Rabies Vaccine Breakthrough Cases Confirmed

Clinical Infectious Diseases reported in March 2023 the first rabies post-exposure prophylaxis (PEP) failure in humans in the U.S. using modern cell-culture vaccines.

In January 2021, an 84-year-old male died from rabies six months after being bitten by a rabid bat despite receiving timely rabies PEP.

The researchers found rabies virus antibodies present in serum and cerebrospinal fluid were non-neutralizing. 

Their recommendation is clinicians should consider measuring rabies-neutralizing antibody titers after completion of PEP if there is any suspicion of immunocompromised in the person.

Previously, The Lancet Infectious Disease reported (Dec 2022) that sporadic breakthrough infections (i.e., rabies in people who have started PEP had been reported.

These researchers identified a total of 122 rabies vaccine breakthrough infections.

Although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare, wrote these researchers.

The rabies virus infects the central nervous system. If a person does not receive the appropriate medical care after a potential rabies exposure, the virus can cause disease in the brain, ultimately resulting in death, wrote the U.S. CDC.

According to the CDC, most rabies infections in the U.S. are rare and related to bat bites, while dog bites are a more frequent source of rabies in other countries.

Various rabies vaccines are available in the U.S. in 2023.