Rabies Vaccination-Reply

Thomas R. Eng, VMD, MPH; Daniel B. Fishbein, MD
JAMA. 1988;259(18):2693-2694. doi:10.1001/jama.1988.03720180021011.
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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


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