SynthesisThe Lancet. Infectious diseases2023
Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures.
Synthesis in The Lancet. Infectious diseases, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
47 citing papers in PubMed, 62 citations in OpenAlex.
- A mixed-methods study of community dog management and rabies awareness in Thailand.One health (Amsterdam, Netherlands) · 2026Article
- Passive Immunization Hesitancy Among Rabies-Exposed Individuals in China: A Multicenter Cross-Sectional Study.Tropical medicine and infectious disease · 2026Article
- Breaking the Silent Barrier: Engineering Antibodies for Brain-Targeted Rabies Immunotherapy.Pharmaceutics · 2026Review
- Fatal rabies in a child.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2026Article
- Determinants of Rabies Post-Exposure Prophylaxis Compliance in Bangladesh: Informing Policy for Elimination by 2030.Tropical medicine and infectious disease · 2026Article
- Trends and Burden of Human Rabies in Iran 2012-2021: A Cross-Sectional Study.Health science reports · 2026Article
- [Acute Flacid Paralysis and Encephalitis: A Deadly Combination. Report of the Latest Case of Human Rabies in Colombia: A Reminder of a Preventable Enemy].Revista de neurologia · 2026Article
- Rabies lyssavirus phosphoprotein possesses RNA duplex-unwinding activities.Molecular therapy. Nucleic acids · 2026Article
- Translating one health research evidence into action: co-production of rabies control knowledge in Côte d'Ivoire.Health research policy and systems · 2026Article
- Rabies in Europe: Epidemiology, Clinical Management, and Prevention.Deutsches Arzteblatt international · 2026Review
- Evaluation of Risk Factors for Failed Seroconversion in the Management of Potential Lyssavirus Exposures.Open forum infectious diseases · 2026Article
- Epidemiological Characteristics of Human Rabies in Chongqing, China, 2016-2024.Tropical medicine and infectious disease · 2026Article
- Analysis of Rabies Epidemiological Characteristics and Failed Post-Exposure Prophylaxis Cases - Hunan Province, China, 2019-2024.China CDC weekly · 2026Article
- Temporal trends and determinants of delayed care-seeking after rabies exposure: a 27,930-patient analysis in Tianjin.Frontiers in public health · 2026Article
- Working towards a single-dose vaccine for rabies post-exposure prophylaxis.Future virology · 2026Article
- From one-size-fits-all to context-specific: the 10-day observation rule-a need for change.Frontiers in public health · 2026Article
- Global burden and cross-country inequalities in rabies from 1990 to 2021: a systemic analysis of the global burden of disease study 2021.BMC infectious diseases · 2025Article
- Research trends in anti-rabies virus monoclonal antibody: A bibliometric analysis.Human vaccines & immunotherapeutics · 2025Article
- Article
- Codon Usage Evolution in Viruses: Implications for Survival and Pathogenicity.Journal of molecular evolution · 2025Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 5 institutions in 2 countries.
Funding
Abstract
Post-exposure prophylaxis (PEP) for rabies is widely administered and highly effective. Nevertheless, sporadic breakthrough infections (ie, rabies in people who have started PEP) have been reported. We conducted a systematic review of articles published between Jan 1, 1980 and June 1, 2022 to characterise breakthrough infections. After reviewing 3380 articles from across all continents, we identified 52 articles, which included a total of 122 breakthrough infections. We classified breakthrough infections on the basis of adherence to core practices (ie, wound cleaning and vaccine administration). Of 86 breakthrough infections with data, median time from exposure to symptom onset was 20 days (IQR 16-24). Most (89 [77%] of 115) participants received PEP within 2 days of an exposure. Severe wounds (defined as those involving multiple wound sites or bites to the head, face, or neck) were common (80 [69%] of 116 [with data]). Deviations from core practices were reported in 68 (56%) of 122 cases. Other possible causes for breakthrough infections included errors in the administration of rabies immunoglobulin, delays in seeking health care, and comorbidities or immunosuppression. Cold-chain integrity assessments and potency testing of PEP biologics were only rarely assessed (8 [7%] of 122 cases), neither of which were found to be a cause of breakthrough infections. Timely and appropriate administration of PEP is crucial to prevent rabies, and although people with high-risk exposures or immunosuppression can develop rabies despite adherence to core practices, this occurrence remains exceedingly rare.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.