Successful postexposure rabies prophylaxis after erroneous starting treatment

Background Postexposure prophylaxis, adequately applied after exposure to a rabid animal, is highly effective in prevention of human disease. Deviatio ns from the recommended vaccination postexposure treatment protocol have be en associated with vaccination failure and human mortality. We investigated an incident in which seven Israel Defense Forces soldiers were bitten by a rabid fox and initially treated not in accordance with the recommended vac cination protocol. Methods. The soldiers received modified anti-rabies postexposure prophylaxi s, including a higher dosage of both the active and the passive vaccines. T he humoral antibody response was monitored subsequently Results. All soldiers showed a satisfactory increase (above 0.5 UE/ml by EL ISA) in serum anti-rabies antibody titers. None developed the disease more than a year after follow-up. Conclusions. Strict adherence to the treatment guidelines following an inju ry by a rabid animal is of utmost importance. We suggest possible compensat ory management after a potentially lethal deviation from protocol. (C) 1999 American Health Foundation and Academic Press.