRIG and vaccine should never be mixed in the same syringe or administered at the same anatomical site because the products could neutralize each other.
A rabies risk assessment should consider the animal involved, circumstances of the exposure, signs consistent with rabies and the type and severity of the wound. PEP generally is not recommended when an animal can undergo a 10-day observation period, tests negative for rabies or public health officials determine that the incident does not present a rabies risk.
People potentially exposed to rabies should immediately wash wounds with soap and water and contact a clinician or public health department. The CDC recommends keeping distance from wildlife, particularly animals that appear injured, sick or dead, and keeping pets current on rabies vaccinations.
Health departments are being asked to help clinicians assess exposures and treatment errors, monitor vaccine supplies and maintain processes for obtaining additional supplies if allocation limits are imposed.
Detailed information for clinicians and the public is available at http://www.cdc.gov/rabies.
Support the local news that supports Chester County. MyChesCo delivers reliable, fact-based reporting and essential community resources—free for everyone. If you value that, click here to become a patron today.