Rabies vaccines (pre- and post-exposure prophylaxis)

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disease risks

post-acute and long-term sequelae

vaccine efficacy and effectiveness

vaccine safety and adverse events

sources

Rabies Rabies lyssavirus

Disease risks

Acute risks of the infection itself: complications, hospitalisation, ICU, death.

Outcome (O)	Population (P)	Estimate	Design (S)	Source
Recognised bat bite among fatal bat-variant rabies cases severity: death case definition: Verified non-transplant human bat rabies virus variant cases in US surveillance summaries	all ages vaccination status: not reported country: United States setting: national surveillance period: 1990-2015 All ages	17.1 proportion of fatal cases with a reported bite (%) per fatal bat-variant case	systematic review	Dato et al. 2016 PLoS One quote Seven (17.1%) of 41 cases reported a bite from a bat. abstract All 41 cases were fatal (preceding sentence). Most fatal bat cases had no recognised bite, which is the basis for treating unrecognised bat contact as an exposure.
Suspected human rabies virus exposure severity: exposure requiring prophylaxis case definition: Suspected exposures (mainly dog bites) reported in included studies	all ages vaccination status: not reported country: Ethiopia setting: community and facility studies period: all years to search date All ages	54.03 (43.92–64.13) incidence per 100,000 population per 100,000 population	meta-analysis 8 articles, 18 data points, 116,484 people	Tariku et al. 2025 BMC Infect Dis quote The pooled incidence rate was 54.03 (95% CI: 43.92-64.13) per 100,000 population. abstract, RESULTS Exposure incidence, not disease. Wide regional variation (4.49 to 107.32 per 100,000 in the same abstract); males 1.67 times more likely to be exposed.
Share of rabies deaths occurring in children severity: death case definition: Deaths attributed to rabies, by age	children under 15 years vaccination status: not reported country: global, mainly Asia and Africa setting: all settings period: current (fact sheet 2026) Infant <1y1-4y5-11y12-17y	40 proportion of rabies deaths (%) per rabies death	expert body	who.int quote It is a viral, zoonotic, neglected tropical disease that causes tens of thousands of deaths annually, with 40% being children under 15. Key facts WHO fact sheet statement; no interval given. Children are over-represented because they are bitten more often, on the head and face, and bites may go unreported.
Source of human rabies: dog-mediated transmission severity: any case definition: Human rabies cases attributed to dog bites and scratches	all ages vaccination status: not reported country: global setting: all settings period: current (fact sheet 2026) All ages	99 proportion of human rabies cases (%) per human rabies case	expert body	who.int quote Dog bites and scratches cause 99% of the human rabies cases and can be prevented through dog vaccination and bite prevention. Key facts This share is global; in countries that have eliminated canine rabies (e.g. the United States, rabies-bur-010) bats and other wildlife dominate.
Death once clinical rabies develops severity: death case definition: Clinical symptoms of rabies after the virus reaches the central nervous system	all ages vaccination status: not reported country: global setting: all settings period: current (fact sheet 2026) All ages	100 CFR (%) once symptomatic per symptomatic case	expert body	who.int quote Once the virus infects the central nervous system and clinical symptoms appear, rabies is fatal in 100% of cases. Key facts WHO rounds to 100%; a few dozen documented survivors exist worldwide (rabies-bur-022). This is the case-fatality once symptoms start, not the risk after a bite.
People receiving rabies vaccine after exposure severity: exposure requiring prophylaxis case definition: Human rabies vaccine recipients worldwide	all ages vaccination status: not reported country: global setting: all settings period: current (fact sheet 2026) All ages	29 people vaccinated per year (millions) per year, global population	expert body	who.int quote Over 29 million people worldwide receive human rabies vaccine annually. Post-exposure prophylaxis Measures exposures treated, not confirmed rabies exposures. The same page gives the 2018 average PEP cost.
Paralytic (dumb) form of rabies severity: death case definition: Paralytic form among human rabies cases	all ages vaccination status: not reported country: global setting: all settings period: current (fact sheet 2026) All ages	20 proportion of human cases (%) per human rabies case	expert body	who.int quote Paralytic rabies accounts for about 20% of the total number of human cases. Symptoms Paralytic rabies is often misdiagnosed, which WHO says contributes to under-reporting.
Death from rabies virus infection severity: death case definition: Rabies virus infection regardless of variant or reservoir	all ages vaccination status: not reported country: United States setting: national surveillance period: 1938-2018 All ages	99 CFR (%) per rabies infection	expert body	cdc.gov quote Rabies virus infection, regardless of the variant or animal reservoir, is fatal in over 99% of cases, making it one of the world’s most deadly diseases. Introduction CDC Vital Signs statement. The same page notes that five of 125 cases since 1960 were survivors whose infection was never laboratory-confirmed.
Persons receiving PEP after an exposure severity: exposure requiring prophylaxis case definition: CDC clinical overview estimate	all ages vaccination status: not reported country: United States setting: all settings period: current (page 2026) All ages	100,000 persons receiving PEP per year per year, United States population	expert body	cdc.gov quote However, about 100,000 Americans receive PEP following an exposure each year. Overview Higher than the 2017-2018 HCUP-based estimate (rabies-bur-013); the two CDC pages use different methods. Same sentence states fewer than 10 human cases a year.
Death from rabies severity: death case definition: Estimated rabies deaths across the African continent	all ages vaccination status: not reported country: Africa setting: continent-wide estimate period: circa 2015 All ages	25 000 human deaths per year per year, Africa population	expert body	Dodet et al. 2015 Int Health quote However, rabies, another deadly disease, is greatly affecting the African continent, with an estimated 25 000 deaths every year. abstract Commentary citing an estimate, not an original model; consistent with the Hampson 2015 regional breakdown.
Death from rabies after a dog bite severity: death case definition: Self-reported dog-bite victims presenting to 19 hospitals, death from rabies on follow-up	all ages vaccination status: mixed country: Nigeria (Abuja) setting: hospital dog-bite surveillance period: 20 years of records All ages	4.2 proportion of dog-bite victims dying of rabies (%) per recorded dog-bite victim	cohort	Mshelbwala et al. 2023 PLoS Negl Trop Dis quote Only 1155 cases of dog bites were recorded throughout the study period, out of which 4.2% (N = 49) died of rabies. abstract Only 1155 bites recorded in 20 years, so severe under-reporting and selection toward serious bites; the figure is not a population risk. Prophylaxis, owned dogs and vaccinated dogs were each associated with lower odds of death (no numbers in abstract).
Death from rabies after a bite from an apparently healthy dog severity: death case definition: Predicted risk when the biting dog was assessed healthy by a veterinary assessor and available for quarantine	all ages vaccination status: not reported country: Haiti setting: national animal-bite surveillance programme period: 2013-2015 All ages	0.05 predicted risk of rabies death (%) per bite victim (dog assessed healthy and quarantined)	cohort	Medley et al. 2017 Trop Med Infect Dis quote Bites from dogs deemed healthy by veterinary assessors and which were available for quarantine presented less than a 0.05% risk of rabies death to the victim. abstract, FINDINGS Reported as "less than" 0.05%. The same study predicts the greatest risk for head or neck bites from symptomatic dogs, without a figure in the abstract. Risk depends on whether the dog is rabid; this is the low-risk end.
Human rabies cases reported in the United States severity: death (nearly all cases fatal) case definition: National rabies surveillance, reported human cases	all ages vaccination status: not reported country: United States setting: national surveillance period: 1960-2018 All ages	125 number of reported human cases over 59 years per United States population, 1960-2018	surveillance	Pieracci et al. 2019 MMWR Morb Mortal Wkly Rep quote RESULTS: From 1960 to 2018, a total of 125 human rabies cases were reported in the United States; 36 (28%) were attributed to dog bites during international travel. abstract, RESULTS 28% were dog bites acquired abroad (same sentence). Reflects the post-canine-rabies-elimination era; see rabies-bur-011 for the bat share.
Bat-associated human rabies severity: death case definition: US-acquired human rabies cases attributed to bats	all ages vaccination status: not reported country: United States setting: national surveillance period: 1960-2018 All ages	70 proportion of US-acquired cases (%) per US-acquired human rabies case	surveillance	Pieracci et al. 2019 MMWR Morb Mortal Wkly Rep quote Among the 89 infections acquired in the United States, 62 (70%) were attributed to bats. abstract, RESULTS Bat exposures are often unrecognised (see rabies-bur-019), which is why they dominate deaths despite dogs dominating PEP use.
Persons treated for potential rabies exposure severity: exposure requiring prophylaxis case definition: Emergency-department PEP visits estimated from HCUP data	all ages vaccination status: not reported country: United States setting: emergency departments period: 2017-2018 All ages	55,000 persons treated per year per year, United States population	surveillance	cdc.gov quote During 2017–2018, an average of 55,000 (range = 45,453–66,000) persons were treated for potential rabies exposure each year. Results Range, not a confidence interval, so no ci fields. Compare with about 2 deaths per year in the same report: PEP demand is roughly 25,000 times the death count.
