Summary

• The Centers for Disease Control and Prevention (CDC) released a Health Advisory on September 10, 2026, describing an increase in reported human rabies exposures and rabies post-exposure prophylaxis (PEP) administration.
• According to pharmacy data as of September 2, 2026, use of the two rabies vaccines and the two rabies immunoglobulins (HRIG) licensed in the United States increased by an estimated 33% and 76%, respectively, compared with the same period last year. Similar increases have been seen in Fairfax County and the rest of Virginia.
• Over the last five years (2021–2025), an average of 445 clients annually have been recommended for or received rabies PEP in the Fairfax Health District (FHD). As of September 14, 2026, 554 clients have been recommended for or received rabies PEP. A large part of this increase is due to potential exposure to bats with 171 clients receiving PEP in 2026 to-date compared with a 5-year average of 78 clients. Of those, 60% did not meet the Advisory Committee on Immunization Practices criteria for rabies PEP.
• Although there is currently no shortage of human rabies vaccine or human rabies immunoglobulin in the US, it is important for clinicians to administer PEP appropriately because errors in rabies risk assessment and PEP administration may result in unnecessary treatment, adverse effects, and avoidable costs.

Suggested Actions:

• When evaluating a patient for a potential exposure to rabies, conduct a risk assessment to determine if rabies PEP is immediately needed. The Fairfax County Health Department (FCHD) Rabies Program is available for rabies PEP consultation at 703-246-2433.
• In general, PEP is not recommended when the animal is available for a 10-day post-exposure observation, when rabies testing is done on a euthanized animal and test results are negative, or when health officials determine the exposure does not pose a rabies risk.
• If rabies PEP is indicated and recommended by the FCHD, ensure appropriate administration.
  • Verify if the patient previously completed pre- or post-exposure prophylaxis. A person is considered vaccinated for rabies if they have received either a full pre-exposure or post-exposure prophylaxis series OR a partial series followed by documentation of a serologic titer ≥0.5 IU/mL using the Rapid Fluorescent Focus Inhibition Test (RFFIT) assay.
  • For persons who were never vaccinated against rabies, administer four total doses of rabies vaccines on day 0, 3, 7, and 14 intramuscularly in the deltoid for adults and children older than 2 years. Infiltrate HRIG into and around every identifiable wound to the extent that is anatomically feasible on day 0. Administer any remaining HRIG in a different anatomic site from the first vaccine dose. If there is clinical concern that a patient’s medical condition may impair their ability to respond to vaccination, administer a five-dose vaccine series (days 0, 3, 7, 14, and 28) and confirm adequate immune response via serological testing. Contact the FCHD for guidance.
  • For persons who were previously vaccinated against rabies, administer two doses of rabies vaccine on days 0 and 3. Do not administer HRIG if the patient previously received rabies vaccine.
     

Additional Information

• Rabies is endemic in the wildlife in Fairfax County and bites from mammals are reportable to the FCHD. To report a potential exposure to rabies, use the FCHD’s Rabies Exposure & PEP Administration Report Form at https://redcap.vdh.virginia.gov/redcap/surveys/?s=RFJ9XF9NJE or call Fairfax County Animal Services at 703-691-2131.
• If a patient reports being exposed to a bat and the bat is still available, delay rabies PEP administration and instruct the patient to call Fairfax County Animal Services at 703-691-2131 to capture the bat and test it for rabies. If the bat tests negative for rabies, no further action is needed. If the bat tests positive for rabies, whoever came into direct contact with it or was sleeping in the same room where the bat was found will need rabies PEP. Contact the FCHD at 703-246-2433 for any rabies PEP questions.
• A typical course of PEP can cost between $11,000 and $14,000 per person. Following rabies PEP administration guidance helps ensure that lifesaving vaccines are available for persons who need it and extraneous costs are avoided.

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