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Rabies post-exposure prophylaxis not always adequate
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Data from a retrospective analysis indicate that patients may be at risk for inadequate antibody response following a four-dose rabies post-exposure prophylaxis regimen. Therefore, adjustments in follow-up measurements of antibody levels are recommended, according to researchers from Switzerland.
According to background information in the study, the CDC recommended a four-dose rabies post-exposure prophylaxis regimen in 2010, and WHO endorsed this regimen later that year. The researchers set out to determine the adequacy of post-exposure prophylaxis in view of this recommendation.
They conducted a retrospective analysis of patients who presented at the Travel Clinic of the University Hospital in Lausanne, Switzerland for rabies post-exposure prophylaxis between January 2005 and August 2011.
Of the 110 patients included in the study, 90 were exposed to rabies while traveling abroad. Among these patients, 54 consulted with a physician abroad and 36 waited until they returned to Switzerland. Among those consulted abroad, the median delay between exposure and initiation of post-exposure prophylaxis was 0 days, but for patients who waited until they returned to Switzerland, the median delay was 10 days.
Ninety-nine patients should have received human rabies immunoglobulin. All of the locally-exposed individuals and 28 of the travelers who waited for treatment until they returned to Switzerland received it. Of the 50 travelers who consulted with physicians abroad, only seven patients received it.
After receiving the four vaccine regimen, six patients who did not receive pre-exposure prophylaxis had antibody titers <0.5 IU/mL, measured between days 21 and 29 after initiation of post-exposure prophylaxis. Four of the patients were exposed abroad and received their vaccine doses when they returned to Switzerland. All patients developed antibody levels >0.5 IU/mL after additional vaccine doses.
“During routine practice, several factors can probably lead to the observed inappropriate antibody response, but these factors are difficult to identify and therefore avoid,” the researchers wrote. “These include unrecognized immunodeficiency, poor quality of vaccines, inappropriate administration of vaccines and other as yet unidentified factors.”
References:
Uwanyiligira M. Clin Infec Dis. 2012;55:201-205.
Disclosures:
The researchers report no relevant financial disclosures.