Death from human rabies severity: death case definition: Community survey of rabies deaths, 21 medical schools, representative population of 10.8 million	all ages, majority adult males vaccination status: unvaccinated country: India setting: community survey, mainland India period: 2003 All ages	17,137 (14,109–20,165) annual incidence of human rabies deaths (number) per year, India population	surveillance	Sudarshan et al. 2007 Int J Infect Dis quote RESULTS: The annual incidence of human rabies was estimated to be 17,137 (95% CI 14,109-20,165). abstract, RESULTS The abstract says the majority of victims were unvaccinated and only about 10% had taken a partial vaccine course, so vaccination_status is recorded as unvaccinated for the typical victim. An expert-group 20% uplift for paralytic forms gives about 2 per 100,000 (same abstract).
Dog as biting animal in fatal rabies severity: death case definition: Animal responsible for the bite among rabies deaths in the national survey	all ages vaccination status: unvaccinated country: India setting: community survey period: 2003 All ages	96.2 proportion of fatal cases bitten by dogs (%) per rabies death	surveillance	Sudarshan et al. 2007 Int J Infect Dis quote The main animals responsible for bites were dogs (96.2%), most of which were stray. abstract, RESULTS Most dogs were stray. Bite sites were mostly the extremities.
Officially recorded rabies deaths severity: death case definition: Deaths recorded in official statistics over the same period	all ages vaccination status: not reported country: United Republic of Tanzania setting: official surveillance period: circa 2000 All ages	10.8 (7.7–14.0) recorded human deaths per year per year, Tanzania	surveillance	Cleaveland et al. 2002 Bull World Health Organ quote The annual mean number of rabies deaths officially recorded for the same period was 10.8 (7.7-14.0). abstract, FINDINGS The denominator for the comparison with rabies-bur-018 is the whole country; the predicted figure is 1499 deaths. Do not present the recorded count as the true burden.
Human rabies incidence severity: death case definition: Reported human rabies cases, provincial surveillance	all ages vaccination status: not reported country: China (Hunan Province) setting: provincial surveillance period: 2019-2024 All ages	0.0592 average annual incidence per 100,000 per 100,000 population per year	surveillance	Chen et al. 2026 China CDC Wkly quote RESULTS: 240 rabies cases were reported in Hunan Province (2019-2024) with an average annual incidence rate of 0.0592 per 100,000 people. abstract, RESULTS Declining trend over the period. Reported cases in a middle-income setting with wide PEP access; compare with the modelled LMIC rates in rabies-bur-018.
Death from rabies severity: death case definition: Nationally reported rabies deaths	all ages vaccination status: not reported country: China setting: national surveillance period: 2020 All ages	200 reported human deaths per year per year, China population	surveillance	Shen et al. 2023 Infect Dis Poverty quote Implementation of a government-led, multi-sectoral "One Health" approach to combating rabies has driven down the total number of rabies deaths nationwide to around 200 in 2020. abstract, RESULTS Down year-on-year since 2007 under a One Health programme while PEP demand rose 15-fold. Reported, not modelled.
Death from rabies severity: death case definition: Nationally reported rabies deaths	all ages vaccination status: not reported country: Philippines setting: national period: circa 2015-2016 All ages	200-300 human deaths per year per year, Philippines population	surveillance	Quiambao et al. 2020 Int J Infect Dis quote OBJECTIVES: Once symptoms appear, rabies is almost always fatal and accounts for 200-300 deaths annually in the Philippines. abstract, OBJECTIVES Range as stated in a cost-effectiveness paper's background; not a primary surveillance report.
Death from dog-mediated rabies severity: death case definition: Modelled human deaths from rabies circulating in domestic dog populations	all ages vaccination status: not reported country: global (country-by-country model) setting: endemic canine rabies countries, mostly LMIC period: model circa 2010-2015 All ages	59,000 human deaths per year per year, global population	modelling	Hampson et al. 2015 PLoS Negl Trop Dis quote This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. abstract, PRINCIPAL FINDINGS The source writes the 95% confidence interval as "25-159,000", meaning 25,000 to 159,000 deaths; it is left out of ci_low/ci_high here because the lower bound as printed would be misread. Deaths are notoriously under-reported, so this is a model, not a count.
Disability-adjusted life years lost to dog-mediated rabies severity: death case definition: Modelled DALYs from premature death due to canine rabies	all ages vaccination status: not reported country: global setting: endemic canine rabies countries period: model circa 2010-2015 All ages	3.7 (1.6–10.4) DALYs lost per year (millions) per year, global population	modelling	Hampson et al. 2015 PLoS Negl Trop Dis quote This study estimates that globally canine rabies causes approximately 59,000 (95% Confidence Intervals: 25-159,000) human deaths, over 3.7 million (95% CIs: 1.6-10.4 million) disability-adjusted life years (DALYs) and 8.6 billion USD (95% CIs: 2.9-21.5 billion) economic losses annually. abstract, PRINCIPAL FINDINGS Same model as rabies-bur-001. Nearly all DALYs come from death because rabies is almost never survived.
Death from endemic canine rabies severity: death case definition: Modelled deaths using probability steps from dog-bite incidence to clinical rabies	all ages vaccination status: not reported country: Africa and Asia setting: endemic canine rabies regions period: circa 2003 All ages	55 000 (24 000–93 000) human deaths per year per year, Africa and Asia	modelling	Knobel et al. 2005 Bull World Health Organ quote FINDINGS: Human mortality from endemic canine rabies was estimated to be 55 000 deaths per year (90% confidence interval (CI) = 24 000-93 000). abstract, FINDINGS The interval is a 90% confidence interval, not 95%, as the source states. Earlier estimate superseded by Hampson 2015 (rabies-bur-001) using the same probability-step approach.
Death from rabies severity: death case definition: WHO Global Health Estimates 2021 model	all ages vaccination status: not reported country: global setting: all settings period: 2021 All ages	44 203 human deaths per year per year, global population	modelling	who.int quote According to the 2021 Global Health Estimates model, rabies causes 44 203 annual deaths. Key facts / Overview WHO itself says the true number is uncertain and likely substantially under-reported because of weak surveillance and misdiagnosis. Lower than the Hampson 2015 model (rabies-bur-001); the two should be shown together, not averaged.
Death from rabies, predicted from dog-bite injuries severity: death case definition: Probability-step model from active-surveillance bite incidence, rabies recognition, wound site and post-exposure treatment	all ages vaccination status: not reported country: United Republic of Tanzania setting: community, active surveillance districts period: circa 2000 All ages	4.9 (2.9–7.2) incidence of rabies deaths per 100,000 per year per 100,000 population per year	modelling	Cleaveland et al. 2002 Bull World Health Organ quote FINDINGS: Predicted human rabies mortality was estimated to be (a) 1499 deaths per year (95% confidence interval 891-2238), equivalent to an annual incidence of 4.9 (2.9-7.2) deaths/100,000, when active surveillance data on bite incidence were used, and (b) 193 deaths per year (32-409), corresponding to an annual incidence of 0.62 (0.1-1.32) deaths/100,000, when national bite statistics were used. abstract, FINDINGS Contrast with the officially recorded 10.8 deaths per year in the same sentence group: the model implies more than 100-fold under-reporting. The alternative estimate using national bite statistics was 0.62 (0.1-1.32) per 100,000.
Survival after clinical rabies severity: survival with sequelae case definition: Survival at 6 months after onset of clinical rabies, documented in the literature	all ages vaccination status: not reported country: global setting: published case reports period: to 2025 All ages	34 number of well-documented survivors worldwide per all human rabies cases ever documented	case series	Jackson 2025 Clin Infect Dis quote Human rabies has a very high fatality rate and there have only been about 34 well-documented survivors, defined as survival at 6 months after onset of clinical rabies. abstract Against tens of thousands of deaths per year, 34 lifetime survivors is the basis for the near-100% case fatality. At least 64 failures of the Milwaukee protocol are reported in the same abstract.
Severity of the exposure among fatal cases severity: death case definition: WHO category III wound among investigated human rabies deaths	all ages vaccination status: mixed country: China setting: national case investigations period: 2016-2020 All ages	66.1 proportion of fatal cases with category III wounds (%) per investigated human rabies case	case series	Ren et al. 2025 PLoS Negl Trop Dis quote Category III wounds were present in 66.1% (n = 952) of all cases. abstract, RESULTS A third of deaths followed category II exposures, which WHO treats as needing vaccine but not immunoglobulin.
Complete PEP plus RIG among people who died of rabies severity: death case definition: Full vaccination course with rabies immunoglobulin, among 1,733 investigated deaths	all ages vaccination status: mixed country: China setting: national case investigations period: 2016-2020 All ages	1.2 proportion of fatal cases with complete PEP and RIG (%) per investigated human rabies case	case series	Ren et al. 2025 PLoS Negl Trop Dis quote However, only 4.3% (n = 41) received rabies immunoglobulin (RIG), and a mere 1.2% (n = 11) underwent complete PEP vaccination in addition to RIG administration. abstract, RESULTS The denominator is deaths, not exposed people, so this cannot be read as a PEP failure rate; it shows that nearly all deaths occurred in people who did not complete PEP. Only 4.3% received RIG at all.
Death from rabies severity: death case definition: Modelled deaths from bite-patient data, travel time to PEP clinics and a decision tree	all ages vaccination status: mixed country: Madagascar setting: national, 31 PEP clinics period: circa 2014-2017 All ages	960 (790–1120) human deaths per year per year, Madagascar population	modelling	Rajeev et al. 2021 PLoS Negl Trop Dis quote We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI): 790-1120), with PEP averting an additional 800 deaths (95% PI: 640-970) each year. abstract, PRINCIPAL FINDINGS 95% prediction interval, not a confidence interval. Deaths that PEP already averts are a separate record (rabies-eff-010). Most sensitive to the assumed underlying exposure incidence.

