{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:31:51Z","timestamp":1760059911310,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Talent Development Plan for High-level Public Health Technical Personnel Project"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Since the introduction of Pasteur\u2019s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had been reported worldwide between 1980 and 2023. Additionally, sporadic media reports from China showed occasional PEP failures between 2017 and 2024. Rabies remains a serious public health problem in over 150 countries and regions. Methods: In this review, we summarize PEP procedures recommended by the Advisory Committee on Immunization Practices (ACIP) and the WHO. We also analyze potential contributing factors to PEP failure, propose a concept of circulating antibodies, and discuss their roles in PEP. Furthermore, we summarize key guidelines for clinical trial design from the U.S. Food and Drug Administration (FDA) and China\u2019s Center for Drug Evaluation (CDE), as well as the latest developments in monoclonal antibody (cocktail) therapies. Results: Adherence to core PEP practices, such as wound cleansing, infiltration of wounds with immunoglobulin (mAbs), and administration of vaccines, and broader societal involvement are crucial for preventing rabies infection in most cases. For high-risk exposures or immunocompromised individuals, the provision of circulating antibodies through high-dose human rabies immune globulin (HRIG) or mAbs is of utmost importance for preventing PEP failure. Conclusions: Early, high-concentration circulating antibodies are important for preventing PEP failure. Addressing the global issue of rabies requires involvement of the entire society. Only through collective efforts can we tackle this neglected disease and achieve WHO\u2019s goal of \u201czero by 30\u201d.<\/jats:p>","DOI":"10.3390\/vaccines13070775","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T14:55:18Z","timestamp":1753109718000},"page":"775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Circulating Antibody\u2019s Role During Post-Exposure Prophylaxis, and Beyond for Rabies: A Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Qingjun","family":"Chen","sequence":"first","affiliation":[{"name":"Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100024, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Cai","sequence":"additional","affiliation":[{"name":"Immunization Program, Wuhan Center for Disease Prevention and Control, Wuhan 430024, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinjun","family":"Lv","sequence":"additional","affiliation":[{"name":"National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Si","family":"Liu","sequence":"additional","affiliation":[{"name":"Emergency Department, Peking University First Hospital, Beijing 100034, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Emergency Department, Peking University First Hospital, Beijing 100034, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiayang","family":"Liu","sequence":"additional","affiliation":[{"name":"Emergency Department and Trauma Center, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoqiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Center of Vaccine Clinical Research, Yunnan Center for Disease Control and Prevention, Kunming 650022, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenwu","family":"Yin","sequence":"additional","affiliation":[{"name":"Infectious Disease Management Department, Chinese Center for Disease Control and Prevention, Beijing 100052, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Emergency Department and Trauma Center, Peking University People\u2019s Hospital, Beijing 100044, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenggang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Immunization Program, Wuhan Center for Disease Prevention and Control, Wuhan 430024, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","unstructured":"WHO (2025, June 01). 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