Currently, people that have potentially been exposed to rabies undergo post-exposure treatment consisting of one dose of rabies antibodies followed by a series of 5 vaccinations on days 0, 3, 7, 14 and 28. It’s not fun but it’s much better than the old horror stories of 14 or more injections in the abdomen, which was the standard until the 1970s. For most people, the series of 5 rabies vaccines is not that big of a deal, but some people have adverse reactions, and having to undergo that many shots is not enjoyable, especially for children.

Now, a US advisory committee has recommended changing the vaccine requirements to 4 doses. There are a couple reasons for this. One is that many people end up skipping the final dose anyway and none have ever come down with rabies (although the strength of this argument is dependent on how many of them were truly exposed and at real risk of disease). Another is the cost of vaccination, which runs $100-200 per dose. When you multiply that by the tens of thousands of people that are treated annually, eliminating a single dose results in pretty big cost savings.

However, it’s interesting that this recommendation has been made without coordinating with vaccine makers. Therefore, if this change is adopted, physicians would have to choose between following the US recommendations or the vaccine label. This could lead to confusion as well as legal liability concerns. "Off-label" drug use is a touchy area, and is generally frowned upon. Vaccine manufacturers may be unwilling to change the label because of a lack of scientific evidence clearly indicating that 4 doses are effective, plus the fact that it would instantly reduce sales by 20%. If this guideline is adopted, significant education efforts, assessment of liability and discussions with manufacturers will be needed. If 4 shots are truly effective (which is probably the case) this is probably a good change.

More information about rabies can be found on the Worms & Germs Resources page.