Sex: F
Vaccine: RAB
Symptoms: Death, Inappropriate schedule of product administration, Rabies
Clinical narrative: This case was reported in a literature article and described the occurrence of rabies in a 72-year-old female subject who received Rabies Vaccine for prophylaxis. Co-suspect products included equine rabies immune globulin vaccine for prophylaxis. Concurrent medical conditions included dog bite (bitten on the head area (category 3 exposure) by a stray dog). Concomitant products included Rabies NVS (Rabies Vaccine), Rabies NVS (Rabies Vaccine) and Rabies NVS (Rabies Vaccine). On an unknown date, less than a year after receiving Rabies Vaccine, the subject developed rabies. Serious criteria included death and GSK medically significant. Additional event(s) included inappropriate schedule of vaccine administered. The outcome of rabies was fatal in August 2015. The outcome(s) of the additional event(s) included inappropriate schedule of vaccine administered (unknown). The subject died in August 2015. The reported cause of death was rabies. The investigator considered that there was a reasonable possibility that the rabies may have been caused by Rabies Vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of rabies in a 72-year-old female who was vaccinated with unspecified rabies vaccine (manufacturer unknown) for prophylaxis. This case corresponds to discussion section in this literature article. The patient was a part of the study to determine the epidemiologic characteristics of patients associated with delays in the initiation and completion of post-exposure prophylaxis (PEP). In this study, a retrospective review of all patients seen between January 1, 2014-December 31, 2016 was performed. On unspecified date in July 2015, the patient was bitten on the head area (comprised of bites to the head, face and neck area) by a stray dog. The exposure was defied as category 3 exposure (includes single or multiple transdermal bites or scratches, licks on broken skin). No information on patient's family history was provided. On unspecified dates in July 2015, on the day of exposure, the patient received all the 4 doses of unspecified rabies vaccines along with Equine rabies immune globulin (eRIG) (administration site and route unspecified; batch number not provided for all) instead of the World Health Organisation (WHO) recommended schedule respectively at day 0, 13 ,7, 14 and 28 of the exposure. [In this study, based on WHO guidelines, patients receiving five doses of intramuscular vaccine and eight doses of intradermal vaccine were considered fully vaccinated. Patients receiving at least one dose were classified as vaccinated.]. The age of vaccination was either 71 or 72 years.  On unspecified date between July 2015 and August 2015, an unknown period after vaccination, the patient developed unspecified symptoms of rabies and subsequently died 2 days later in August 2015. The cause of death was rabies. It was unknown if autopsy was performed. This case has been considered serious due to death. Treatment was unknown. The authors did not comment on the relationship of rabies with unspecified rabies vaccine. The authors concluded, "Country has made tremendous progress towards reducing the burden of rabies. However, despite the wide availability of PEP, we found relatively low rates of vaccine completion. Our findings suggest provider training and patient education is needed to ensure appropriate treatment is completed. Moreover, our data suggest changes to information reported through the national surveillance system for monitoring good clinical practice for rabies prevention and control. This is 1 of the 3 valid cases reported in the same literature article.; Reported Cause(s) of Death: rabies.