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Human Diploid Cell Rabies Vaccine: More Protection for Less Risk?

E. Russell Alexander, MD
JAMA. 1980;244(8):816. doi:10.1001/jama.1980.03310080050029.
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It is estimated that animal bites come to medical attention at an annual rate of 1/200 persons.1 This encounter results in rabies vaccination for 30,000 persons per year. As an infectious diseases consultant, I can certify that the complications and concerns surrounding rabies vaccination are the most frequent problems that are brought to us—as they are to the local, state, or federal epidemiologist.

The concern is well based. In 1957, duck embryo vaccine (DEV) was substituted for nerve-tissue—Origin vaccine (Semple type), because the same protection could be gained for a significant decrease in reactions—from neuroparalytic reaction of about 1/2,000 vaccinates to 1/24,400 (twenty-one among 512,000 recipients of DEV 1958-1975).2 Although this was a 12-fold reduction, the price of rabies protection remained high. The 21 reactions included five cases of transverse myelitis, seven cases of cranial or peripheral neuropathy, and nine cases of encephalopathy. Virtually all recipients of DEV


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