Post-acute and long-term sequelae

What can follow the acute illness: chronic disease, disability, cancers, congenital syndromes, post-infectious conditions.

Outcome (O)	Population (P)	Comparator	Estimate	Design (S)	Source
Serious neurological sequelae among rabies survivors severity: serious neurological sequelae case definition: Survivors defined as alive 6 months after onset of clinical rabies	all ages vaccination status: not reported country: global setting: published case reports period: to 2025 All ages	vs none (survivors are case reports; no uninfected comparator exists)	34 well-documented survivors worldwide (count); the source says many had serious neurological sequelae	case series	Jackson 2025 Clin Infect Dis quote about 34 well-documented survivors, defined as survival at 6 months after onset of clinical rabies. ... Many have had serious neurological sequelae. abstract No proportion is given; the review says only that many of the roughly 34 survivors had serious sequelae. Survival itself is so rare that post-acute burden is essentially undefined for rabies; the acute outcome is death.

Vaccine efficacy and effectiveness

Every estimate compiled, annotated by population (P), intervention (I), comparator (C), outcome (O) and study design (S).

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Adequate antibody response (RVNA >= 0.5 IU/mL by day 14) after PEP severity: surrogate (immunogenicity) case definition: Immunogenicity threshold recommended by WHO as a surrogate; not clinical protection	all ages (overall population) country: multiple setting: clinical trials and observational studies period: to 2017 All ages	purified chick embryo cell vaccine (PCECV), >= 2.5 IU per dose platform: inactivated cell-culture vaccine doses: PEP by intramuscular or intradermal route vs WHO serological threshold (no untreated arm)	almost all above 0.5 IU/ml by day 14 proportion reaching RVNA >= 0.5 IU/mL by day 14 (almost all)	meta-analysis 54 estimates of immune response	Preiss et al. 2018 Expert Rev Vaccines quote EXPERT COMMENTARY: There were 54 estimates of immune responses to vaccination, which showed that in the overall population, after starting PEP with PCECV by the IM or ID route (≥2.5 IU per dose), almost all individuals had rabies virus neutralizing antibody (RVNA) titers above the World Health Organization (WHO) recommended serological threshold for an adequate immune response to vaccination (RVNA ≥0.5 IU/ml by day 14). abstract, EXPERT COMMENTARY Antibody titre is a surrogate; no correlate of protection has been formally defined (see the ACIP statement in rabies-eff-032). The review pooled studies with and without RIG.
Geometric mean antibody titre over time (surrogate) severity: surrogate (immunogenicity) case definition: Pooled GMTs after PrEP and PEP schedules, dose-response meta-analysis	all ages country: multiple setting: 80 studies period: inception to January 2020 All ages	cell-culture rabies vaccines, intradermal and intramuscular platform: inactivated cell-culture vaccine doses: 1-week schedules vs 3-12 week schedules vs longer PrEP/PEP schedules taking 3-12 weeks	1-week as effective as 3 to 12 week schedules GMT equivalence of 1-week vs 3-12 week schedules (as effective)	meta-analysis 80 studies, 191 datasets, 12,413 participants	Xu et al. 2021 Vaccine quote Short 1-week schedules were as effective as longer schedules that can take between 3 and 12 weeks to complete. abstract, RESULTS Surrogate outcome. No clinical-failure data. Same review reports lower titres in people over 50 (rabies-eff-016).
Geometric mean antibody titre in older adults (surrogate) severity: surrogate (immunogenicity) case definition: Pooled GMTs by age group	older than 50 years vs younger than 50 years country: multiple setting: 80 studies period: inception to January 2020 50-64y65+	cell-culture rabies vaccines platform: inactivated cell-culture vaccine doses: PrEP and PEP schedules as pooled vs participants younger than 50 years	significantly lower GMT in older (>50yrs) GMT in >50 vs <50 years (significantly lower)	meta-analysis 80 studies, 12,413 participants	Xu et al. 2021 Vaccine quote Significantly lower GMT levels were achieved in older (>50yrs) compared to younger (<50yrs) participants. abstract, RESULTS No magnitude in the abstract. The review concludes older people warrant special attention; ACIP does not advise routine titre checks in immunocompetent older adults.
Reaching the pre-defined immune correlate after fractional intradermal vs full-dose standard-route vaccination severity: surrogate (immunogenicity) case definition: Risk difference in seroprotection, ID fractional dose vs IM/SC full dose, WHO schedules	all ages country: multiple setting: randomised and controlled trials period: to 2020 All ages	licensed rabies vaccines given intradermally at 20-60% of the antigen dose platform: inactivated cell-culture vaccine doses: primary schedules, same schedule in both arms vs intramuscular or subcutaneous full-dose vaccination	0.00 (-0.02–0.02) risk difference in seroprotection (ID minus standard route)	meta-analysis	Schnyder et al. 2020 Travel Med Infect Dis quote Non-inferiority of immunogenicity with 20-60% of antigen used with ID vaccines was demonstrated for influenza (H1N1: RD -0·01; 95% CI -0·02, 0·01; I2 = 55%, H2N3: RD 0·00; 95% CI -0·01, 0·01; I2 = 0%, B: RD -0·00; 95% CI -0·02, 0·01; I2 = 72%), rabies (RD 0·00; 95% CI -0·02, 0·02; I2 = 0%), and hepatitis B vaccines (RD -0·01; 95% CI -0·04, 0·02; I2 = 20%). abstract, RESULTS I2 = 0%. Non-inferiority of fractional ID dosing on a serological endpoint; it is the basis for WHO's 60-80% cost saving with ID PEP.
Primary immunogenicity (RVNA >= 0.5 IU/mL) of 2-dose vs 3-dose intramuscular PrEP (surrogate) severity: surrogate (immunogenicity) case definition: Systematic review of 12 studies, GRADE-assessed by the ACIP Rabies Work Group	all ages in the included studies country: multiple setting: 12 studies, 1,401 subjects period: to 2021 All ages	HDCV or PCECV intramuscular platform: inactivated cell-culture vaccine doses: 2 doses (days 0 and 7) vs 3-dose IM schedule (days 0, 7, and 21 or 28)	1.00 (0.99–1.01) risk ratio for primary immunogenicity, 2-dose vs 3-dose	systematic review GRADE: moderate 12 studies, 1,401 subjects	cdc.gov quote Using the GRADE approach, the Work Group concluded with moderate (level 2) certainty that the primary immunogenicity of the 2-dose (days 0 and 7) IM schedule is comparable to that of the 3-dose (days 0, 7, and 21 or 28) IM schedule (risk ratio = 1.00 [95% CI = 0.99–1.01]). ¶ ACIP deliberated whether the 2-dose (days 0 and 7) IM PrEP schedule should replace the 3-dose schedule for all persons for whom rabies PrEP is indicated based on this finding and other findings within the EtR framework**: the target population’s acceptability of the 2-dose series, feasibility of implementing the 2-dose series, minimal resource use, and anticipated increase in health equity because the 2-dose series is less expensive than the 3-dose series. Methods / PrEP schedule and primary immunogenicity Basis for the 2022 ACIP change to a 2-dose PrEP series. ID and IM studies were pooled because primary immunogenicity is similar by route. Long-term persistence after 2 doses is lower (rabies-eff-030).
Seroconversion (>= 0.5 IU/mL) after booster, by priming schedule (surrogate) severity: surrogate (immunogenicity) case definition: Pooled post-booster seroconversion across PrEP schedules; lowest for single 2-site ID priming	all ages in included studies country: multiple setting: 54 studies period: inception to January 2024 All ages	cell-culture rabies vaccine, one 2-site intradermal PrEP dose then booster platform: inactivated cell-culture vaccine doses: 1 priming dose (2-site ID) plus booster vs 2- and 3-dose schedules (almost 100% post-booster)	98.7 post-booster seroconversion for 1-dose 2-site ID priming (%; lowest of all schedules)	meta-analysis 54 studies	Davis et al. 2025 Vaccine quote Following the administration of booster doses, all schedules boosted to GMTs higher than after the primary series resulting in almost 100 % seroconversion, with the lowest seroconversion (98.7 %) for those who received a one 2-site ID dose for their primary vaccination. abstract, RESULTS Same review: one-dose schedules had significantly lower short- and long-term seroconversion, and 2-dose IM maintained seroconversion less well than 3-dose IM over time, while 2-site ID and IM routes were generally similar. No clinical outcomes.
Abridged PEP schedule assessment for the WHO 2018 position paper severity: any case definition: Safety, immunogenicity, clinical outcome data and direct cost across 14 studies	all ages country: multiple setting: systematic review for WHO SAGE period: evidence since the 2010 position paper All ages	cell-culture rabies vaccine, 1-week 2-site intradermal PEP platform: inactivated cell-culture vaccine doses: 2-site ID on days 0, 3, 7 vs longer PEP schedules of up to 5 visits over about a month (2010 WHO position)	1-week 2-site ID most advantageous qualitative ranking (safe, immunogenic, supported by clinical outcome data, least direct cost)	systematic review 14 studies	Kessels et al. 2019 Vaccine quote The 1-week, 2-site ID PEP schedule was found to be most advantageous, as it was safe, immunogenic, supported by clinical outcome data and involved the least direct costs (i.e. cost of vaccine) compared to other schedules. abstract This is the evidence base for the WHO 2018 one-week ID schedule; the position paper itself could not be snapshotted (see flag). Few studies evaluated schedules in confirmed exposures.
Correlate of protection for rabies antibody severity: surrogate (immunogenicity) case definition: ACIP statement on the evidence base for the 0.5 IU/mL threshold	all ages country: United States setting: ACIP recommendation period: 2022 All ages	rabies vaccines (HDCV, PCECV) platform: inactivated cell-culture vaccine doses: any vs none (methodological statement)	0.5 IU/mL used as the threshold; no correlate formally defined existence of a defined correlate of protection (none; 0.5 IU/mL adopted as a conservative threshold)	expert body	cdc.gov quote A correlate of protection for rabies antibody titers has not been defined. ... most published studies use 0.5 IU/mL as a correlate of protection. Methods / rabies antibody titer Every immunogenicity record in this file (RVNA >= 0.5 IU/mL) is a surrogate. ACIP notes no infections occurred among vaccinated persons under the older, lower cut-off of about 0.1-0.3 IU/mL.
Death from rabies after bite by proven rabid animal severity: death case definition: Patients bitten by proven rabid animals, followed 3 years	all ages, as treated prior infection: bite from proven rabid animal, RIG into wounds on day 0 country: Thailand setting: metropolitan rabies control centre period: 1994-1996 All ages	purified Vero cell rabies vaccine with human or equine RIG platform: inactivated cell-culture vaccine doses: intramuscular conventional regimen or Thai Red Cross intradermal regimen vs intramuscular vs intradermal (randomised); no untreated arm	all alive and well at 3 years survival at 3 years among treated (all alive) follow-up: 3 years	RCT	Jaiiaroensup et al. 1998 Vaccine quote Eighty-four patients bitten by proven rabid animals were found to be alive and well 3 years later. abstract, RESULTS Randomisation was between routes, not against no treatment. Both arms had zero deaths: 44 IM and 40 ID (next sentence of the abstract).
Death from rabies after bite by proven rabid animal, intradermal arm severity: death case definition: Patients bitten by proven rabid animals randomised to the intradermal regimen	all ages, as treated prior infection: bite from proven rabid animal country: Thailand setting: metropolitan rabies control centre period: 1994-1996 All ages	purified Vero cell rabies vaccine, Thai Red Cross intradermal regimen, with RIG platform: inactivated cell-culture vaccine doses: Thai Red Cross intradermal regimen vs intramuscular conventional regimen (44 patients, all alive)	40 patients alive and well at 3 years in the intradermal arm (n) follow-up: 3 years	RCT	Jaiiaroensup et al. 1998 Vaccine quote Forty-four of these had received the intramuscular and 40 the intradermal postexposure regimens with human or equine immune globulin injected into wounds on the first day of treatment. abstract, RESULTS All 40 ID and all 44 IM patients survived. Supports reduced-dose intradermal PEP with RIG in real exposures, within the limits of a small series.
