Evidence map›Paper›PMID 36988328›Full record

ReviewClinical infectious diseases : an official publication of the Infectious Diseases Society of America2023

Fatal Human Rabies Infection With Suspected Host-Mediated Failure of Post-Exposure Prophylaxis Following a Recognized Zoonotic Exposure-Minnesota, 2021.

Stacy M Holzbauer, Caroline A Schrodt, Rajesh M Prabhu, Rebecca J Asch-Kendrick, Malia Ireland, Carrie Klumb, Melanie J Firestone, Gongping Liu, Katie Harry, Jana M Ritter and 31 more

Open access · hybridAbstract readCase ReportsReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.6field-weighted citation impact, top 11% of its field
1 · What the graph read from it

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 18 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

41 authors at 9 institutions in 2 countries.

Stacy M HolzbauerMinnesota Department of Health, St. Paul, Minnesota, USA.
Caroline A SchrodtEpidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Rajesh M PrabhuEssentia Health, Duluth, Minnesota, USA.
Rebecca J Asch-KendrickMidwest Medical Examiner's Office, Ramsey, Minnesota, USA.
Malia IrelandMinnesota Department of Health, St. Paul, Minnesota, USA.
Carrie KlumbMinnesota Department of Health, St. Paul, Minnesota, USA.
Melanie J FirestoneMinnesota Department of Health, St. Paul, Minnesota, USA.
Gongping LiuMinnesota Department of Health, St. Paul, Minnesota, USA.
Katie HarryMinnesota Department of Health, St. Paul, Minnesota, USA.
Jana M RitterDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Min Z LevineInfluenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Lillian A OrciariDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Kimberly WilkinsDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pamela YagerDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Crystal M GiganteDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
James A EllisonDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Hui ZhaoDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Michael NiezgodaDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Yu LiDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Robin LevisUS Food and Drug Administration, Silver Spring, Maryland, USA.
Dorothy ScottUS Food and Drug Administration, Silver Spring, Maryland, USA.
Panayampalli S SatheshkumarDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Brett W PetersenDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Agam K RaoDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
W Robert BellUniversity of Minnesota, Minneapolis, Minnesota, USA.
Sonja M BjerkEssentia Health, Duluth, Minnesota, USA.
Sara ForrestEssentia Health, Duluth, Minnesota, USA.
Wangcai GaoAllina Health, Minneapolis, Minnesota, USA.
Richard DasheiffEssentia Health, Duluth, Minnesota, USA.
Kari RussellEssentia Health, Duluth, Minnesota, USA.
Melissa PappasEssentia Health, Duluth, Minnesota, USA.
Jessica KieferEssentia Health, Duluth, Minnesota, USA.
Wesley BicklerEssentia Health, Duluth, Minnesota, USA.
Anthony WisemanEssentia Health, Duluth, Minnesota, USA.
Joel JuranteeEssentia Health, Duluth, Minnesota, USA.
R Ross ReichardDepartment of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
Kirk E SmithMinnesota Department of Health, St. Paul, Minnesota, USA.
Ruth LynfieldMinnesota Department of Health, St. Paul, Minnesota, USA.
Joni ScheftelMinnesota Department of Health, St. Paul, Minnesota, USA.
Ryan M WallaceDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Jesse BonwittDivision of High Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Centers for Disease Control and Prevention · USEssentia Health · USMinnesota Department of Health · USUnited States Food and Drug Administration · USAllina Health · USMayo Clinic · USOffice of the Chief Medical Examiner · CAThe Centers · USUniversity of Minnesota System · US

Funding

Intramural CDC HHS CC999999
6 · The paper itself

Abstract

backgroundNo human rabies post-exposure prophylaxis (PEP) failure has been documented in the United States using modern cell culture-based vaccines. In January 2021, an 84-year-old male died from rabies 6 months after being bitten by a rabid bat despite receiving timely rabies PEP. We investigated the cause of breakthrough infection.

methodsWe reviewed medical records, laboratory results, and autopsy findings and performed whole-genome sequencing (WGS) to compare patient and bat virus sequences. Storage, administration, and integrity of PEP biologics administered to the patient were assessed; samples from leftover rabies immunoglobulin were evaluated for potency. We conducted risk assessments for persons potentially exposed to the bat and for close patient contacts.

resultsRabies virus antibodies present in serum and cerebrospinal fluid were nonneutralizing. Antemortem blood testing revealed that the patient had unrecognized monoclonal gammopathy of unknown significance. Autopsy findings showed rabies meningoencephalitis and metastatic prostatic adenocarcinoma. Rabies virus sequences from the patient and the offending bat were identical by WGS. No deviations were identified in potency, quality control, administration, or storage of administered PEP. Of 332 persons assessed for potential rabies exposure to the case patient, 3 (0.9%) warranted PEP.

conclusionsThis is the first reported failure of rabies PEP in the Western Hemisphere using a cell culture-based vaccine. Host-mediated primary vaccine failure attributed to previously unrecognized impaired immunity is the most likely explanation for this breakthrough infection. Clinicians should consider measuring rabies neutralizing antibody titers after completion of PEP if there is any suspicion for immunocompromise.

Indexed as

RabiesRabies VaccinesAged, 80 and overAntibodies, ViralHumansMaleMinnesotaPost-Exposure ProphylaxisAntibodies, ViralRabies Vaccinesbatpost-exposure prophylaxisrabiesvaccine failurewhole-genome sequencing

Identifiers

PMID36988328
PMCPMC11097918
OpenAlexW4361267608

What OpenQuestion holds

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Registered trials

None linked

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.