Rabies PEP Decision Tree
Walk the CDC ACIP rabies post-exposure prophylaxis decision tree.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Animal involved
- Bat in a room with sleeping person
- Previously vaccinated against rabies
- No, immunocompetent
Result: Begin PEP if bat unavailable for testing. If PEP indicated: HRIG 20 IU/kg infiltrated at wound; vaccine days 0, 3, 7, 14.
Answer the questions this way to reach that result. Your own answers give your own.
Inputs and output
- What you enter
Two answers: the animal involved, then whether the patient has been vaccinated against rabies before.
- What you get
- Whether post-exposure prophylaxis is indicated, and if so the HRIG dose and the vaccine day schedule.
What this is
Sophie Well asks about the exposure type (bite, scratch, mucous-membrane contact, or bat in the sleeping area), the animal species and its observation or testing status, the patient's prior rabies vaccination history, and any local public-health guidance, and returns the recommended PEP regimen: wound care, human rabies immune globulin dosing and infiltration around the wound, and the four-dose rabies vaccine series on days 0, 3, 7, and 14 (with a fifth dose on day 28 for immunocompromised patients). Source: CDC ACIP rabies PEP recommendations (current edition).
When to use it
Use this in the ED, urgent care, or primary care when a patient presents after a potential rabies exposure - dog or cat bite in an area without reliable observation, any bat exposure including a found bat in a bedroom, or contact with a wild carnivore. PEP is time-sensitive but not an emergency in the resuscitation sense; the right speed is hours-to-days, not minutes. Coordinate with the state or local health department before declining PEP for any wild-mammal exposure, because the rabies fatality rate once symptoms begin is effectively 100% and the cost-benefit math always favors prophylaxis when the exposure cannot be ruled out.
How this is calculated
CDC/ACIP rabies post-exposure prophylaxis. Rupprecht CE, et al. Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: ACIP recommendations. MMWR Recomm Rep. 2010;59(RR-2):1-9. Read the source ↗
Source: CDC rabies post-exposure prophylaxis decision aid
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.