Rabies transmission risks during peripartum--Two cases and a review of the literature

We report two cases of probable rabies in near-term/at-term pregnant women in sub-Saharan Africa and Asia. One baby was delivered by caesarean section and the other one vaginally. Both received post-exposure prophylaxis (PEP), including RIG and vaccine and both are alive and healthy, at 9 and 24 months, respectively. We found 14 other published cases of infants born from rabid mothers. One confirmed case of rabies transmission occurred. The other children born from rabid mothers, with or without caesarean section, did not acquire rabies, and were still healthy at the time of reporting, with or without post-exposure prophylaxis. Mother-to-child transmission of rabies is possible, but rare, because rabies virus is not present in blood and exposure of the baby's mucosa to maternal infectious fluids and tissue seems limited. A conservative approach should however, be adopted, and rabies PEP, including RIG, be administered as soon as possible to babies born from probably rabid mothers. Whether cesarean-section clearly provides prevention remains unclear. Rabies can be prevented in pregnant women by PEP administration. Rabies cell-culture vaccines are safe and effective and can be administered to pregnant and lactating women, as well as newborns. Efforts must focus on raising rabies awareness in the general population, as well as in healthcare workers.