Adequate RVNA (>= 0.5 IU/mL) at day 49 (surrogate) severity: surrogate (immunogenicity) case definition: Difference in percentage with adequate RVNA, 4-site/1-week minus 2-site Thai Red Cross	healthy individuals aged 1 year and older country: multiple (phase III multicentre, NCT02177032) setting: clinical trial, simulated PEP period: circa 2014-2016 n: 443 vs 442 participants 1-4y5-11y12-17y18-49y50-64y	PCECV intradermal, 4-site/1-week regimen platform: inactivated cell-culture vaccine doses: 4-site intradermal over 1 week vs 2-site Thai Red Cross intradermal regimen	-1 (-2.4–0.0) percentage-point difference in adequate RVNA at day 49	RCT	Kerdpanich et al. 2018 PLoS Negl Trop Dis quote At D49, the difference in percentage of participants with adequate RVNA concentrations between the 4-site/1-week and the 2-site/TRC groups was -1 (95%CI: -2.4-0.0); thus, non-inferiority was concluded. abstract, PRINCIPAL FINDINGS Non-inferiority margin -5%; all participants in both arms were adequate by day 14. GMCs were 18 vs 12 IU/mL at day 14 (rabies-eff-019). HRIG lowered concentrations in adults (rabies-eff-020).
RVNA geometric mean concentration at day 14 (surrogate) severity: surrogate (immunogenicity) case definition: GMC by regimen	healthy individuals aged 1 year and older country: multiple setting: clinical trial, simulated PEP period: circa 2014-2016 1-4y5-11y12-17y18-49y50-64y	PCECV intradermal, 4-site/1-week regimen platform: inactivated cell-culture vaccine doses: 4-site intradermal over 1 week vs 2-site Thai Red Cross regimen (12 IU/mL)	18 RVNA GMC at day 14 (IU/mL)	RCT	Kerdpanich et al. 2018 PLoS Negl Trop Dis quote RVNA geometric mean concentrations were 18 IU/mL in 4-site/1-week groups and 12 IU/mL in 2-site/TRC groups at D14, and subsequently declined in all groups. abstract, PRINCIPAL FINDINGS Concentrations declined in all groups after day 14. Higher early titre with the compressed regimen, which is the rationale for the WHO 2018 one-week ID schedule.
Seroconversion (RVNA >= 0.5 IU/mL) at day 14 (surrogate) severity: surrogate (immunogenicity) case definition: Seroconversion after the third vaccine administration, 1-week 4-site ID without RIG (category II exposures)	50 years and younger prior infection: WHO category II exposure to a suspected rabid animal country: Philippines setting: single-centre trial in exposed patients (NCT01622062) period: circa 2012-2014 n: 200 5-11y12-17y18-49y	purified Vero cell rabies vaccine (Verorab), 1-week 4-site intradermal (4-4-4-0-0) platform: inactivated cell-culture vaccine doses: 4-site ID on days 0, 3, 7 vs Thai Red Cross 28-day 2-site ID regimen with pERIG (98.8%)	100 seroconversion at day 14 (%)	RCT	Quiambao et al. 2019 Vaccine quote RESULTS: On Day14, after the third vaccine administration, seroconversion rates were non-inferior in both comparisons and were, respectively, 100%, 99.4%, 98.8% in G1, G2, G3 with a decrease to 97.6%, 89%, 79.8% at Year 1. abstract, RESULTS Real exposures, not simulated. Category II patients were allocated, not randomised, to this arm. Year-1 persistence is in rabies-eff-022 and rabies-eff-023.
Seroconversion maintained at year 1 (surrogate; waning) severity: surrogate (immunogenicity) case definition: RVNA >= 0.5 IU/mL one year after 1-week 4-site ID PEP without RIG	50 years and younger prior infection: WHO category II exposure country: Philippines setting: single-centre trial in exposed patients period: circa 2012-2015 5-11y12-17y18-49y	purified Vero cell rabies vaccine, 1-week 4-site intradermal, no RIG platform: inactivated cell-culture vaccine doses: 4-site ID on days 0, 3, 7 vs Thai Red Cross 28-day regimen with pERIG (79.8%) and 1-week regimen with pERIG (89%)	97.6 proportion with RVNA >= 0.5 IU/mL at year 1 (%) follow-up: 1 year	RCT	Quiambao et al. 2019 Vaccine quote RESULTS: On Day14, after the third vaccine administration, seroconversion rates were non-inferior in both comparisons and were, respectively, 100%, 99.4%, 98.8% in G1, G2, G3 with a decrease to 97.6%, 89%, 79.8% at Year 1. abstract, RESULTS The order in the sentence is G1, G2, G3. Titres fall over a year in every arm; the RIG arms fell most. Antibody at a year is not required for protection after a completed course because memory is boosted by PEP, but this is the waning signal.
Seroconversion maintained at year 1 after the reference Thai Red Cross regimen (surrogate; waning) severity: surrogate (immunogenicity) case definition: RVNA >= 0.5 IU/mL one year after 28-day 2-site ID PEP with pERIG, category III exposures	50 years and younger prior infection: WHO category III exposure country: Philippines setting: single-centre trial in exposed patients period: circa 2012-2015 n: 199 5-11y12-17y18-49y	purified Vero cell rabies vaccine, Thai Red Cross 28-day 2-site intradermal (2-2-2-0-2) with purified equine RIG platform: inactivated cell-culture vaccine doses: 2-site ID days 0, 3, 7 and 28 vs 1-week 4-site ID with pERIG (89%) and without RIG (97.6%)	79.8 proportion with RVNA >= 0.5 IU/mL at year 1 (%) follow-up: 1 year	RCT	Quiambao et al. 2019 Vaccine quote RESULTS: On Day14, after the third vaccine administration, seroconversion rates were non-inferior in both comparisons and were, respectively, 100%, 99.4%, 98.8% in G1, G2, G3 with a decrease to 97.6%, 89%, 79.8% at Year 1. abstract, RESULTS Lowest year-1 persistence of the three arms; its day-14 seroconversion was 98.8%. Shows the reference regimen with RIG wanes fastest on this surrogate.
Adequate RVNA (>= 0.5 IU/mL) from day 14 to day 180 (surrogate) severity: surrogate (immunogenicity) case definition: Healthy adult volunteers, one-week 4-site intradermal regimen (4-4-4)	healthy adults country: India setting: randomised open-label trial, simulated PEP period: circa 2011 n: 80 (40 per vaccine) 18-49y50-64y	PCECV or PVRV, one-week 4-site intradermal regimen (4-4-4) platform: inactivated cell-culture vaccine doses: 4 ID sites on days 0, 3, 7 vs PCECV vs PVRV (randomised); no standard-regimen arm	all subjects adequate from day 14 to day 180 proportion with adequate RVNA day 14 to day 180 (all)	RCT	Sudarshan et al. 2012 Hum Vaccin Immunother quote All subjects in both the groups had adequate RVNA concentration of  0.5 IU/mL from day 14 to till day 180 and the difference of geometric mean concentrations between the two groups was not significant (P > 0.606). abstract Simulated PEP in healthy volunteers, no exposure. Those without adequate titre at day 365 boosted promptly with a single-visit 4-site dose, showing immune memory.
RVNA >= 0.5 IU/mL at day 28 with HDCV plus HRIG (surrogate) severity: surrogate (immunogenicity) case definition: Simulated Essen PEP (days 0, 3, 7, 14, 28) with HRIG on day 0, healthy adults	adults 18 years and older country: France setting: dual-centre phase 3 trial (NCT03965962) period: circa 2019-2021 n: 640 randomised across 4 arms 18-49y50-64y65+	human diploid cell vaccine (Imovax Rabies) plus HRIG platform: inactivated cell-culture vaccine doses: 5 intramuscular doses (Essen) vs PVRV + HRIG (100%) and PVRV-NG2 + HRIG (99.6%)	98.7 proportion with RVNA >= 0.5 IU/mL at day 28 (%)	RCT	Pineda-Peña et al. 2024 Clin Infect Dis quote Nearly all participants (99.6%, PVRV-NG2 + HRIG; 100%, PVRV + HRIG; 98.7%, HDCV + HRIG; 100%, PVRV-NG2 alone) achieved RVNA titers ≥0.5 IU/mL at D28. abstract, RESULTS Licensed-vaccine comparator arm of a next-generation vaccine trial; simulated PEP, no exposure. Also supports that concomitant HRIG did not prevent near-universal seroconversion by day 28.
RVNA >= 0.5 IU/mL at day 14 with the licensed PVRV in a Zagreb regimen with HRIG (surrogate) severity: surrogate (immunogenicity) case definition: Simulated Zagreb PEP (2-1-1, days 0, 7, 21) with HRIG on day 0, healthy adults	adults 18 years and older country: Thailand setting: phase III trial period: circa 2020-2022 n: 66 (PVRV arm) 18-49y50-64y65+	purified Vero cell rabies vaccine (licensed PVRV) plus HRIG platform: inactivated cell-culture vaccine doses: Zagreb 2-1-1 intramuscular vs PVRV-NG2 plus HRIG (91.0%, 84.1-95.6%)	94.6 (85.1–98.9) proportion with RVNA >= 0.5 IU/mL at day 14 (%)	RCT	Chansinghakul et al. 2024 Open Forum Infect Dis quote In the PVRV-NG2 group and PVRV group, respectively, 91.0% (95% CI, 84.1%-95.6%) and 94.6% (95% CI, 85.1%-98.9%) had RVNA titers ≥0.5 IU/mL at day 14, increasing to 100% (95% CI, 96.8%-100%) and 100% (95% CI, 93.5%-100%) by day 35. abstract, RESULTS Both arms reached 100% by day 35. Day-14 seroconversion in the Zagreb regimen with HRIG is lower than in ID regimens without RIG (rabies-eff-021), consistent with the HRIG blunting in rabies-eff-020.
RVNA >= 0.5 IU/mL at 1 year after 2-dose PrEP (surrogate; waning) severity: surrogate (immunogenicity) case definition: Healthy children randomised to 2 doses (days 0, 28) or 3 doses (days 0, 7, 28) of PVRV IM	2-12 years, median 5.8 years country: Thailand setting: randomised open-label trial period: 2017-2018 n: 78 (2-dose) vs 29 (3-dose) 1-4y5-11y	purified Vero cell rabies vaccine (Verorab) intramuscular platform: inactivated cell-culture vaccine doses: 2 doses (days 0 and 28) vs 3-dose schedule (100% at 1 year, p = 0.01)	80 proportion with RVNA >= 0.5 IU/mL at 1 year pre-booster (%) follow-up: 1 year	RCT	Janewongwirot et al. 2019 Vaccine quote At 1-year prior to receiving the booster, only 80% of the children in 2D group maintained RVNA titers ≥0.5 IU/ml compared to 100% of the children in 3D group (p = 0.01). abstract, RESULTS All children in both arms were adequate after the primary series and all reached >= 0.5 IU/mL 7 days after a booster (rabies-eff-030), which is what matters for PEP after an exposure. Note the 2-dose arm used day 28, not WHO's day 7.
Anamnestic response 7 days after a booster given 1 year after PrEP (surrogate) severity: surrogate (immunogenicity) case definition: RVNA >= 0.5 IU/mL 7 days after booster mimicking exposure	2-12 years country: Thailand setting: randomised open-label trial period: 2017-2018 1-4y5-11y	purified Vero cell rabies vaccine, 2-dose PrEP then 1 booster platform: inactivated cell-culture vaccine doses: 2 priming doses plus 1 booster vs 3-dose priming then booster (GMT 22.2, 15.8-31.4; p = 0.75)	20.9 (17.4–25.3) proportion with RVNA >= 0.5 IU/mL 7 days post-booster (all); GMT 2-dose arm (IU/mL) follow-up: 7 days after booster at 1 year	RCT	Janewongwirot et al. 2019 Vaccine quote However, all participants in both groups had RVNA ≥0.5 IU/ml at 7-day post booster vaccination [GMT 2D: 20.9 (95%CI 17.4-25.3) and 3D: 22.2 (95%CI 15.8-31.4) IU/ml (P = 0.75)]. abstract, RESULTS Shows priming, not persistent antibody, is what PrEP provides: even the 20% of 2-dose children who had fallen below 0.5 IU/mL responded within a week.
Seroconversion (>= 0.5 IU/mL) 14 days after 1-week PrEP (surrogate) severity: surrogate (immunogenicity) case definition: Healthy participants randomised to 1-week (days 0, 7) IM or ID PrEP with HDCV or PVRV	2-64 years country: multiple (phase III, NCT03700242) setting: clinical trial period: circa 2018-2020 n: 570 across 5 arms 1-4y5-11y12-17y18-49y50-64y	HDCV or PVRV, 1-week PrEP (days 0 and 7), IM or 2-site ID platform: inactivated cell-culture vaccine doses: 2 visits over 1 week vs classic 3-week HDCV IM PrEP (100%)	96.7-97.2 seroconversion 14 days post-last PrEP dose (%, range across 1-week arms)	RCT	Quiambao et al. 2022 Vaccine quote Seroconversion rates were high 14 days post-last PrEP injection (ranging from 96.7 % to 97.2 % across groups 1, 3-5; 1-week PrEP) and reached 100 % in Group 2 (3-week PrEP). abstract Non-inferiority of the 1-week IM HDCV arm versus the 3-week regimen was NOT demonstrated on this endpoint. After simulated PEP one year later all but one participant across all groups seroconverted, so priming was adequate.
