Rabies post-exposure prophylaxis in malnourished children exposed to suspect rabid animals

Area of Science:

• Pediatrics
• Immunology
• Infectious Diseases

Background:

• Asia has the highest burden of childhood malnutrition and human rabies deaths globally.
• Protein energy malnutrition (PEM) may impair immune responses, potentially affecting vaccine efficacy.
• Rabies post-exposure prophylaxis (PEP) is critical for preventing rabies after potential exposure.

Purpose of the Study:

• To assess the immunogenicity of rabies vaccine in children with moderate to severe PEM.
• To evaluate the safety of rabies vaccine in this vulnerable population.

Main Methods:

• A clinical trial involving 45 children with PEM exposed to potentially rabid animals.
• Administration of purified chick embryo cell rabies vaccine (PCECV) on a 5-dose schedule (days 0, 3, 7, 14, 30).
• Measurement of rabies virus neutralizing antibody titers on days 0, 14, and 30.

Main Results:

• All participants achieved protective rabies virus neutralizing antibody titers (>0.5 IU/mL) by day 14.
• The immune response was deemed acceptable despite severe PEM.
• No serious adverse events were reported during the vaccination course.

Conclusions:

• Rabies vaccination (PCECV) is immunogenic and safe in children with moderate to severe PEM.
• Malnutrition did not prevent an adequate immune response to rabies PEP in this cohort.
• These findings support the use of standard rabies PEP regimens in malnourished children requiring vaccination.