Rabies Post-Exposure Prophylaxis (PEP)

Rabies Post-Exposure Prophylaxis (PEP)


From 2010-2019, in San Diego County, 91 rabid animals identified- all bats except one fox (no dogs/cats)

  • 92% of rabies cases in US from wild animals (bats primarily), with 8% from domesticated animals

Average cost of PEP: $3,800 with 55,000 Americans receiving rabies PEP each year (~40% unnecessary)

  • In 1 year, 102 patients (~8-9 per month) received rabies PEP across the Scripps System
  • Scripps cost for rabies immune globulin ($2350) + rabies vaccine series ($1220)= $3570
  • Adverse events: injection site reaction, myalgias, dizziness, headache, malaise

No domestic animal has tested positive for rabies in San Diego since 1968

  • Last case of rabies in San Diego was in 2001 from a man bitten by a dog in the Philippines
  • Last local case of rabies exposure was from a bobcat in 1969
  • Because rabies biologics are valuable resources that are periodically in short supply…a risk assessment weighing cost and potential adverse consequences…along with their severity and risk for the person acquiring rabies should be conducted
  • PEP should be allocated judiciously and reserved for individuals for whom exposure to rabies virus is likely
  • Most a "medical urgency," not a "medical emergency" except direct exposure to a confirmed rabid animal’s saliva

Treatment Considerations

Utilize guideline-based recommendations, patient education, and shared-decision making when assessing possible exposure to rabies virus and if vaccine and immune globulin are indicated

  • Wound care with irrigation, soap, povidone/iodine (virucidal)
  • Antibiotics if indicated

More Information

  1. CAHAN San Diego - Health Information: Animal Rabies in San Diego County. June 26, 2019. Accessed on November 13, 2019. 
  2. California Compendium of Rabies Control and Protection. California Department of Public Health Veterinary Public Health Section, 2012.
  3. Manning SE, et al. Human rabies prevention--United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 57:1, 2008. 
  4. World Health Organization: Expert Committee on Rabies. Eighth Report. Technical report series 824. Geneva, WHO, 1992.
  5. Johns Hopkins ABX Guide – Rabies. Accessed November 15, 2019. 
  6. Moran GJ, Talan DA, Mower , et al. Appropriateness of rabes postexposure prophylaxis treatment for animal exposures. Emergency ID Net Study Group. JAMA, 2000; 284:1001-1007.