Rabies encephalitis after a bite from an animal with proven rabies severity: death case definition: 106 patients bitten by animals with proven rabies, alive and well at 1 year	all ages, as treated prior infection: bite from animal with proven rabies; 47 with severe exposure also given HRIG country: Thailand setting: rabies clinic period: circa 1985 All ages	purified Vero cell rabies vaccine (PVRV), Essen-type schedule platform: inactivated cell-culture vaccine doses: 6 intramuscular doses (days 0, 3, 7, 14, 28, 91) vs assumed untreated mortality of 15% (no concurrent control)	81 VE (%) lower 95% confidence limit, assuming 15% untreated mortality follow-up: 1 year	cohort	Suntharasamai et al. 1986 Lancet quote If the untreated mortality is 15%, PVRV is 81% efficient in protecting patients against rabies encephalitis (95% confidence limit). abstract No deaths occurred; the 81% is the lower confidence limit derived from zero deaths against an assumed 15% untreated death rate. It is not a measured relative risk. The assumption drives the figure.
Death from rabies after severe bite by proven rabid animal severity: death case definition: 100 Thai patients severely bitten by proven rabid animals, followed 1 year	all ages, as treated prior infection: severe bite from proven rabid animal; immunoglobulin given on day 0 to severe exposures country: Thailand setting: rabies clinic (Thai Red Cross) period: circa 1989 All ages	purified Vero cell rabies vaccine, Thai Red Cross intradermal regimen, with equine or human RIG platform: inactivated cell-culture vaccine doses: 2-site intradermal 0.1 mL days 0, 3, 7 then 1 site days 30 and 90 vs none concurrent; descriptive efficacy with zero deaths	100 efficacy (%) (no deaths among treated) follow-up: 1 year	cohort	Chutivongse et al. 1990 Lancet quote There were no deaths; the efficacy of the regimen was 100%. abstract Zero deaths in 100 severely exposed people. No untreated control, so "100%" means no failures, not a comparative estimate.
Death from rabies after category III exposure severity: death case definition: 113 patients with category III exposures from confirmed rabid animals, monitored monthly for 1 year	all ages, as treated prior infection: category III exposure to laboratory-confirmed rabid animals country: Philippines setting: two bite referral centres period: circa 2003 All ages	purified chick embryo cell vaccine (PCECV) 0.1 mL intradermal, Thai Red Cross regimen platform: inactivated cell-culture vaccine doses: Thai Red Cross intradermal regimen vs none concurrent; descriptive outcome series	all 113 patients alive at 1 year survival at 1 year among treated (all alive) follow-up: 1 year	cohort	Quiambao et al. 2005 Vaccine quote a clinical trial was conducted in 113 patients presenting with category III exposures from confirmed rabid animals at two bite referral centres in the Philippines. ... all patients were alive 1 year after their initial exposure. abstract Phase IV efficacy series with no untreated group. The abstract says the ID regimen cuts PEP cost by up to 84% versus the five-dose Essen regimen.
Death from rabies after bite by laboratory-confirmed rabid dog severity: death case definition: Followed-up patients given intradermal vaccine plus wound-only equine RIG	all ages, as treated prior infection: bite from laboratory-confirmed rabid dog country: India (Himachal Pradesh) setting: single anti-rabies clinic period: June 2014-June 2018 All ages	intradermal cell-culture rabies vaccine with equine RIG infiltrated into wounds only (no systemic RIG) platform: inactivated cell-culture vaccine doses: intradermal PEP course with wound-only eRIG vs none concurrent; descriptive (80% of 7506 eRIG recipients followed)	26 patients bitten by confirmed rabid dogs alive at 1 year (n) follow-up: 1 year	cohort	Bharti et al. 2019 Vaccine quote Of the 80% of patients who were followed up, all were healthy at the end of a year, including 26 patients bitten by laboratory-confirmed rabid dogs. abstract Follow-up was incomplete (80%). Wound-only RIG was adopted by WHO in 2018; this series is the field experience behind it. The same abstract reports two deaths in 2014 among patients vaccinated without any RIG during a shortage.
Suspected or possible rabies death after PEP severity: death case definition: Patients at risk of rabies eligible for RIG, phone follow-up at least 15 months after exposure	all ages, as treated prior infection: exposure eligible for RIG (severe) country: Cote d'Ivoire setting: anti-rabies centres, Bouake and San Pedro period: April 2016-March 2018 All ages	cell-culture rabies vaccine plus equine RIG platform: inactivated cell-culture vaccine doses: active plus passive immunisation vs vaccine without eRIG (0.5%, 0.1-1.4%)	1.2 (0.3–3.6) possible rabies mortality (%) follow-up: at least 15 months	cohort	Gerber et al. 2020 Acta Trop quote Three suspected or possible rabies deaths occurred in each of the two groups, corresponding to a possible rabies mortality of 1.2% (95% CI 0.3-3.6%) in the eRIG group and 0.5% (95% CI 0.1-1.4%) in the non-eRIG group. abstract, RESULTS Three deaths in each group; the difference (0.7%) was not significant. Only about half of each group was reached for follow-up, and deaths in both groups were tied to treatment delay and non-compliance. No death occurred after correct and timely vaccination regardless of eRIG. A benefit of eRIG for severe exposures cannot be excluded.
Suspected or possible rabies death after PEP without RIG severity: death case definition: Patients eligible for RIG who received active immunisation only, phone follow-up	all ages, as treated prior infection: exposure eligible for RIG (severe) country: Cote d'Ivoire setting: anti-rabies centres period: April 2016-March 2018 All ages	cell-culture rabies vaccine without RIG platform: inactivated cell-culture vaccine doses: active immunisation only vs vaccine plus eRIG (1.2%, 0.3-3.6%)	0.5 (0.1–1.4) possible rabies mortality (%) follow-up: at least 15 months	cohort	Gerber et al. 2020 Acta Trop quote Three suspected or possible rabies deaths occurred in each of the two groups, corresponding to a possible rabies mortality of 1.2% (95% CI 0.3-3.6%) in the eRIG group and 0.5% (95% CI 0.1-1.4%) in the non-eRIG group. abstract, RESULTS The non-RIG arm was defined by local RIG availability, not randomisation; groups may differ in exposure severity. Three possible deaths of 641 followed. Read with rabies-eff-008.
Anamnestic response to a single IM booster 10-24 years after PrEP (surrogate) severity: surrogate (immunogenicity) case definition: Adequate antibody response measured on days 3, 7 and 14 after booster	adults country: Netherlands setting: observational study period: circa 2020 18-49y50-64y65+	cell-culture rabies vaccine, single intramuscular booster platform: inactivated cell-culture vaccine doses: 1 booster after 2- or 3-dose PrEP (IM or ID) vs 2-dose vs 3-dose and IM vs ID priming (no difference)	all 28 participants participants responding adequately to booster (all of 28) follow-up: 10-24 years after PrEP	cohort	De et al. 2022 J Infect Dis quote RESULTS: All 28 participants responded adequately regardless of route of administration or 2-dose vs 3-dose PrEP regimen. abstract, RESULTS Memory reactivated within 7 days even after two decades. Small sample; supports no routine boosters for travellers after PrEP.
Antibody persistence (>= 0.5 EU/mL ELISA) a median 8.5 years after intradermal PrEP (surrogate; waning) severity: surrogate (immunogenicity) case definition: Travellers who had received ID PrEP at least 5 years earlier	adults, median 56.4 years at enrolment country: Australia setting: travel medicine clinic period: circa 2020 n: 158 18-49y50-64y65+	intradermal rabies PrEP (0.1 mL doses) platform: inactivated cell-culture vaccine doses: primary ID PrEP schedule vs none (single-arm persistence)	82.3 proportion antibody-positive before booster (%) follow-up: median 8.5 years (IQR 6.9-11.7) since PrEP	cohort	Mills et al. 2022 J Travel Med quote The majority of participants (82.3%) were antibody-positive at Day 0. abstract, RESULTS ELISA, not RFFIT. Persistence was lower in those vaccinated at 50 or older (rabies-eff-035). Nearly all boosted (rabies-eff-036).
Antibody persistence after ID PrEP by age at primary vaccination (surrogate; waning) severity: surrogate (immunogenicity) case definition: Antibody-positive at day 0 among those aged 50 or older at primary vaccination	50 years and older at primary vaccination country: Australia setting: travel medicine clinic period: circa 2020 50-64y65+	intradermal rabies PrEP platform: inactivated cell-culture vaccine doses: primary ID PrEP schedule vs aged under 50 at primary vaccination (87.0%)	75.8 proportion antibody-positive before booster (%) follow-up: median 8.5 years since PrEP	cohort	Mills et al. 2022 J Travel Med quote The proportion of participants who were antibody-positive at Day 0 was higher among those who were younger at primary vaccination (87.0% if aged<50 years, 75.8% of aged ≥50 years). abstract, RESULTS Age effect on persistence, consistent with the Xu 2021 meta-analysis (rabies-eff-016). Trend with time since vaccination was not statistically significant.
Antibody-positive 7 days after a single 0.1 mL ID booster (surrogate) severity: surrogate (immunogenicity) case definition: Antibody >= 0.5 EU/mL at day 7 after booster	adults, median 56.4 years country: Australia setting: travel medicine clinic period: circa 2020 n: 158 18-49y50-64y65+	purified Vero cell rabies vaccine (Verorab) 0.1 mL intradermal booster platform: inactivated cell-culture vaccine doses: 1 ID booster after primary ID PrEP vs pre-booster status (82.3% positive)	99.4 proportion antibody-positive after one ID booster (%) follow-up: 7 days after booster	cohort	Mills et al. 2022 J Travel Med quote All except one participant (99.4%) were antibody-positive after one ID booster dose. abstract, RESULTS A single fractional ID dose restored antibody in nearly everyone within a week, a median 8.5 years after priming.
Seropositive (>= 0.5 IU/mL) after a primary intradermal PrEP course (surrogate) severity: surrogate (immunogenicity) case definition: Travellers given ID PrEP, 37.1% older than 50 years	median 37.5 years, 37.1% over 50 years country: Australia setting: travel medicine clinic period: 2000-2016 n: 835 18-49y50-64y65+	intradermal rabies PrEP (1IDx3, 2IDx2 or 4IDx1 schedules) platform: inactivated cell-culture vaccine doses: 3, 2 or 1 visit ID schedules vs schedules compared with each other; 1IDx3 highest at 93.4%	92.5 (90.5–94.1) proportion seropositive after primary course (%)	cohort	Furuya-Kanamori et al. 2020 J Travel Med quote The proportion seropositive after primary course was 92.5% (95%CI: 90.5-94.1%) and highest with the 1IDx3 schedule (93.4%; 95%CI: 91.4-95.0%). abstract, RESULTS Lower than the near-100% seen in trials of IM PrEP in younger adults; includes older travellers and a non-standard single-visit schedule (rabies-eff-038).
Seronegative status after primary ID PrEP, single-visit 4-site schedule vs 3-visit schedule (surrogate) severity: surrogate (immunogenicity) case definition: Adjusted odds of titre below 0.5 IU/mL after primary course	median 37.5 years, 37.1% over 50 country: Australia setting: travel medicine clinic period: 2000-2016 18-49y50-64y65+	intradermal rabies PrEP, 4 x 0.1 mL on a single day (4IDx1, not WHO-endorsed) platform: inactivated cell-culture vaccine doses: 1 visit (4 sites) vs 1 x 0.1 mL on days 0, 7, 21-28 (1IDx3)	4.17 (1.43–12.18) OR for seronegative status, 4IDx1 vs 1IDx3 (adjusted for age and timing)	cohort	Furuya-Kanamori et al. 2020 J Travel Med quote After adjusting for age and timing of the serology, the odds of seronegative status were four times higher (OR 4.17; 95%CI: 1.43-12.18) with the 4IDx1 schedule compared to 1IDx3. abstract, RESULTS Negative finding for the single-visit schedule. Post-booster seropositivity was still 98.7% overall (rabies-eff-039).
