Rabies postexposure prophylaxis in routine practice in view of the new Centers for Disease Control and Prevention and World Health Organization recommendations

BACKGROUND: New recommendations for rabies PEP were published by the CDC and the WHO in 2010.We investigated the adequacy of rabies post-exposure prophylaxis (PEP) of patients consulting our travel clinic in view of these new recommendations.MethodsA retrospective analysis of the files of all patients who consulted for rabies PEP at the Travel Clinic of the University Hospital, Lausanne, Switzerland, between January 2005 and August 2011 was conducted.ResultsOne hundred and ten patients treated with rabies PEP were identified. Median age of the patients was 34 years (range 2 - 79), 53% were women. Ninety subjects were potentially exposed to rabies while travelling abroad.Shortcomings in the management of these patients were 1) late initiation of rabies PEP in travelers who waited to be back in Switzerland to seek medical care, 2) administration of human rabies immune globulins (HRIG) in only 7 of 50 travelers (14%) who sought care abroad and for whom HRIG was indicated, 3) antibody levels >0.5 IU/ml in 6 of 90 patients (6.7%) after 4 doses of vaccine.ConclusionsPatients do not always receive optimal rabies PEP under real-life conditions. A significant proportion of patients did not develop adequate antibody levels after 4 doses of vaccine. These data indicate that the measurement of antibody levels on day 21 of the Essen post-exposure prophylaxis regimen is useful in order to verify an adequate immune response