Immune response after rabies vaccine in a kidney transplant recipient

Authors

  • R. Rodríguez-Romo,

    1. Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  • L.E. Morales-Buenrostro,

    1. Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
    2. Nephrology and Mineral Metabolism Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  • L. Lecuona,

    1. Agricultural Specialist in Animal Health, Wildlife Program, USDA/APHIS/IS-WS Mexico
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  • N. Escalante-Santillán,

    1. Jurisdiccion Sanitaria Tizayuca City, Hidalgo, Mexico
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  • A. Velasco-Villa,

    1. Centers for Disease Control and Prevention, National Center for Emerging Zoonotic Infectious Diseases, Division of Viral and Rickettsial Diseases, Atlanta, Georgia, USA
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  • I. Kuzmin,

    1. Centers for Disease Control and Prevention, National Center for Emerging Zoonotic Infectious Diseases, Division of Viral and Rickettsial Diseases, Atlanta, Georgia, USA
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  • C.E. Rupprecht,

    1. Centers for Disease Control and Prevention, National Center for Emerging Zoonotic Infectious Diseases, Division of Viral and Rickettsial Diseases, Atlanta, Georgia, USA
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  • C. De-Leo,

    1. Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  • J. Ramírez,

    1. Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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  • J. Alberú

    1. Transplantation Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Josefina Alberú, MD, Vasco de Quiroga 15, Delegación Tlalpan, CP 14000. México City, Mexico
Tel: 52 55 56559471
Fax: 52 55 56559471
E-mail: josefinaalberu@hotmail.com

Abstract

R. Rodríguez-Romo, L.E. Morales-Buenrostro, L. Lecuona, N. Escalante-Santillán, A. Velasco-Villa, I. Kuzmin, C.E. Rupprecht, C. De-Leo, J. Ramírez, J. Alberú. Immune response after rabies vaccine in a kidney transplant recipient.
Transpl Infect Dis 2011: 13: 492–495. All rights reserved

Abstract: A 48-year-old male kidney-transplant recipient was bitten by a rabid dog. His immunosuppressive treatment consisted of cyclosporine 60 mg b.i.d., mycophenolate mofetil (MMF) 250 mg t.i.d., and prednisone 5 mg. After wound care, he received 5 doses of purified vero cell rabies vaccine on days 0, 3, 7, 14, and 28, and human rabies immunoglobulin, according to international guidelines. Adequate levels of rabies virus neutralizing antibodies were observed after the administration of the third vaccine dose. However, a decrease of antibody titer was detected by day 28. Immunosuppressive medication was minimized, withdrawing MMF and reducing the dose of cyclosporine. Booster doses of the same vaccine were administered on days 38, 41, 45, 52, and 66. Adequate neutralizing antibody response was recovered during the ensuing 12 months, under reduced immunosuppression. Nineteen months after the incident, the patient remains with good graft function and is asymptomatic for rabies. It remains to be determined whether the attained immune response was either the result of the booster vaccinations or the reduction of immunosuppression alone. Nevertheless, such an outcome would have been possible only with the combined management strategy implemented.

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