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December 13, 2000

Postexposure Prophylaxis for Rabies

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

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.