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Experts: Rabies remains present across U.S.; careful risk assessment needed to avoid costly, unnecessary PEP
Summary
CDC and state public‑health officials told clinicians that rabies persists in nearly every U.S. state and that structured risk assessment — aided by CDC calculators and health‑department consultation — is essential to ensure only patients with real exposures receive postexposure prophylaxis.
Federal and state public‑health officials on a CDC COCA webinar said rabies continues to pose a daily public‑health challenge across the continental United States and urged clinicians to use structured risk assessments and available CDC tools to avoid unnecessary, costly postexposure prophylaxis (PEP).
Dr. Ryan Wallace, veterinary medical officer in the National Center for Emerging and Zoonotic Infectious Diseases at CDC, said, “But thousands of animals are diagnosed with rabies, and tens of thousands of Americans are treated for rabies exposures every single year.” He reviewed rabies’ biology, the typical clinical progression and the narrow window for experimental therapies once clinical signs appear.
Wallace outlined the biogeo‑behavioral risk assessment clinicians should apply: assess the animal’s biology (is it a regional reservoir species?), exposure geography (is the variant present locally?), and animal behavior (provoked versus unprovoked). He said that although roughly 1.3 million people seek care for animal bites annually, only about 100,000 are recommended PEP after assessment, and the average PEP course in the United States costs about $12,000.
To support decision making, Wallace highlighted two CDC resources: an R Shiny risk‑calculator that estimates the probability an animal has rabies based on species, location and exposure details, and a PEP schedule generator that checks adherence to recommended timing. He said the calculator flags deviations that should prompt public‑health consultation.
In a later Q&A, Wallace addressed organ‑donor safety, noting three donor‑derived rabies events in the United States since 1990 that led to six recipient deaths and saying CDC is working with donation safety groups and analyzing case detection to reduce risk while preserving organ‑transplant activity.
Why this matters: clinicians who default to immediate PEP without consulting public health can expose patients to substantial cost and adverse events, strain vaccine supplies and miss opportunities to reserve PEP for truly at‑risk patients. The webinar stressed that coordination with local or state health departments and use of CDC tools improves adherence to Advisory Committee on Immunization Practices (ACIP) guidance.
The webinar recording, slides and transcript are being posted on the CDC COCA website; presenters encouraged clinicians to consult local public‑health teams for complex cases.
