Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
To the Editor: The article by Dr Moran and
colleagues1 provides useful information
about postexposure prophylaxis (PEP) for rabies. The figure, however, does
not provide current rabies PEP treatment information. The figure caption refers
to the 1991 Advisory Committee on Immunization Practices (ACIP),2
while the text references the 1999 ACIP guidelines.3
There are significant differences between the 1991 and 1999 ACIP recommendations.
The PEP recommendations in the 1999 guidelines reflect both the developing
epidemiology of the disease and advances in medical knowledge. One of the
changes, for example, involves rabies PEP recommendations for high-risk exposures
to skunks and raccoons when the brain of the animal is available for testing.
In this situation, the algorithm in the article recommends withholding PEP
until the results of the brain test are available and initiation of treatment
only if the result is positive for rabies. The 1999 ACIP guidelines, however,
recommend initiating rabies PEP immediately while the brain test is being
performed and discontinuing treatment later if the test results are negative.
The 1999 ACIP and Centers for Disease Control and Prevention recommendations
are available at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056176.htm.
Ryan J. Postexposure Prophylaxis for Rabies. JAMA. 2000;284(22):2870-2871. doi:10.1001/jama.284.22.2869