CDC reports increase in rabies exposures and PEP use in multiple US jurisdictions

The Centers for Disease Control and Prevention (CDC) is warning of increased rabies activity and associated human exposures in multiple United States jurisdictions, while urging clinicians and public health officials to ensure that rabies post-exposure prophylaxis (PEP) is administered appropriately when indicated.¹

In a September 10 Health Alert Network advisory, the agency reported that multiple US jurisdictions have experienced local increases in human exposures involving known rabies vectors or animals in which rabies is less commonly reported since July 2026. The agency also reported an increase in rabies-related inquiries and PEP use, as well as errors in PEP administration.¹

From July through August 2026, the CDC received 17% more rabies-related inquiries than during the same period in 2025, including reports of mass exposure events involving more than 1 person. At least 8 state health departments also reported increased rabies PEP use, PEP administration errors, or both during that period.¹

According to weekly pharmacy data through September 2, use of the 2 rabies vaccines and 2 human rabies immune globulin (HRIG) products licensed in the US increased by an estimated 33% and 76%, respectively, compared with the same period in 2025. The CDC said there is currently no shortage of human rabies vaccine or HRIG in the US.¹

The agency's accompanying statement said the increases underscore the importance of proper administration of rabies vaccines and HRIG to ensure patients receive effective protection while avoiding unnecessary treatment, costs and strain on supplies.²

Appropriate risk assessment remains critical

Rabies is a zoonotic viral disease that is nearly 100% fatal after clinical signs develop but is preventable when appropriate PEP is administered before symptoms begin. Infected animals can transmit rabies through bites, scratches or oral secretions.¹

The agency emphasized that PEP should be administered based on an appropriate assessment of the exposure and the risk of rabies in the animal. Risk assessments should consider the animal's rabies epidemiology, the circumstances of the exposure, whether the animal displayed clinical signs consistent with rabies, and the type and severity of the wound. Public health officials can assist with these assessments.¹

PEP generally is not recommended when an animal is available for a 10-day post-exposure observation period, when rabies testing is negative, or when health officials determine that the exposure does not pose a rabies risk.¹

Errors in PEP administration

The advisory also highlighted several reported errors in PEP administration, including administering rabies vaccine in the gluteal area, failing to infiltrate HRIG into and around identifiable wounds when anatomically feasible, administering HRIG and vaccine in the same syringe or anatomical site, and administering HRIG to people who previously received rabies vaccination. Other errors included misclassifying vaccination history or immune status, using an incorrect vaccine schedule, and unnecessarily restarting a vaccine series after a schedule deviation.¹

Recommendations for clinicians and the public

The CDC recommends that clinicians consult their state, local, tribal or territorial health department regarding rabies epidemiology and individual exposure situations and follow current Advisory Committee on Immunization Practices recommendations for PEP.¹

The agency also reminded the public to avoid contact with wildlife and animals that appear sick, injured or dead, and to keep pets current on rabies vaccination. Anyone who has been bitten or scratched by wildlife or a sick-acting animal should immediately wash the wound with soap and water and contact a health care provider or public health professional for guidance.¹

References

1. Centers for Disease Control and Prevention. Nationwide increase in reported human rabies exposures: rabies post-exposure prophylaxis administration. Health Alert Network. Published September 10, 2026. Accessed September 14, 2026. https://www.cdc.gov/han/php/notices/han00533.html
2. Centers for Disease Control and Prevention. CDC statement on increases in recent animal rabies activity and associated human exposures. News release. Published September 10, 2026. Accessed September 14, 2026. https://www.cdc.gov/media/releases/2026/cdc-statement-on-increases-in-recent-animal-rabies-activity-and-associated-human-exposures.html