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Rabies and post-exposure prophylaxis in Thai children
P Thongcharoen1, C Wasi, S Sirikawin
1Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Rabies is a significant threat to children in Thailand. This study evaluated two vaccines, human diploid cell rabies vaccine (HDCV) and purified Vero cell rabies vaccine (PVRV), showing promising results in preventing rabies deaths in exposed children.
Area of Science:
- Epidemiology
- Vaccinology
- Pediatrics
Background:
- Thailand faces a substantial burden of human rabies deaths annually, with children under 14 disproportionately affected.
- Paediatric rabies cases present with a typical incubation period of one to three months and severe, often fatal, symptoms.
Purpose of the Study:
- To report clinical data on paediatric rabies cases in Thailand from 1980-1986.
- To evaluate the protective efficacy of human diploid cell rabies vaccine (HDCV) and purified Vero cell rabies vaccine (PVRV) in children exposed to rabies.
Main Methods:
- Analysis of 120 medical records of paediatric rabies cases.
- Clinical observation and follow-up of children receiving HDCV (n=50) or PVRV (n=27) post-exposure.
Main Results:
- Rabies in children presented with symptoms including hydrophobia, restlessness, fever, vomiting, and aerophobia, with rapid progression to death in hospitalized cases.
- HDCV administration in 50 children resulted in survival without serious adverse effects over a two-year follow-up, with mild reactions in 1.5% of doses.
- PVRV administration in 27 children also showed no rabies deaths within two years, with mild local reactions in 6 subjects. PVRV recipients developed high rabies neutralizing antibody titers by day 30, maintained above 0.5 IU/ml at one year.
Conclusions:
- Both HDCV and PVRV appear to be effective and safe rabies vaccines for post-exposure prophylaxis in children in Thailand.
- The study highlights the critical need for timely vaccination and underscores the efficacy of modern rabies vaccines in preventing fatal outcomes in paediatric rabies exposure.
Abstract:
Thailand is an endemic area for rabies, with approximately 300 human deaths reported annually. More than half of the rabies patients are children under 14 years of age. This paper reports clinical data of paediatric rabies cases occurring from 1980 to 1986, and the protective efficacies of human diploid cell rabies vaccine (HDCV) and purified Vero cell rabies vaccine (PVRV) in children exposed to rabid animals. The analysis of 120 medical records revealed that rabies in children had incubation periods which ranged from less than fifteen days to more than three months, but generally between one to three months. The most frequent symptoms observed in the patients were hydrophobia, restlessness, fever, vomiting and aerophobia. Most of the rabid children admitted to hospital died within 24 hours. HDCV was administered to 50 children exposed to rabies with the cumulative dosages of 327 ml. All patients survived without serious adverse effects during a-two year follow-up. Mild reactions were seen in 1.5 percent (5/327 doses). Unfortunately, levels of rabies antibody in these vaccinees were not determined. Among another series of children exposed to rabid animals, comprising 27 individuals who received a total of 168 doses of PVRV, only mild local reactions were seen in 6 subjects. No rabies deaths were reported in 2 years of follow-up. The children who received PVRV either with or without human rabies immune globulin developed similar levels of rabies neutralizing (NT) antibody, which reached the high titers on day 30. At one year after the first dose of vaccination, all vaccinees still had NT antibody at titers higher than 0.5 IU/ml.(ABSTRACT TRUNCATED AT 250 WORDS)