Rabies post-exposure prophylaxis with purified equine rabies immunoglobulin: One-year follow-up of patients with laboratory-confirmed category III rabies exposure in the Philippines

Category III rabies post-exposure prophylaxis (PEP) encompasses wound cleansing, infiltration of rabies immunoglobulins (RIG) and rabies vaccination. A Manila-based prospective prescription monitoring one-year follow-up study enrolled 193 patients, aged 16 months-79 years. Patients received PEP, including infiltration of highly purified equine RIG (pERIG, Favirab™), following exposure to animals confirmed rabid by direct fluorescence antibody test (dFAT). No serious adverse events were considered related to PEP. One-year post-exposure, 191 of the 193 patients (99%) were in good health. Two deaths occurred, one due to myocardial infarction (unrelated to rabies) in a 73-year-old man, 291 days post-exposure, and one due to rabies infection in a six-year-old boy, 28 days post-exposure. The results show the recommended PEP treatment is highly effective. The single rabies fatality demonstrates the importance of ensuring immediate and complete application of recommended PEP, sustained education and training in rabies management.