Routine pre-exposure rabies prophylaxis: a reassessment.

The rational use of rabies biologics is a difficult challenge. Pre-exposure rabies prophylaxis (PRE-RP) is one important rabies prevention strategy currently recommended by the US Public Health Service for groups considered at high risk of exposure to rabies. However, standard post-exposure rabies prophylaxis (POST-RP) appears equally effective in preventing rabies; PRE-RP still requires a limited vaccination series if a rabies exposure occurs and, at current costs, standard POST-RP may be a less expensive strategy than PRE-RP. For PRE-RP, as with other human rabies prevention strategies, the central problem is to obtain reasonable estimates of actual rabies exposure risks, which provide the rationale for well-designed programs.