Practical management of rabies and the 1982 outbreak in Zorzor District, Liberia

A rabies outbreak in Zorzor District, Liberia, in 1982 resulted in 31 known bitten and 12 known exposed patients. Human diploid cell strain (HDCS) vaccine was used to vaccinate 40 patients. Of these, 34 were vaccinated at Curran Lutheran Hospital, Zorzor, Liberia, mostly by the intradermal (i.d.) route. Five of 28 bitten patients who started their vaccinations did not complete the 4-dose course, including a 16-year-old boy who did not return after the first injection and later died of rabies. There were also 2 deaths in 3 known bitten but unvaccinated patients. None of the 23 bitten who received 4 doses of HDCS vaccine contracted rabies. The i.d. route was also used for pre-exposure prophylaxis. This method of vaccination is less expensive than the intramuscular route and in our clinical setting we would not have been able to vaccinate all the patients without using it. A practical approach to rabies vaccination in a developing country and the technique of intradermal vaccination are discussed.