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. Deviations from the recommended vaccination postexposure treatment protocol have been 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 vaccination protocol. Methods. The soldiers received modified anti-rabies postexposure prophylaxis, including a higher dosage of both the active and the passive vaccines. The humoral antibody response was monitored subsequently. Results. All soldiers showed a satisfactory increase (above 0.5 UE/ml by ELISA) 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 injury by a rabid animal is of utmost importance. We suggest possible compensatory management after a potentially lethal deviation from protocol.