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Volume 18, Number 9—September 2012

Dispatch

Inadequate Antibody Response to Rabies Vaccine in Immunocompromised Patient

Eran KopelComments to Author , Gal Oren, Yechezkel Sidi, and Dan David
Author affiliations: The Chaim Sheba Medical Center, Tel Hashomer, Israel (E. Kopel, G. Oren, Y. Sidi); Ministry of Health, Tel Aviv, Israel (E. Kopel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Y. Sidi); and Kimron Veterinary Institute, Bet Dagan, Israel (D. David)

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Table

Summary of published reports on inadequate antibody response to rabies vaccine in immunocompromised patients*

Characteristic Case-patient 1 (8) Case-patients 2–6 (9) Case-patients 7–13 (10) Case-patient 14 (11) Case-patient 15 (12) Case-patient in this study
Age, y 6 NA 7–38 55 55 74
Sex F NA 4 F, 3 M M M F
Country Thailand Thailand Thailand Israel Mexico Israel
Vaccination year 1998 NA 1998–1999 1999 2009 2011
Underlying illness AIDS HIV infection AIDS Advanced B-cell lymphoma Kidney transplant recipient Advanced B-cell lymphoma
Leukocyte count at baseline 44 CD4+/μL 111–250 CD4+/μL 25–199 CD4+/μL NA NA 250 lymphocytes/μL
Vaccine type (dose) PVRV (0.1 mL) PVRV (0.1 mL) PVRV (0.1 mL) PCECV (1.0 mL) PVRV (0.5 mL) PVRV (0.5 mL)
Standard PEP regimen (d) 4 sites, ID (0, 3, 7); 2 sites, ID (60, 90) 2 sites, ID (0, 3, 7); 1 site, ID (28, 90) 4 sites, ID (0, 3, 7); 2 sites, ID (60, 90) 1 site, IM (0, 3, 7, 14, 28) 1 site, IM (0, 3, 7, 14, 28) 1 site, IM (0, 3, 7, 14)†
Ig at day 0 (dose) NA Equine rabies Ig (40 IU/kg) Human rabies Ig (20 IU/kg) Human rabies Ig (20 IU/kg) Human rabies Ig (20 IU/kg) Human rabies Ig (20 IU/kg)
VNA titer in case-patients without adequate vaccine response (d of last measurement) <0.07 IU/mL in serum (90) Undetectable and <0.5 IU/mL in serum samples for 2 patients (90) <0.04 IU/mL and 0.23 IU/mL in samples for 2 patients (90) 0.2 IU/mL in serum (30) 0.31 IU/mL in serum (28) <0.07 IU/mL in serum and <0.04 IU/mL in CSF (15)

*NA, not available; PVRV, purified Vero cell vaccine; PCECV, purified chick embryo cell vaccine; PEP, postexposure prophylaxis; ID, intradermal; IM, intramuscular; VNA, rabies virus neutralizing antibodies; CSF, cerebrospinal fluid.
†The patient died before the scheduled fifth dose on day 28.

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