{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:50:33Z","timestamp":1790113833907,"version":"4.0.1"},"reference-count":41,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>In the US, rabies postexposure prophylaxis (PEP) is often administered without a comprehensive and regionally appropriate rabies risk assessment. For low-risk exposures, this can result in patients incurring out-of-pocket expenses or experiencing adverse effects of PEP unnecessarily.<\/jats:p><\/jats:sec>Objective<\/jats:title>To use a model to estimate (1) the probability that an animal would test positive for rabies virus (RABV) given that a person was exposed, and (2) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP, and to propose a risk threshold for recommending PEP according to model estimates and a survey.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this decision analytical modeling study, positivity rates were calculated using more than 900\u202f000 animal samples tested for RABV between 2011 and 2020. Other parameters were estimated from a subset of the surveillance data and the literature. Probabilities were estimated using Bayes\u2019 rule. A survey was administered among a convenience sample of state public health officials in all US states (excluding Hawaii) plus Washington, DC and Puerto Rico to determine a risk threshold for PEP recommendation. Respondents were asked whether they would recommend PEP given 24 standardized exposure scenarios while accounting for local rabies epidemiology.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>A quantitative and regionally appropriate approach for helping health care practitioners and public health professionals determine whether to recommend and\/or administer rabies PEP.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 1728 unique observations were obtained from the model for the probability that an animal would test positive for RABV given that a person was exposed, and 41\u202f472 for ) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP. The median probability that an animal would test positive for RABV given that a person was exposed ranged from 3\u2009\u00d7\u200910\u22127<\/jats:sup> to 0.97, while the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP ranged from 1\u2009\u00d7\u200910\u221210<\/jats:sup> to 0.55. Fifty public health officials out of a target sample size of 102 responded to the survey. Using logistic regression, a risk threshold was estimated for PEP recommendation of 0.0004; PEP may not be recommended for exposures with probabilities below this threshold.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this modeling study of rabies in the US, the risk of death|exposure was quantified and a risk threshold was estimated. These results could be used to inform the decision-making process as to the appropriateness of recommending rabies PEP.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.17121","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T15:31:57Z","timestamp":1686324717000},"page":"e2317121","source":"Crossref","is-referenced-by-count":9,"title":["Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US"],"prefix":"10.1001","volume":"6","author":[{"given":"Kelly","family":"Charniga","sequence":"first","affiliation":[{"name":"Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Division of High-Consequence Pathogens and Pathology, National Center for 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