Rabies in Oman: Failed postexposure vaccination in a lactating woman bitten by a fox

Abstract

Rabies was first detected in the Sultanate of Oman in 1990, when a child from Buraimi, northern Oman, on the border with the United Arab Emirates (U.A.E), died after being bitten by a fox.’ Subsequently, animal-bite surveillance revealed evidence of a country-wide epizootic of rabies in the common fox (Vulpes vulpes), which spread from the border of the U.A.E. to involve the whole of Oman, excepting Musandem Province in the northeast2s3 Shortly after the first case, postexposure prophylactic immunization for rabies (passive immunization with human rabies immune globulin [HRIG] and active immunization with human diploid cell vaccine [HDCV]), was made available in all Omani hospitals. Nevertheless, despite adequate postexposure prophylaxis, two more cases of rabies occurred in 1991 and 1992, following bites by a wolf and a fox, respectively.* This report presents another case of rabies that developed despite postexposure immunization in a lactating woman who was bitten by a fox. On April 20,1997, while sleeping in the desert, a 17year-old Bedouin woman was bitten on the upper lip by a fox. Her husband immediately drove her to the district hospital, where two deep lacerations on her upper lip were cleaned and dressed, but not stitched. Two 1-mL doses of inactivated Merieux rabies HDCV were administered by intramuscular injection into each deltoid, according to the Ministry of Health protocol. Antitetanus toxoid was given. At the time, HRIG was unavailable in the hospital, but the woman was ordered to go immediately to the regional hospital, a distance of several hours’ drive on a surfaced road, where HRIG was available. Unfortunately, she delayed attending the regional hospital until April 22, when, according to official guidelines for patients presenting more than 48 hours after injury,