Rabies Vaccination-Reply

Abstract

In Reply. —We disagree with a number of Dr Diamond's statements about rabies and rabies postexposure prophylaxis. Postexposure prophylaxis failures with rabies immune globulin and cell-culture vaccines (eg, human diploid cell rabies vaccine [HDCV]) are rare occurrences. As stated in the editorial note of the LEADS FROM THE MMWR article that appeared in JAMA , only two laboratory-confirmed cases of rabies occurring despite administration of rabies immune globulin and HDCV within 24 hours of exposure have been reported during the ten-year period that cell-culture vaccines have been used worldwide. We have been in communication with Dr Wasi regarding eight other possible cases of rabies despite postexposure prophylaxis with rabies immune globulin and cell-culture vaccine. However, none of these patients had received rabies immune globulin and cell-culture vaccine within 24 hours of exposure. In addition, it is unclear how rabies immune globulin and vaccine were administered, what type of local wound care