Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 18, Number 9—September 2012

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)

Main Article


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.

Main Article

  1. Rupprecht  CE, Gibbons  RV. Clinical practice. Prophylaxis against rabies. N Engl J Med. 2004;351:262635. DOIPubMedGoogle Scholar
  2. Hankins  DG, Rosekrans  JA. Overview, prevention, and treatment of rabies. Mayo Clin Proc. 2004;79:6716. DOIPubMedGoogle Scholar
  3. Warrell  MJ, Warrell  DA. Rabies and other lyssavirus diseases. Lancet. 2004;363:95969. DOIPubMedGoogle Scholar
  4. World Health Organization. Rabies vaccines: WHO position paper. Wkly Epidemiol Rec. 2010;85:309–20 [cited 2011 Nov 13].
  5. Israel Ministry of Health, Public Health Services. Guidelines for rabies prevention [in Hebrew]. Circular no. 3/2010, May 26, 2010.
  6. Rupprecht  CE, Briggs  D, Brown  CM, Franka  R, Katz  SL, Kerr  HD, Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010;59:19.PubMedGoogle Scholar
  7. Smith  JS, Yager  PA, Baer  GM. A rapid reproducible test for determining rabies neutralizing antibody. Bull World Health Organ. 1973;48:53541.PubMedGoogle Scholar
  8. Pancharoen  C, Thisyakorn  U, Tantawichien  T, Jaijaroensup  W, Khawplod  P, Wilde  H. Failure of pre- and postexposure rabies vaccinations in a child infected with HIV. Scand J Infect Dis. 2001;33:3901. DOIPubMedGoogle Scholar
  9. Jaijaroensup  W, Tantawichien  T, Khawplod  P, Tepsumethanon  S, Wilde  H. Postexposure rabies vaccination in patients infected with human immunodeficiency virus. Clin Infect Dis. 1999;28:9134. DOIPubMedGoogle Scholar
  10. Tantawichien  T, Jaijaroensup  W, Khawplod  P, Sitprija  V. Failure of multiple-site intradermal postexposure rabies vaccination in patients with human immunodeficiency virus with low CD4+ T lymphocyte counts. Clin Infect Dis. 2001;33:e1224. DOIPubMedGoogle Scholar
  11. Hay  E, Derazon  H, Bukish  N, Scharf  S, Rishpon  S. Postexposure rabies prophylaxis in a patient with lymphoma. JAMA. 2001;285:1667. DOIPubMedGoogle Scholar
  12. Rodríguez-Romo  R, Morales-Buenrostro  LE, Lecuona  L, Escalante-Santillán  N, Velasco-Villa  A, Kuzmin  I, Immune response after rabies vaccine in a kidney transplant recipient. Transpl Infect Dis. 2011;13:4925. DOIPubMedGoogle Scholar
  13. Schneider  E, Whitmore  S, Glynn  KM, Dominguez  K, Mitsch  A, McKenna  MT; Centers for Disease Control and Prevention. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years—United States, 2008. MMWR Recomm Rep. 2008;57:112.PubMedGoogle Scholar
  14. World Health Organization. WHO expert consultation on rabies. World Health Organ Tech Rep Ser. 2005;931:188.

Main Article

Page created: August 17, 2012
Page updated: August 17, 2012
Page reviewed: August 17, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.