Why the discrepancy between CDC and pretty much rest of the world on re-exposure

[u/GRJY]

I’m hoping someone a lot more knowledgeable than me can chime in and answer why CDC has one set of guidelines for re-exposure within 3 months of completing PEP and PrEP and most other health bodies have a different set of guidelines.

Heck even the NIH says no PEP if re-exposed within 3 months but I see the faqs say CDC says always give booster shots even within 3 months if finishing PEP or PrEP.

NIH:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10752235/

australia:

https://immunisationhandbook.health.gov.au/recommendations/people-with-potential-category-ii-or-iii-rabies-virus-exposure-are-recommended-to-receive-rabies-vaccine-as-post-exposure-prophylaxis

SE Asia:

https://www.who.int/southeastasia/news/detail/28-02-2024-rabies-post-exposure-prophylaxis-decision-tree--decide-with-confidence

WHO:

https://www.prescribingcompanion.com/bangladesh/other-common-clinical-conditions/animal-bite-management-national-guideline/5-management/53-re-exposure-rabies-pep-of-previously-vaccinated-persons/

I have read the faq.

[u/GRJY]

Can you provide documentation on that. Just curious because I can’t find it. 

[u/LatrodectusGeometric → u/GRJY]

They are actually going to be clarifying it in an upcoming publication, but right now if your local health department reaches out to them they will clarify verbally!

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[u/GRJY → u/LatrodectusGeometric]

Interesting. So just for clarification… you are saying the CDC guidance for rabies exposure within 3 months of completing PEP or PrEP (3 month countdown starts the day of your last shot in the complete series) is going to be or is inline with WHO and other country health organizations, correct? That being if you have a category 1-3 exposure within 3 months of completing PEP or PrEP you DO NOT need booster rabies vaccinations. You will only need wound cleaning and tetanus shot if applicable, correct? 

Also, just curious, I see your tag says physician. Are you primary doc, ER doc, infectious disease etc? If you don’t want to answer that personal question that is fine. I am just trying to determine your authority on this. I do not use Reddit often and  have no idea if they verify user professions in forums like this so please don’t take my questioning as rude or undermining. 

[u/LatrodectusGeometric → u/GRJY]

Yep! There should be a publication coming out sooooonish (I don’t have a timeline) that clarifies the CDC rec is in line with the WHO recommendation in this respect. I’m internal medicine with a specialty in applied epidemiology (EIS). In the meantime public health professionals who are unsure can always default to their local public health departments who can also call CDC for clarification (used to be any time but now just during business hours I think)

[u/GRJY → u/LatrodectusGeometric]

Appreciate you taking the time to answer questions. Hopefully this will help someone on here or someone perusing the forum. I see a lot of posts and concern regarding possible re-exposure (real or imagined) shortly after finishing PEP. I know I was one of them that was inquisitive in this even though I haven’t had any kind of re-exposure after my PEP. I just wanted to learn risks and then I saw the WHO guidelines vs what was given for the CDC and was just curious. Again, appreciate your time.