According to a new article in the journal, Clinical Infectious Diseases, authors report on the first reported failure of rabies post-exposure prophylaxis (PEP) in the Western Hemisphere using a cell culture vaccine.
On July 27, 2020, an 84-year-old man in Minnesota was awoken by a bat biting his right hand.
The bat tested positive for rabies on July 30 at the Minnesota Department of Health (MDH) prompting initiation of PEP (HRIG and rabies vaccine) that day. The patient was previously unvaccinated against rabies. Though there was no visible wound, he washed his hands with soap and water after the exposure.
He received three additional doses of rabies vaccine (Days 3, 7, 14), as recommended for previously unvaccinated immunocompetent persons.
The man’s wife also received PEP for a possible unrecognized exposure during sleep.
In January 2021, the patient began having symptoms and died 15 days after symptom onset on January 22.
The PEP was evaluated for storage, administration, integrity and potency and determined to be acceptable.
Authors conclude a host-mediated primary vaccine failure attributed to previously unrecognized impaired immunity is the most likely explanation for this breakthrough infection.
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