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December 13, 2000

Postexposure Prophylaxis for Rabies—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(22):2870-2871. doi:10.1001/jama.284.22.2869

In Reply: Dr Ryan is correct that our algorithm was based on 1991 ACIP guidelines and was intended to illustrate the criteria used to determine "appropriateness" of rabies PEP at the time our study was conducted. It was not intended as an algorithm to guide current treatment decisions. The ACIP guidelines were revised in 1999 and now recommend that rabies PEP should be initiated "as soon as possible" after exposure to wild terrestrial carnivores, as opposed to waiting for the results of brain testing. Treatment can be terminated if the animal is found to be free of rabies by brain testing. This is certainly appropriate in areas where rabies is common among such animals or if there is uncertainty about the prompt availability of brain testing results. However, there are many areas in the United States where rabies is rare even among wild carnivores. It is reasonable to withhold rabies treatments in lower-risk areas pending results of brain testing, provided that results will be available within 48 hours and patient follow-up can be ensured. To our knowledge, there has never been a case of human rabies in a person who received properly administered PEP within several days of exposure.

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