Figure. Booster algorithm for people at ongoing risk of exposure to rabies virus or other lyssaviruses
Figure. Booster algorithm for people at ongoing risk of exposure to rabies virus or other lyssaviruses
IU = international units; PEP = post-exposure prophylaxis; PrEP = pre-exposure prophylaxis
This flowchart helps to decide if people at ongoing occupational risk need booster doses of rabies vaccine.
For laboratory staff at risk, perform serological testing every 6 months.
For veterinary workers, people who handle bats or may need to handle bats, and people who have ongoing exposure to potentially rabid terrestrial mammals in rabies-enzootic countries, give a single intramuscular booster dose 1 year after pre-exposure prophylaxis. Then perform serological testing or give a booster dose every 3 years from receipt of the 1-year booster dose.
After serological testing, for those who have a virus neutralising antibody titre of at least 0.5 IU/mL, no further action is needed until either there is further exposure (then give post-exposure prophylaxis as per rabies or bat lyssavirus post-exposure algorithms, unless exposure occurs within 3 months of receiving complete post-exposure prophylaxis, when no immediate vaccination is required) or the next serological testing period elapses (then perform serology).
For those with a virus neutralising antibody titre of <0.5 IU/mL, give a single intramuscular booster dose for immunocompetent people. For immunocompromised people, give a single intramuscular booster dose then check serology after 2–4 weeks. If the antibody titre is <0.5 IU/mL, give another booster dose. If further exposure occurs, give post-exposure prophylaxis as per the terrestrial animal post-exposure algorithm or the bat post-exposure algorithm.