. 2022 Sep 14;27(3):169–190. doi: 10.1089/apb.2022.0019

Table 2.

Updated risk categories for pre-exposure rabies prophylaxis

ACIP risk category	Description	Notes^a
1	Recognizes elevated risk for unrecognized and recognized exposures, including unusual or high-risk exposures, such as with people performing testing for rabies in diagnostic laboratories.
2	Recognizes an elevated risk for unrecognized and recognized exposures. Level 2 is applicable to persons who frequently handle bats, have contact with bats, enter high-density bat environments, perform animal necropsies, enter bat roosts, or who collect suspected rabies samples.	Recommend rabies antibody titers checked every 2 years; a booster dose should be administered if titers are <0.5 IU/mL.
3	Recognizes an elevated risk for recognized exposures and sustained risk and is applicable to people who interact with animals that could be rabid, including occupational activities that typically involve contact with animals, people who handle wildlife reservoir species, and those who explore or study caves. In addition, Level 3 encompasses those who might have difficulty getting prompt access to safe PEP, such as in rural areas or far from the closest PEP clinic.	Recommend either rabies antibody titers checked during years 1–3 after completion of the 2-dose primary series (and a booster dose if the titer is <0.5 IU/mL) or preemptively receive a one-time IM booster dose of rabies vaccine no sooner than day 21 and no later than year 3 after completion of the 2-dose primary series.
4	Covers the same population as Level 3 except that the risk duration is less than or equal to 3 years, for example, a short-term student project with hands-on animal care less than 3 years after PrEP administration.

^{^a}

Those who have completed the pre-exposure rabies vaccine series should be informed that if a high-risk exposure occurs (consult with public health on need for post-exposure vaccine after any potential exposure), they will also need PEP with additional doses of a modern cell-culture vaccine administered as soon as possible with a second dose 3 days later (days 0 and 3). Remember that those exposed who have not completed pre-exposure vaccine will need post-exposure vaccine: 4 doses as well as rabies immune globulin.

ACIP, Advisory Committee on Immunization Practices; IM, intramuscular; IU, international unit; PEP, post-exposure prophylaxis; PrEP, pre-exposure rabies prophylaxis.

Adapted from ACIP Guidelines.³⁹