Summary of NACI statement of January 30, 2026: Updated guidance for use of Rabies Vaccine for pre-exposure prophylaxis (PrEP)

On this page

• Overview
• What you need to know

Overview

On January 30, 2026, the Public Health Agency of Canada (PHAC) released the National Advisory Committee on Immunization's (NACI) guidance for use of rabies vaccine for pre-exposure prophylaxis (PrEP). This guidance is based on current evidence and NACI expert opinion.

Following a review of the evidence, NACI issued updated recommendations as follows:

Risk groups for pre-exposure prophylaxis

• NACI now categorizes people recommended to receive PrEP into three groups: very high risk, high risk, and moderate risk. For each group, NACI provides recommendations regarding vaccination schedules and the need for and frequency of blood tests (serology testing) to monitor the response to the vaccine.

Schedules for pre-exposure prophylaxis by risk group

• Most groups are recommended to receive an initial series of 3 doses of rabies vaccine or 2 doses plus a booster, with schedules varying by risk group.
• People in the moderate risk group who are not immunocompromised and whose risk is only expected to be short-term (defined as less than 3 years) are now recommended to receive a 2-dose series.

Route of administration for pre-exposure prophylaxis

• Rabies PrEP may be administered either intramuscularly (at one injection site for each dose) or intradermally (at two injection sites for each dose). Both routes are acceptable and interchangeable if needed.

Serology testing after pre-exposure prophylaxis

• Routine serology is no longer recommended after intradermal administration if given at two sites per dose.
• Serology is recommended after vaccination for people who are immunocompromised and for those taking chloroquine/hydroxychloroquine, and on a regular basis for those whose occupational risk means they may not recognize an exposure and therefore might not seek post-exposure prophylaxis (PEP).

Post-exposure prophylaxis for those who previously received pre-exposure prophylaxis

• NACI continues to recommend that anyone who receives PrEP should still seek post-exposure prophylaxis (PEP) after a potential exposure to rabies.
• NACI has provided guidance regarding the PEP schedules for those who have previously received rabies vaccination, noting that the PEP schedule is generally simpler for those who have previously received PrEP..

Product interchangeability

• When possible, the same vaccine product should be used for all doses. However, purified chick embryo cell vaccines (PCECV), human diploid cell vaccines (HDCV), and purified Vero cell rabies vaccines (PVRV) are considered interchangeable if required.

For the full statement please see: Updated guidance for use of rabies vaccine for pre-exposure prophylaxis (PrEP) [PDF].

What you need to know

• Rabies is a rare but almost universally fatal infection that most commonly results from the bite of an infected animal. Treatment of rabies is almost always ineffective once symptoms develop, however rabies can be prevented through the use of rabies post-exposure prophylaxis (PEP) after an exposure to a potentially rabid animal or the rabies virus in a laboratory setting.
• Rabies vaccination before an exposure (rabies pre-exposure prophylaxis, PrEP) is recommended for certain groups who are at increased risk of exposure to potentially rabid animals or to the rabies virus in the laboratory. The NACI statement outlines groups who are recommended to receive PrEP.
• Those who have previously received PrEP are still recommended to receive PEP after an exposure to a potentially rabid animal or the rabies virus in a laboratory, but the PEP schedule is generally simpler in those who have previously received PrEP.
• The schedule for rabies vaccine for PrEP has been adjusted for certain groups. Some groups who are only likely to have short-term risk of exposure to rabies virus (for example, travellers who are not immunocompromised and whose risk is expected to last less than 3 years) are only recommended to received 2 doses of rabies vaccine for PrEP. All others are recommended to receive 3 doses of rabies vaccine for PrEP, as outlined in Table 1 of the NACI statement.
• In addition to this update on pre-exposure vaccination for some individuals, NACI is also working on more detailed guidance about when and how to provide post-exposure prophylaxis after a potential rabies exposure.
• NACI will continue to monitor the evolving evidence and will update guidance as needed.

To receive information regarding updates to the Canadian Immunization Guide and new NACI recommendations, statements and literature reviews, please subscribe to our publications mailing list.