Seropositive after an ID booster (surrogate) severity: surrogate (immunogenicity) case definition: Travellers returning for a booster after ID PrEP, 43.5% over 50	median 45.9 years, 43.5% over 50 years country: Australia setting: travel medicine clinic period: 2000-2016 n: 771 18-49y50-64y65+	intradermal rabies booster after ID PrEP platform: inactivated cell-culture vaccine doses: 1 booster vs none (single-arm)	98.7 (97.6–99.3) proportion seropositive post-booster (%)	cohort	Furuya-Kanamori et al. 2020 J Travel Med quote Overall, 98.7% (95%CI: 97.6-99.3%) were seropositive post-booster. abstract, RESULTS All 46 travellers boosted 3 or more years after PrEP were seropositive. Older travellers boost well even when primary seroconversion was lower.
Adequate RVNA (>= 0.5 IU/mL) without booster up to 10 years after 3-dose PrEP (surrogate; waning) severity: surrogate (immunogenicity) case definition: Unboosted adults primed with 3 doses of PCEC on the conventional 4-week schedule, followed to year 10	adults country: Germany (NCT02545517) setting: phase III extension study period: circa 2013-2023 n: 459 enrolled 18-49y50-64y	purified chick embryo cell (PCEC) rabies vaccine, conventional 3-dose PrEP platform: inactivated cell-culture vaccine doses: 3 doses over 4 weeks vs accelerated 1-week schedule with JE vaccine (57.8%) and conventional schedule with JE vaccine (60.2%)	62.0 probability of adequate RVNA at study end, unboosted (%) follow-up: up to 10 years	cohort	Jelinek et al. 2025 PLoS Negl Trop Dis quote At the study end, the probability of detecting adequate RVNA concentrations in unboosted participants was 57.8%, 60.2%, and 62.0% for the Rabies+JE-Accelerated, Rabies+JE-Conventional, and Rabies-Conventional groups, respectively. abstract, PRINCIPAL FINDINGS Roughly four in ten lose detectable adequate titre by year 10 without a booster; 68.6% never needed one during follow-up. Loss of titre is not loss of priming (see rabies-eff-033).
Decline in neutralising antibody titre after primary PrEP (surrogate; waning) severity: surrogate (immunogenicity) case definition: Twenty-year cohort of vaccinated recipients, overall decay rate	adults, older age groups declined faster country: United Kingdom setting: rabies-vaccinated cohort (laboratory workers and others) over 20 years period: circa 1995-2015 18-49y50-64y65+	cell-culture rabies vaccines (manufacturer varied) platform: inactivated cell-culture vaccine doses: primary course vs decline after booster (27% per 2-fold change in time)	37 reduction in antibody titre per 2-fold change in time since primary vaccination (%)	cohort	Mansfield et al. 2016 Vaccine quote Additionally, the decay rate was demonstrated through the overall decline in antibody titre for all individuals, which was a 37% and 27% reduction per 2-fold change in time following primary and booster vaccination respectively. abstract Decay was faster in older age groups (p = 0.012) and influenced by vaccine make and sex. Modelled from titres, not from clinical failures.
Neutralising antibody 32 years after post-exposure HDCV (surrogate; persistence) severity: surrogate (immunogenicity) case definition: 26 of the 45 Iranian PEP recipients of 1975-1976 traced 32 years later	adults (bitten 32 years earlier) prior infection: severe bites from rabid wolves and dogs in 1975-1976 country: Iran setting: follow-up of the Bahmanyar 1976 cohort period: 2007-2008 n: 26 18-49y50-64y65+	human diploid cell vaccine (HDCV) post-exposure course; 17 had one booster 28 years earlier platform: inactivated cell-culture vaccine doses: PEP course (plus 1 booster in 17 of 26) vs none (single-arm follow-up)	0.3 to 2.69 RVNA range at 32 years (IU/mL) follow-up: 32 years	cohort	Fayaz et al. 2011 Vaccine quote In this study contact was made with 26 of 45 above persons, 32 years after their initial treatment and all had rabies neutralizing antibody ranging from 0.3 to 2.69 IU/ml of serum. abstract All 9 never-boosted persons mounted an anamnestic response to a single booster. Some values were below 0.5 IU/mL, yet all responded, again showing priming outlasts titre.
Neutralising antibody response to PEP in HIV infection with CD4 < 200/microL (surrogate) severity: surrogate (immunogenicity) case definition: HIV-infected patients with CD4+ T lymphocyte counts below 200/microL	adults immune status: HIV infection, CD4 < 200 cells/microL country: Thailand setting: rabies clinic period: circa 2000 18-49y50-64y	cell-culture rabies vaccine, 4-site intradermal with doubled doses (4-4-4-0-2-2) platform: inactivated cell-culture vaccine doses: doubled 4-site ID regimen vs expected response in immunocompetent recipients (not measured in this study)	poor response with CD4 < 200/microL neutralising antibody response (poor)	cohort	Tantawichien et al. 2001 Clin Infect Dis quote This study of HIV-infected patients with CD4(+) T lymphocyte counts < 200/microL indicated that patients had a poor response after 4-site intradermal vaccinations (4-4-4-0-2-2, doubling the intradermal doses of cell-culture rabies vaccine). abstract Even doubled intradermal dosing failed in advanced HIV. Basis for WHO/ACIP advice to check titres after PEP in immunocompromised people and to give RIG regardless of prior vaccination.
Inadequate antibody titre (< 0.5 EU/mL) after a full PEP course in non-HIV secondary immunodeficiency (surrogate) severity: surrogate (immunogenicity) case definition: Immunocompromised patients tested for post-PEP titre at two French antirabies clinics	adults and children as treated immune status: non-HIV secondary immunodeficiency (e.g. immunosuppressive therapy, malignancy) country: France setting: two antirabies clinics period: 2013-2018 All ages	cell-culture rabies vaccine, full PEP course platform: inactivated cell-culture vaccine doses: full PEP course vs none (single-arm; no immunocompetent comparator)	6 of 28 number with inadequate post-PEP titre out of those tested	cohort	Parize et al. 2020 Vaccine quote RESULTS: A total of 28 individuals were included, 6 had inadequate post-PPE titers. abstract, RESULTS Roughly one in five non-responders, and none of the tested variables predicted who. Supports systematic post-PEP titre testing in immunocompromised patients.
Seroconversion (RVNA >= 0.5 IU/mL) at day 14 in HIV patients on stable ART (surrogate) severity: surrogate (immunogenicity) case definition: Simulated PEP in HIV-infected patients with a six-dose Essen regimen	median 30.5 years immune status: HIV infection on stable antiretroviral therapy country: China setting: single-arm pilot study period: circa 2023 n: 30 18-49y	human diploid cell vaccine, six-dose Essen (2 doses day 0, then days 3, 7, 14, 28) platform: inactivated cell-culture vaccine doses: 6 doses vs none (single arm); no difference by CD4 above vs below 500 cells/microL	100 seroconversion at day 14 (%)	cohort	Wu et al. 2025 Hum Vaccin Immunother quote The seroconversion rate reached 100% on day 14. abstract Contrast with rabies-eff-044: treated HIV with preserved CD4 counts responds, advanced untreated HIV may not. Small pilot without a comparator arm.
Neutralising antibody from day 14 to day 365 after PEP in pregnancy (surrogate) severity: surrogate (immunogenicity) case definition: 29 pregnant women exposed to rabies given PVRV on the Essen regimen	pregnant women pregnancy: pregnant at time of PEP prior infection: rabies exposure country: India setting: antirabies clinic with obstetric follow-up period: circa 1998 n: 29 18-49y	purified Vero cell rabies vaccine, Essen regimen platform: inactivated cell-culture vaccine doses: Essen intramuscular regimen vs none (single arm)	adequate and well above the minimum protective level of 0.5 RVNA adequacy day 14 to 365 (adequate, above 0.5 IU/mL) follow-up: 1 year	cohort	Sudarshan et al. 1999 J Commun Dis quote The rabies neutralizing antibody titers from day 14 to day 365 following vaccination in these women was adequate and well above the minimum protective level of 0.5 iu/ml of serum. abstract Pregnancy outcomes were normal and some infants had passively acquired antibody to 3 months. Rabies is a contraindication to withholding PEP in pregnancy, not to giving it.
Secondary exposure warranting PEP among contacts of a rabies patient severity: exposure requiring prophylaxis case definition: Contacts of the index patient assessed for rabies exposure	all ages country: United States (Minnesota) setting: public-health contact investigation period: 2021 All ages	rabies PEP (vaccine plus RIG) platform: inactivated cell-culture vaccine doses: standard PEP vs none (descriptive)	0.9 proportion of assessed contacts warranting PEP (%)	outbreak investigation	Holzbauer et al. 2023 Clin Infect Dis quote Of 332 persons assessed for potential rabies exposure to the case patient, 3 (0.9%) warranted PEP. abstract, RESULTS Human-to-human transmission has not been documented outside transplantation; this shows the public-health response load per case rather than a transmission risk.
Human rabies in persons who had previously received PrEP severity: death case definition: All human rabies cases diagnosed in the US, January 2000-December 2020	all ages country: United States setting: national surveillance period: 2000-2020 All ages	rabies PrEP (any schedule) platform: inactivated cell-culture vaccine doses: PrEP series vs none (descriptive: all 52 cases were in persons without PrEP)	52 human rabies cases among previously PrEP-vaccinated persons (none of 52)	surveillance	cdc.gov quote During January 2000–December 2020, 52 cases of human rabies were diagnosed in the United States, 38 of which were indigenously acquired (i.e., from rabies exposures that occurred in the United States) ( 4 ); none were in persons who had previously received PrEP. Background The value is the total case count; the finding is that none of them had received PrEP. Not an effectiveness estimate because the PrEP-vaccinated population and its exposure rate are unknown.
Rabies deaths averted by current PEP provision severity: death case definition: Modelled deaths prevented by PEP delivered through 31 clinics	all ages country: Madagascar setting: national model period: circa 2014-2017 All ages	rabies PEP as delivered in Madagascar clinics platform: inactivated cell-culture vaccine doses: as delivered vs no PEP (counterfactual in a decision tree)	800 (640–970) deaths averted per year	modelling	Rajeev et al. 2021 PLoS Negl Trop Dis quote We estimate 960 human rabies deaths annually (95% Prediction Intervals (PI): 790-1120), with PEP averting an additional 800 deaths (95% PI: 640-970) each year. abstract, PRINCIPAL FINDINGS 95% prediction interval. Model assumes PEP is highly effective; the number is driven by the assumed exposure incidence. Expanding to one clinic per district was modelled to cut deaths by a further 19%.
PEP failure with modern cell-culture vaccine severity: death case definition: Documented failures of PEP in the United States before January 2021, and the 2021 index case	84-year-old man (index case) immune status: unrecognised monoclonal gammopathy and metastatic prostate cancer in the index case country: United States setting: national experience period: to 2021 65+	cell-culture rabies vaccine with rabies immunoglobulin platform: inactivated cell-culture vaccine doses: timely full PEP vs none (descriptive)	first documented case: 84-year-old died 6 months after a rabid bat bite despite timely PEP documented PEP failures in the US with cell-culture vaccines (none before this single 2021 case)	case series	Holzbauer et al. 2023 Clin Infect Dis quote No human rabies post-exposure prophylaxis (PEP) failure has been documented in the United States using modern cell culture-based vaccines. ... an 84-year-old male died from rabies 6 months after being bitten by a rabid bat despite receiving timely rabies PEP. abstract, BACKGROUND The 2021 Minnesota death after a bat bite is reported as the first PEP failure in the Western Hemisphere with a cell-culture vaccine, attributed to host immune impairment: antibodies were present but non-neutralising. The report advises titre checks after PEP when immunocompromise is suspected.

