Investigating Possible Etiologies of Post-Exposure Prophylaxis Failure and Deaths From Rabies Infection: Case Reports
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 10 No. 3 (2020),
27 September 2020
,
Page 27378
https://doi.org/10.32598/ijmtfm.v10i3.27378
Abstract
Rabies virus, as a neurotropic agent, is transmitted to humans usually after animal biting. Rabies
is endemic in most Middle Eastern countries. Pre-exposure Prophylaxis (PrEP) program is
recommended for high-risk populations in endemic areas. The present study reported 7 deaths
from rabies infection despite human Post-Exposure Prophylaxis (PEP) and the evolution
of their possible etiologies from 2014 to 2018 in Iran. In this study, 29 rabid human deaths
were evaluated despite PEP in 2014-2018. Seven people deceased despite receiving PEP. The
most damaged organs were hands and face (71.43%). Injecting anti-Rabies Immunoglobulin
(RIG) around the wound, improper cleansing, and delayed PEP were the main causes of PEP
failure. In addition, immunodeficiency in a patient was another cause of failure. Our obtained
data suggested that immediate precise measures after exposure based on the World Health
Organization (WHO) recommendation, maintaining the temperature integrity (cold chain) of
vaccines, and RIGs during transportation, and performing detailed injection schedule could
prevent PEP failure in most cases. Furthermore, society’s awareness plays a key role in
controlling the disease, especially in endemic areas.
- Rabies
- Rabies Vaccine
- Post-exposure prophylaxis
- Lyssavirus
How to Cite
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