A case of human survival of rabies, South Africa

Figures & data

Table 1: Summary of recorded cases of human recovery from rabies virus infection

Case number	Year	Location	Age, Sex	Source of exposure	Rabies prophylaxis, pre or post exposure	Clinical Management	Sequelae	Laboratory findings	Reference
1	1970	United States	6, M	Bat (bitten on thumb)	PEP received: 14 doses of duck embryo vaccine, no immunoglobulin	Supportive	None	Serum VNT* at 1:63 000	[20]
2	1972	Argentina	45, F	Dog (severe bites)	PEP received: delayed, only ten days post exposure, 14 daily doses of suckling mouse brain vaccine with two boosters, no immunoglobulin	Supportive	Mild	Serum and CSF VNT at 1: 640 000 and 1: 160 000	[16]
3	1977	United States	32, M	Laboratory exposure, possible airborne route (vaccine strain)	PEP received: Duck embryo vaccine only, no immunoglobulin	Supportive	Severe	Information not provided	[21]
4	1992	Mexico	9, M	Dog (multiple bites on face)	PEP received: Vero rabies vaccine (four doses) and human diploid cell culture vaccine (one dose), no immunoglobulin. Wound was sutured.	Supportive	Severe	Serum and CSF VNT at peak: 1: 37 800 and 1: 78125	[17]
5	2000	India	6, F	Dog (bites on face and hands)	PEP received: purified chick embryo vaccine, no immunoglobulin before onset	Supportive	Severe	Serum and CSF antibody response measured by mouse neutralization: 1: 265 000 and 1: 124 000 respectively at peak	[18]
6	2004	USA	15, F	Bat	No vaccination or immunoglobulin pre- or post exposure	Treatment with experimental protocol	Mild with recovery	VNT response; No RNA and virus	[3]
7	2007	Equatorial Guinea	5, M	Dog	No vaccination or immunoglobulin pre- or post exposure	Treatment with experimental protocol	Death (Rubin and co-authors argue that death was not related to rabies)	PCR positive on saliva Direct fluorescent antibody test positive on skin; Isolated from skin VNT in serum and CSF	[4]
8	2008	Brazil	15, M	Vampire bat	PEP received: 4 doses of vaccine, no immunoglobulin	Experimental protocol provided, but with vaccination	Mild	PCR positive on skin biopsy	[5]
9	2009	USA (Texas)	17, F	Bats (no specific exposure, but contact reported)	No PEP received. Vaccination and RIG provided as part of management (one month post onset)	Supportive	None	IFA antibodies in serum and CSF; No VNT; No PCR results or virus isolated	[7]
10	2011	USA (California)	8, F	Possibly cats	No PEP received. Vaccination and immunoglobulin provided as part of management	Treatment with experimental protocol	Unclear	IFA antibodies in serum and CSF; No VNT in serum or CSF; No PCR results or virus isolated	[6]
11	2011	India	13, F	Dog (category III dog bite on leg)	No vaccination or immunoglobulin, pre or post exposure	Supportive	None	ELISA antibodies in serum: 1.6 IU/ml	[15]
12	2011	India	17, M	Dog (category III dog bite on leg)	PEP received: delayed, three days after exposure, four doses of vaccine at time of onset, no immunoglobulin post exposure. Immunoglobulin applied after onset of symptoms	Supportive	Severe	VNT antibodies in serum (>1: 16 000) and CSF (>1:8000)	[8]
13	2012	South Africa	4, M	Multiple exposures to dogs One exposure was noted as category III	PEP received: three doses of vaccine after the second exposure, onset of disease before fourth dose was administered,, no immunoglobulin	Supportive	Severe	VNT antibodies in serum and CSF (>13 975 IU/ml); IFA antibodies in serum (>1:512) and CSF (>1: 8 192). PCR on saliva, skin and CSF specimen negative.	This report

^* VNT: Virus neutralizing antibody titre.

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