Vaccine safety and adverse events

Harms measured after vaccination against an unvaccinated or baseline comparator. Kept separate from post-acute sequelae, which follow the disease, not the vaccine.

Outcome (O)	Population (P)	Intervention / comparator	Estimate	Design (S)	Source
Congenital malformations and spontaneous abortion after PEP in pregnancy severity: congenital malformation / spontaneous abortion case definition: Pregnant women given Verorab post-exposure, 20-year clinical experience review	pregnant women pregnancy: pregnant country: multiple setting: review of clinical experience 1985-2005 period: 1985-2005 n: 251 pregnant women 18-49y	purified Vero cell rabies vaccine (Verorab) platform: inactivated cell-culture vaccine doses: post-exposure schedules vs background rates (implicit; no explicit control)	no increase among 251 pregnant women increase in congenital malformations or spontaneous abortions (none observed)	systematic review	Toovey 2007 Travel Med Infect Dis quote Verorab has been administered safely and effectively post-exposure to 251 pregnant women, without any increase in congenital malformations or spontaneous abortions. abstract Manufacturer-supported narrative review; no explicit comparison group. Consistent with Sudarshan 1999 (rabies-eff-047).
Serious adverse events over 1 year severity: serious adverse event case definition: SAEs reported in a phase III trial, investigator-assessed causality	1 year and older country: multiple setting: phase III trial, simulated PEP period: circa 2014-2016 n: 443 vs 442 1-4y5-11y12-17y18-49y50-64y	PCECV intradermal, 4-site/1-week vs 2-site TRC platform: inactivated cell-culture vaccine doses: 1-week vs 28-day ID regimens vs 2-site Thai Red Cross regimen	none of 15 and 19 serious adverse events judged vaccination-related (count) follow-up: 365 days	RCT	Kerdpanich et al. 2018 PLoS Negl Trop Dis quote Of the 15 serious adverse events reported in 4-site/1-week groups and 19 in 2-site/TRC groups, none were vaccination-related. abstract, PRINCIPAL FINDINGS Open-label; causality assessed by investigators. Similar safety profiles across regimens.
Low-grade fever after rabies vaccination severity: mild systemic reaction case definition: Recorded systemic adverse reactions in pre- and post-exposure recipients	all ages as recruited country: Thailand setting: metropolitan rabies control centre period: 1994-1996 n: 1198 All ages	purified Vero cell rabies vaccine platform: inactivated cell-culture vaccine doses: IM conventional or ID Thai Red Cross schedules vs intradermal vs intramuscular (fever more common with IM; pruritus more common with ID)	8 proportion with low-grade fever (%)	RCT	Jaiiaroensup et al. 1998 Vaccine quote Low-grade fever, the only significant adverse systemic event, was more common in the intramuscular groups and was noted in 8% of all subjects. abstract, RESULTS Only pruritus at injection sites (ID) and low-grade fever (IM) differed significantly. No serious reactions reported.

Gaps

No PEP effectiveness estimate against an untreated concurrent control exists: every clinical-outcome series (rabies-eff-002 to rabies-eff-007) is a treated cohort with zero deaths, and the only "VE" figure (81%) is a lower confidence limit computed against an assumed 15% untreated mortality. A randomised untreated arm would be unethical, so this gap is permanent.
No record quantifies the probability of rabies after a bite from a confirmed rabid animal without PEP, by bite site or WHO category. The Hampson 2009 PLoS Biology full text and the Cleaveland 2002 full text carry such probability steps, but PMC blocked the snapshot with a reCAPTCHA; the abstracts give only R0 and modelled death totals. The Haiti cohort gives only the low-risk end (healthy, quarantined dog: under 0.05%).
No record for the Wilde 2007 series of seven true PEP failures (PMID 17905484): its abstract contains no digits, so the compiler cannot carry a numeric value; the finding is in the flags instead.
No clinical-outcome study of PrEP alone (exposure without subsequent PEP) was found; PrEP evidence is entirely serological priming and boostability plus the ACIP observation that none of 52 US cases in 2000-2020 had received PrEP.
No WHO 2018 position paper numbers (GRADE tables, the 1-week 2-site ID schedule statement, RIG wound-infiltration recommendation) are quoted: iris.who.int served a 6-character stub for the WER 93(16) PDF and the Vaccine excerpt abstract (PMID 30107991) carries no figures. The Kessels 2019 systematic review (rabies-eff-049) stands in for it.
No immunogenicity or outcome record for infants under 1 year or for immunocompromised children with the abridged schedules; the Kessels review names both as evidence gaps.
No current pre-vaccine-era historical figure (for example mortality after rabid-wolf bites treated with nerve-tissue vaccine or untreated) could be sourced from a cached abstract; the Bahmanyar 1976 HDCV abstract refers to "past experience with other vaccines" without a number.
No record for rabies exposure incidence or deaths in Latin America, or for the WHO-validated eliminations (Mexico, Chile, Bhutan) beyond the fact-sheet sentence, which carries no numbers.
No record on bite-site (head/face) case fatality or incubation-period risk; the search returned nothing usable and the Hunan abstract gives incubation medians only for failed-PEP cases.
No quantified post-acute record: rabies is fatal in essentially every symptomatic case, so there is no survivor cohort with a sequela proportion. Searches for "rabies survivors" and "survival from rabies encephalitis" returned only narrative reviews and single case reports (de Souza 2014, Jackson 2025) without a numerator and denominator beyond the count of survivors.

