"Early death" and the contraindication of vaccine during treatment of rabies

Administration of rabies vaccine or rabies immune globulin (RIG) during symptomatic rabies is ineffective, and there are concerns about the phenomenon of "early death" reported in animals that develop rabies after receipt of rabies vaccine or immune globulin. Survival analyses of the original animal data confirm these findings in two species, whereas analyses of human case reports and the Milwaukee Protocol registry suggest lower risk of "early death" in humans. There may be a deleterious interaction of rabies vaccine and RIG with bat rabies in humans. Animal studies of bat rabies virus with bat-origin vaccines and RIG are urgently needed. (C) 2009 Elsevier Ltd. All rights reserved.