Rabies post-exposure prophylaxis for a child with severe allergic reaction to rabies vaccine

Abstract

Most adverse events (AEs) during the immunization of rabies vaccine were slight, there was little information about the allergic reaction induced by rabies vaccines and had to stop or change the immunization program. Here, we reported a case that a 4-year-old boy had category II exposure to rabies and showed severe allergic reaction after being immunized with lyophilized purified vero cell rabies vaccine (PVRV). After the anti-allergy therapy with hormone, allergy testing indicated medium allergy to egg and milk, and implied the allergic reaction most likely associated with animal-sourced gelatin in lyophilized PVRV. Therefore, a new immunization program with liquid PVRV without stabilizers under the Zegrab regimen (2-1-1) was enrolled at day 7 post-exposure. Although lower than the levels of normal <5 -year population at day 14 and 45, the neutralizing antibody (RVNA) titers of this boy showed adequate protective antibody ( 0.5 IU/ml), even after 365 d post-immunization. This study not only highlighted the importance of several types of rabies vaccines co-existing in the market, but also implied the necessary for doctors to fully understand the allergies history of patients prior to immunize rabies vaccine.

Delayed Presentation with Anaphylactic Shock following Injection of Anti-Rabies Vaccine Post Exposure Prophylaxis (PEP) in a Patient: A Case Report

“…Other rare presentation of anaphylaxis include nausea, vomiting, diarrhea, cramping, pain, tachycardia, hypotension, chest pain, cardiac arrest, metallic taste in mouth, uterine contraction, scrotal edema, dizziness, seizures, sense of impending doom. 2,4 Since the symptoms show multisystem organ involvement sometimes diagnosis of anaphylaxis can be difficult with atypical presentation.…”

“…In such cases patients must be treated with epinephrine, antihistamine, steroids and intravenous fluids. 2 The risk of patient acquiring rabies must be considered carefully before deciding to discontinue the vaccine. 5 In this case, it was challenging to identify the cause of the AEs and offer prompt medication.…”

“…When a person with history of serious hypersensitivity to rabies vaccine must be re vaccinated alternate vaccine types can be considered and antihistamines can be administered. 2 Epinephrine should be readily available to counter attack anaphylactic reaction and person should be observed immediately after vaccination to avoid imminent death due to shock.…”

“…Modern rabies vaccines and immunoglobins is crucial method to prevent rabies virus infection. 2 Mild systemic reactions had been reported however severe Adverse effects (AEs) that had to stop or change the immunization were rarely reported. 3…”

Analysis on the risks of severe adverse events in rabies post-exposure prophylaxis and appropriate decision-making procedure

“…In a previous study. 19 a child suffered from AEs was allergic to eggs and milk while the first vaccine applied to him after dog bite was stabilized by gelatin and components from cattle, so it finally concluded that the vaccine containing heterologous protein was the culprit to him. Occurrence of Henoch Schönlein purpura (HSP) in an adult patient post rabies vaccination was also rare and serious.…”