Flags for review

rabies-bur-001 (Hampson 2015) omits its confidence interval on purpose: the abstract prints "25-159,000", which means 25,000-159,000 deaths; copying "25" as ci_low would render as an interval of 25 to 159,000. A reviewer should decide whether to add it as 25,000-159,000 by hand or leave it in notes.
The three global death estimates (59,000 Hampson 2015; 55 000 Knobel 2005; 44 203 WHO GHE 2021) are models with different methods and years, and Knobel's interval is a 90% CI. They must be shown as a range with their method labelled, not averaged or presented as a trend.
WHO (rabies-bur-007) says rabies is "fatal in 100% of cases" once symptomatic while CDC (rabies-bur-012) says "over 99%" and Jackson 2025 counts about 34 documented survivors (rabies-bur-022). These are consistent (survival is on the order of a few dozen lifetime cases against ~59,000 deaths a year) but a page showing 100% next to 99% should say why.
The two CDC estimates of US PEP use (about 55,000 per year from 2017-2018 HCUP data, rabies-bur-013; about 100,000 per year on the current clinical-overview page, rabies-bur-014) differ by nearly two-fold with no stated reconciliation. Show both with their source and date.
rabies-bur-013 ("55,000 persons treated") and the "approximately two deaths" per year in the same report are different denominators; do not compute a deaths-per-PEP ratio from them as if PEP recipients were all truly exposed.
rabies-bur-020 (Abuja: 4.2% of recorded dog-bite victims died), rabies-bur-023 and rabies-bur-024 (China: 66.1% of deaths had category III wounds; 1.2% of deaths had complete PEP plus RIG) all have deaths or recorded bites as denominators. None is a population risk or a PEP failure rate; they must not be multiplied with the incidence records.
rabies-eff-002: the only "VE" in the file (81%) is a lower confidence bound derived from zero deaths among 106 treated patients under an ASSUMED 15% untreated mortality. If the page prints it as vaccine efficacy it must say so; it is not a measured relative risk.
Every rabies-eff record from rabies-eff-014 onward (except rabies-eff-028) is a serological surrogate (RVNA >= 0.5 IU/mL or GMT). ACIP states in the cached MMWR that no correlate of protection has been defined (rabies-eff-032). The page should separate "clinical outcome" records (rabies-eff-002 to rabies-eff-013) from "immunogenicity" records visually.
Documented true PEP failures: Wilde 2007 (PMID 17905484) presents seven deaths after PEP given fully to WHO recommendations and calls them extremely rare; the abstract contains no digits so it could not be compiled as a record. The Minnesota 2021 case (rabies-eff-012) is the first cell-culture-vaccine PEP failure in the Western Hemisphere and was attributed to unrecognised immune impairment (non-neutralising antibody). A reviewer should decide how to present failure counts with no denominator.
rabies-eff-008 and rabies-eff-009 (Cote d'Ivoire eRIG vs no eRIG) found no significant mortality difference, but allocation was by local RIG availability, follow-up reached only about half of patients, and deaths in both arms were tied to delayed or incomplete PEP. This is weak evidence on RIG and must not be read as RIG being unnecessary; WHO still recommends RIG for category III exposures.
rabies-eff-031 reports a NEGATIVE non-inferiority result: the 1-week IM HDCV PrEP arm did not meet non-inferiority against the 3-week regimen on 14-day seroconversion (96.7-97.2% vs 100%), even though all arms boosted after simulated PEP a year later. WHO (2018) and ACIP (2022) nonetheless recommend 2-dose, 1-week PrEP; the page should show the trial result as it is.
rabies-eff-038 is a negative finding for a non-standard single-visit 4-site ID PrEP schedule (OR 4.17 for seronegativity vs the 3-visit schedule). It is not a WHO-endorsed schedule and must not be read as evidence against WHO's 2-visit ID PrEP.
Several records carry text values because the source reports the finding in prose (zero deaths, "almost all", "poor response", "no increase"): rabies-eff-004, rabies-eff-005, rabies-eff-012, rabies-eff-014, rabies-eff-015, rabies-eff-016, rabies-eff-024, rabies-eff-032, rabies-eff-033, rabies-eff-044, rabies-eff-049 and rabies-saf-001. Each value still contains only digits that occur in the quoted sentence, as the compiler requires. Check that the site renderer handles non-numeric values and that none is plotted on a numeric axis.
PMC blocked websource.py with a reCAPTCHA for the Hampson 2009 and Cleaveland 2002 full texts, and iris.who.int served an empty DSpace stub for the WHO 2018 position paper PDF (two URL forms tried). A human with a browser should snapshot these three sources and add the per-bite probability of rabies and the WHO GRADE statements.
The validator warns that many notes fields contain numbers not in the quote. Those numbers are record-id cross references (e.g. rabies-eff-035) and years, or figures that appear elsewhere in the same cached abstract (e.g. 68.6% in rabies-eff-040, 0.012 in rabies-eff-041); none introduces a figure from outside the cached source.

Search log (40 searches)

Hampson global burden canine rabies 2015 estimating · PubMed → Found PMID 25881058 (Hampson 2015 global burden model) and 26721555 (Taylor 2017 on estimation difficulties); compiled as rabies-bur-001, rabies-bur-002.
rabies post-exposure prophylaxis failure systematic review · PubMed → No results with this wording; rerun as the next query.
rabies post-exposure prophylaxis failures · PubMed → Found PMID 17905484 (Wilde 2007 true failures), 36988328 (Minnesota 2021 host-mediated failure), 40465669 (China 2016-2020 fatal cases and PEP use), 41837254 (Hunan 2019-2024); compiled as burden and efficacy records.
rabies WHO position paper 2018 abbreviated schedule · PubMed → No results; the position paper was located with the later query "Rabies vaccines WHO position paper April 2018".
rabies pre-exposure prophylaxis booster anamnestic response systematic review · PubMed → No results with this wording.
rabies pre-exposure prophylaxis booster response years · PubMed → Found PMID 33502530 (De Pijper 2022 booster 10-24 years after PrEP), 34875078 (Mills 2022 ID PrEP persistence), 27997343 (Mansfield 2016 antibody decay), 31943042 (Furuya-Kanamori 2020 older travellers), 31358408 (Thai children 2-dose vs 3-dose), 40424340 (Jelinek 2025 PCEC 10-year persistence).
intradermal intramuscular rabies vaccine immunogenicity meta-analysis · PubMed → Found PMID 33478786 (Xu 2021 dose-response meta-analysis), 40081151 (Davis 2025 PrEP doses and routes), 29939085 (Preiss 2018 PCECV PEP), 32898704 (Schnyder 2020 fractional ID dose).
rabies post-exposure prophylaxis one week regimen immunogenicity · PubMed → Found PMID 30737043 (Kessels 2019 abridged schedules SR behind the WHO 2018 position), 29874228 (Kerdpanich 2018 4-site/1-week PCECV), 30890382 (Quiambao 2019 1-week 4-site PVRV), 35933278 (Quiambao 2022 1-week PrEP), 22699446 (Sudarshan 2012 one-week ID).
Rabies vaccines WHO position paper April 2018 · PubMed → Found PMID 30107991 (WHO recommendations excerpt in Vaccine); the abstract carries no numbers. The WER PDF itself could not be snapshotted (see flag).
human rabies United States epidemiology 1938 2018 deaths · PubMed → Found PMID 31194721 (Pieracci 2019 Vital Signs); compiled as rabies-bur-010, rabies-bur-011; the MMWR page was also snapshotted (cdc-gov-dba67946e0).
rabies vaccine HIV immunocompromised antibody response · PubMed → Found PMID 32586759 (Parize 2020 non-HIV immunodeficiency PEP response).
rabies vaccination HIV-infected patients CD4 neutralizing antibody · PubMed → Found PMID 11641838 (Tantawichien 2001 failure in CD4<200) and 40326716 (Wu 2025 six-dose Essen in HIV on ART).
probability of developing rabies after bite rabid dog without prophylaxis · PubMed → Found PMID 31974465 (Ma 2020 Haiti risk model) and 30270873 (Medley 2017 Haiti cohort); compiled as rabies-bur-021.
Hampson transmission dynamics prospects elimination canine rabies PLoS Biology · PubMed → Found PMID 19278295; abstract gives R0 only, and the PMC full text with the per-bite probability of rabies was blocked by reCAPTCHA (see flag).
Cleaveland estimating human rabies mortality Tanzania dog bite injuries · PubMed → Found PMID 12075367; compiled as rabies-bur-018, rabies-bur-019.
Sudarshan burden human rabies India national multi-center epidemiological survey · PubMed → Found PMID 16678463; compiled as rabies-bur-016, rabies-bur-017.
human rabies survivors outcome review · PubMed → Narrative reviews only (PMID 24582283, 23602163); no survivor cohort with sequela rates.
rabies survivors · PubMed → Found PMID 40139921 (Jackson 2025, about 34 documented survivors); compiled as rabies-bur-022 and rabies-pa-001.
bitten by laboratory-confirmed rabid dogs post-exposure prophylaxis outcome survival · PubMed → Found PMID 31395454 (Bharti 2019 wound-only eRIG, 26 confirmed rabid-dog bites).
rabies vaccine pregnancy outcomes cohort post-exposure · PubMed → No results with this wording; rerun as the next query.
rabies vaccine pregnant women safety immunogenicity · PubMed → Found PMID 10937299 (Sudarshan 1999 PVRV in 29 pregnant women) and 17983973 (Toovey 2007 Verorab 20-year review, 251 pregnant women).
human rabies China incidence trend surveillance 2007 2020 · PubMed → Found PMID 37024944 (Shen 2023 scoping review); compiled as rabies-bur-026.
rabies immunoglobulin effectiveness category III exposure deaths retrospective · PubMed → No results with this wording.
rabies post-exposure prophylaxis timing delay death risk · PubMed → Found PMID 32659281 (Gerber 2020 eRIG vs no eRIG field trial, Cote d'Ivoire); compiled as rabies-eff-008, rabies-eff-009.
Thai Red Cross intradermal rabies regimen efficacy · PubMed → Found PMID 15705476 (Quiambao 2005 PCECV ID in 113 category III confirmed exposures), 1969993 (Chutivongse 1990 TRC-ID in 100 proven exposures), 9711804 (Jaiiaroensup 1998 IM vs ID randomized).
rabid wolf bites human diploid cell vaccine · PubMed → Found PMID 1036566 (Bahmanyar 1976 Iran HDCV) and 21458608 (Fayaz 2011 32-year persistence).
untreated rabies exposure mortality rabid animals · PubMed → Found PMID 2873399 (Suntharasamai 1986 PVRV in 106 proven exposures, efficacy against assumed 15% untreated mortality).
Dato bat rabies virus variant cases systematic review · PubMed → Found PMID 27459720; compiled as rabies-bur-015.
rabies Africa human deaths estimate incidence · PubMed → Found PMID 15976877 (Knobel 2005), 25303941 (Dodet 2015), 39762751 (Ethiopia exposure meta-analysis), 36809362 (Abuja dog-bite deaths), 33901194 (Madagascar PEP access model).
rabies pre-exposure prophylaxis protection without booster exposure outcome · PubMed → Found PMID 37394127 (single-visit PrEP review) and 12962581; no clinical-outcome study of PrEP alone was found (see gap).
rabies post-exposure intradermal intramuscular randomized trial seroconversion · PubMed → Found PMID 38478634 (Pineda-Pena 2024 PVRV-NG2 vs HDCV/PVRV + HRIG) and 39544495 (Chansinghakul 2024 Zagreb regimen with HRIG).
rabies deaths India multicentric survey incidence · PubMed → No results with this wording (Sudarshan 2007 found by the later author query).
rabies bite site head face case fatality · PubMed → No results.
rabies vaccine elderly older adults immunogenicity · PubMed → No rabies-specific primary study found; the older-adult subgroup is taken from the Xu 2021 meta-analysis.
rabies pre-exposure prophylaxis children long-term antibody Philippines · PubMed → No results.
rabies children bite victims Asia age distribution deaths · PubMed → No usable results; the children share is taken from the WHO fact sheet.
rabies elimination Latin America human cases decline dog vaccination · PubMed → Found PMID 31557160 and 23798691 (policy reviews); not compiled.
WHO rabies fact sheet · websource → Snapshotted https://www.who.int/news-room/fact-sheets/detail/rabies as who-int-5a81d85fbb; compiled as rabies-bur-004 to rabies-bur-009.
CDC rabies pages and MMWR · websource → Snapshotted CDC About Rabies (cdc-gov-2b6a736456), Clinical Overview (cdc-gov-f463373a61), Vital Signs MMWR 2019 (cdc-gov-dba67946e0) and ACIP 2022 PrEP MMWR (cdc-gov-91adb594ca).
WHO rabies position paper WER 93(16) PDF · websource → iris.who.int returned a 6-character DSpace stub for both URL forms and the who.int item page (who-int-3f6ea3fa79) carries only the overview; no position-paper numbers could be quoted.