People exposed to rabies need only four vaccinations, not the five currently recommended, a vaccine advisory committee said Wednesday.
In the past, rabies shots were dreaded almost as much as the disease itself. Until the 1970s, an encounter with a rabid animal led to at least 14 shots in the abdomen. But vaccines have improved, and five shots in the arm or thigh have been the U.S. standard for more than 20 years.
The Advisory Committee on Immunization Practices voted unanimously that four shots — all given within the first 14 days after exposure to rabies — are sufficient.
The panel advises the U.S. Centers for Disease Control and Prevention, which issues official guidance to doctors
Committee members made the decision after hearing that out of 20,000 to 40,000 Americans exposed to rabies each year, an estimated 1,000 get only three or four shots and none of them have developed rabies.
The shots cost between $100 and $200 apiece. Two companies make rabies vaccine for the U.S. market, Novartis and Sanofi Pasteur.
The committee’s recommendations usually harmonize with what drug companies’ package insert information about how their product should be used, but not in this case. A Novartis official, Clement Lewin, said he disagreed with the panel setting a precedent by making an off-label recommendation. He said it might confuse doctors who read company information about the vaccine that calls for five doses over 28 days, but see government guidance that says four shots are enough.
Rabies is a viral disease transmitted through the bite of a rabid animal. Most rabies cases occur in wild animals like raccoons, skunks, bats, and foxes.
The virus can infect the nervous system and can cause symptoms like insomnia, anxiety, confusion, paralysis, salivating, hallucinations, difficulty swallowing and fear of water. Death usually occurs within days of the onset of symptoms.
It’s a recurring menace in the developing world, but the number of U.S deaths have declined to an average of two or three each year.