Apropos of a case of rabies occurring despite vaccination after exposure

: Rabies is endemic in Sub-Saharan Africa. Control is based on vaccination of subjects at high-risk for exposure and prompt post-exposure treatment. However the severity of some animal bites and early mismanagement can lead to development of rabies despite post-exposure treatment. This danger is illustrated by the case described herein involving a 35-year-old man who was bitten by a rabid dog and treated with 5 doses of antirabies vaccine. The wound, which consisted of two deep punctures on the forearm, was promptly washed with water and disinfected. Despite this treatment, characteristic clinical manifestations of rabies appeared one month after exposure and the patient died 48 hours later. This case raises the question of the causes for failure of the preventive recommendations proposed by the WHO for category III animal bites. In our case, two possible causes of failure and subsequent lethal outcome are that serotherapy was not associated and the incubation period was short. Other possible causes of rabies after post-exposure therapy are discussed with reference to the literature.