Clinical and Epidemiological Study

Infection

, Volume 35, Issue 4, pp 219-224

First online:

Adverse Effects of Rabies Pre- and Postexposure Prophylaxis in 290 Health-Care-Workers Exposed to a Rabies Infected Organ Donor or Transplant Recipients

  • F. MattnerAffiliated withInstitute of Medical Microbiology and Hygiene, Universitätsklinikum Schleswig-Holstein, Campus LübeckInstitute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School Email author 
  • , F. BitzAffiliated withDept. of Anethesia, Clinic for Nephrology (Nephrologisches Zentrum Niedersachsen)
  • , M. GoedeckeAffiliated withPhilipps-Universität Marburg
  • , A. ViertelAffiliated withJohannes Gutenberg Universität Mainz
  • , S. KuhnAffiliated withHannover Medical School
  • , P. GastmeierAffiliated withInstitute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School
  • , L. MattnerAffiliated withInstitute of Mathematics, Universität zu Lübeck
  • , F. BiertzAffiliated withDept. of Biometry, Hannover Medical School
  • , A. HeimAffiliated withInstitute of Virology, Hannover Medical School
    • , C. Henke-GendoAffiliated withInstitute of Virology, Hannover Medical School
    • , I. EngelmannAffiliated withInstitute of Virology, Hannover Medical School
    • , A. MartensAffiliated withDivision of Thoracic and Cardiovascular Surgery, Hannover Medical School
    • , M. StrüberAffiliated withDivision of Thoracic and Cardiovascular Surgery, Hannover Medical School
    • , T. F. SchulzAffiliated withInstitute of Virology, Hannover Medical School

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Abstract

The recent unfortunate rabies transmissions through solid organ transplants of an infected donor in Germany required the initiation of a vaccination program to protect health care workers (HCWs) with close contact to rabies-infected patients. A systematic follow-up of adverse effects was initiated. Rabies postexposure prophylaxis (PEP) was started in 269 HCWs at four German hospitals. Pre-exposure prophylaxis (PreEP) was administered to 74 HCWs caring for an already diagnosed rabies patient. At each vaccination date, HCWs were interviewed for symptoms possibly representing adverse effects. Adverse effects of PEP and PrePEP were compared. Out of 269 HCWs, 216 were included for the investigation of adverse effects. Of these 216 HCWs, 114 (53%) individuals developed at least one systemic adverse effect. Incidences of tiredness (30.6%), malaise (26.4%), headache (26.9%), dizziness (14.8%), and chills (13.0%) declined in the course of PEP (p < 0.05), whereas incidences of fever (7.4%), paraesthesias (7.9%), arthralgias (1.9%), myalgias (4.2%), nausea (9.3%), diarrheas (2.8%) and vomiting (1.4%) did not. In 11 (5.1%) HCWs PEP was discontinued mostly due to adverse reactions (four suffered strong headaches, two HCWs meningeal irritations, two chills, one paraesthesia, one malaise, and one a rush). Systemic effects of PEP or PreEP did not differ significantly. Despite relatively high incidences of moderate severe adverse reactions rabies PEP is safe. Strong headache, tiredness, dizziness, and paraesthesias are the most important postvaccinal symptoms. Vaccinees suffering from adverse effects of PEP must be strongly encouraged to complete PEP, as it is to date the only protection against fatal rabies.