Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus.
BACKGROUND: Australia uses a protocol combining human rabies immunoglobulin (HRIG) and rabies vaccine for post-exposure prophylaxis (PEP) of rabies and Australian bat lyssavirus (ABLV), with the aim of achieving an antibody titre of ≥0.5 IU/ml, as per World Health Organization (WHO) guidelines, as s...
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ftdoajarticles:oai:doaj.org/article:b3214f362e0d4ce4bcfc63a5205978a9 2023-05-15T15:15:24+02:00 Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. Niall Conroy Susan Vlack Julian M Williams John J Patten Robert L Horvath Stephen B Lambert 2013-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0002066 https://doaj.org/article/b3214f362e0d4ce4bcfc63a5205978a9 EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC3584984?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0002066 1935-2727 1935-2735 https://doaj.org/article/b3214f362e0d4ce4bcfc63a5205978a9 PLoS Neglected Tropical Diseases, Vol 7, Iss 2, p e2066 (2013) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2013 ftdoajarticles https://doi.org/10.1371/journal.pntd.0002066 2022-12-31T01:17:52Z BACKGROUND: Australia uses a protocol combining human rabies immunoglobulin (HRIG) and rabies vaccine for post-exposure prophylaxis (PEP) of rabies and Australian bat lyssavirus (ABLV), with the aim of achieving an antibody titre of ≥0.5 IU/ml, as per World Health Organization (WHO) guidelines, as soon as possible. METHODOLOGY/PRINCIPAL FINDINGS: We present the course of PEP administration and serological testing for four men with complex requirements. Following dog bites in Thailand, two men (62 years old, 25 years old) received no HRIG and had delayed vaccine courses: 23 days between dose two and three, and 18 days between dose one and two, respectively. Both seroconverted following dose four. Another 62-year-old male, who was HIV-positive (normal CD4 count), also suffered a dog bite and had delayed care receiving i.m. rabies vaccine on days six and nine in Thailand. Back in Australia, he received three single and one double dose i.m. vaccines followed by another double dose of vaccine, delivered intradermally and subcutaneously, before seroconverting. A 23-year-old male with a history of allergies received simultaneous HRIG and vaccine following potential ABLV exposure, and developed rash, facial oedema and throat tingling, which was treated with a parenteral antihistamine and tapering dose of steroids. Serology showed he seroconverted following dose four. CONCLUSIONS/SIGNIFICANCE: These cases show that PEP can be complicated by exposures in tourist settings where reliable prophylaxis may not be available, where treatment is delayed or deviates from World Health Organization recommendations. Due to the potentially short incubation time of rabies/ABLV, timely prophylaxis after a potential exposure is needed to ensure a prompt and adequate immune response, particularly in patients who are immune-suppressed or who have not received HRIG. Serology should be used to confirm an adequate response to PEP when treatment is delayed or where a concurrent immunosuppressing medical condition or therapy exists. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 7 2 e2066 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
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English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Niall Conroy Susan Vlack Julian M Williams John J Patten Robert L Horvath Stephen B Lambert Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Australia uses a protocol combining human rabies immunoglobulin (HRIG) and rabies vaccine for post-exposure prophylaxis (PEP) of rabies and Australian bat lyssavirus (ABLV), with the aim of achieving an antibody titre of ≥0.5 IU/ml, as per World Health Organization (WHO) guidelines, as soon as possible. METHODOLOGY/PRINCIPAL FINDINGS: We present the course of PEP administration and serological testing for four men with complex requirements. Following dog bites in Thailand, two men (62 years old, 25 years old) received no HRIG and had delayed vaccine courses: 23 days between dose two and three, and 18 days between dose one and two, respectively. Both seroconverted following dose four. Another 62-year-old male, who was HIV-positive (normal CD4 count), also suffered a dog bite and had delayed care receiving i.m. rabies vaccine on days six and nine in Thailand. Back in Australia, he received three single and one double dose i.m. vaccines followed by another double dose of vaccine, delivered intradermally and subcutaneously, before seroconverting. A 23-year-old male with a history of allergies received simultaneous HRIG and vaccine following potential ABLV exposure, and developed rash, facial oedema and throat tingling, which was treated with a parenteral antihistamine and tapering dose of steroids. Serology showed he seroconverted following dose four. CONCLUSIONS/SIGNIFICANCE: These cases show that PEP can be complicated by exposures in tourist settings where reliable prophylaxis may not be available, where treatment is delayed or deviates from World Health Organization recommendations. Due to the potentially short incubation time of rabies/ABLV, timely prophylaxis after a potential exposure is needed to ensure a prompt and adequate immune response, particularly in patients who are immune-suppressed or who have not received HRIG. Serology should be used to confirm an adequate response to PEP when treatment is delayed or where a concurrent immunosuppressing medical condition or therapy exists. |
format |
Article in Journal/Newspaper |
author |
Niall Conroy Susan Vlack Julian M Williams John J Patten Robert L Horvath Stephen B Lambert |
author_facet |
Niall Conroy Susan Vlack Julian M Williams John J Patten Robert L Horvath Stephen B Lambert |
author_sort |
Niall Conroy |
title |
Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
title_short |
Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
title_full |
Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
title_fullStr |
Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
title_full_unstemmed |
Using serology to assist with complicated post-exposure prophylaxis for rabies and Australian bat lyssavirus. |
title_sort |
using serology to assist with complicated post-exposure prophylaxis for rabies and australian bat lyssavirus. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2013 |
url |
https://doi.org/10.1371/journal.pntd.0002066 https://doaj.org/article/b3214f362e0d4ce4bcfc63a5205978a9 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 7, Iss 2, p e2066 (2013) |
op_relation |
http://europepmc.org/articles/PMC3584984?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 doi:10.1371/journal.pntd.0002066 1935-2727 1935-2735 https://doaj.org/article/b3214f362e0d4ce4bcfc63a5205978a9 |
op_doi |
https://doi.org/10.1371/journal.pntd.0002066 |
container_title |
PLoS Neglected Tropical Diseases |
container_volume |
7 |
container_issue |
2 |
container_start_page |
e2066 |
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1766345772093145088 |