IMMUNE-RESPONSE TO TISSUE-CULTURE RABIES VACCINE IN SUBJECTS WHO HAD PREVIOUS POSTEXPOSURE TREATMENT WITH SEMPLE OR SUCKLING MOUSE-BRAIN VACCINE

Nerve tissue derived Semple and suckling mouse brain rabies vaccines a re still widely used. Patients who experience a new rabies exposure an d who were given such vaccines decades earlier are not uncommon in rab ies endemic countries. The World Health Organization recommends that p ersons who have had a previous course of a potent tissue or avian cult ure rabies vaccine and are reexposed, be given booster injections on d ays 0 and 3 without rabies immune globulin, Persons who have had previ ous pre- or postexposure vaccination with a vaccine of unproven potenc y, should receive a full course of tissue or avian cell vaccine and im mune globulin in the event of a new exposure, This study evaluated the immune response in 98 Thai patients who gave a history of rabies post exposure treatment with Semple or suckling mouse brain vaccines 10-50 years previously. The majority (81) had an anamnestic response and dev eloped neutralizing antibodies that were above the recommended minimal acceptable level (0.5 IU ml(-1)) on day 7. This suggests that they st ill had immunological memory. A minority of 18% had antibody titers be low this level on day 7. However, they all developed titers above 0.5 IU mi on days 14 and 30. Failure to have an accelerated response to re vaccination by day 7 did not appear to be related to age or time elaps ed since previous nerve tissue derived vaccine administration. If was nor possible to predict which subject will or will not have an accepta ble level of antibody before clay 14, Rabies exposed patients who give a prior history of vaccination with an unknown or nerve tissue derive d vaccine should therefore be treated as if they had never been vaccin ated. Copyright (C) 1996 Elsevier Science Ltd.