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LETTER TO THE EDITOR Table of Contents   
Year : 2015  |  Volume : 12  |  Issue : 1  |  Page : 100
Dog bite, immunoglobulin, and preexposure vaccination

1 Pokee-Clinic, Bangkok, Thailand
2 Hainan Medical University, Haikou, Hainan, China

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Date of Web Publication6-Feb-2015

How to cite this article:
Pokee N, Wiwanitkit V. Dog bite, immunoglobulin, and preexposure vaccination. Afr J Paediatr Surg 2015;12:100

How to cite this URL:
Pokee N, Wiwanitkit V. Dog bite, immunoglobulin, and preexposure vaccination. Afr J Paediatr Surg [serial online] 2015 [cited 2021 Oct 24];12:100. Available from:

The recent letter from Bertozzi and Appignani on the topic of rabies immunisation is very interesting. [1] Bertozzi et al. agreed with our previous report that "immunoglobulin should be based on the severity of the wound. [2]" In addition, Bertozzi et al. raised two important considerations:

  1. The problem on determination of wound severity and,
  2. The use of pre-exposure prophylaxis.

For the first issue, it is not a myth. Standard guideline for using of immunoglobulin can be available. The possible adverse effect of immunoglobulin is the issue that should be weight before using it. For the second issue, Bertozzi et al. discussed on the cost and availability of vaccine and immunoglobulin. [1] It is no doubt that any vaccine or immunoglobulin cost. However, in term of cost-effectiveness, the lost due to no immunisation to the patient is significantly more. Hampson et al. confirmed that post-exposure prophylaxis for rabies is an actual cost-effective strategy. [3] Focusing on the pre-exposure prophylaxis, it is not routinely recommended. In Thailand, where the dog borne rabies is highly prevalent, it is still not suggested. If Bertozzi et al. actually considered on the cost, the pre-exposure vaccination seems to be not cost-effective for both local people in endemic areas and travellers who visit those areas. [4]

   References Top

Bertozzi M, Appignani A. Dog bite injuries of genitalia and rabies immunisation. Afr J Paediatr Surg 2014;11:371.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Pokee N, Wiwanitkit V. Dog bite injuries of genitalia. Afr J Paediatr Surg 2014;11:200.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Hampson K, Cleaveland S, Briggs D. Evaluation of cost-effective strategies for rabies post-exposure vaccination in low-income countries. PLoS Negl Trop Dis 2011;5:e982.  Back to cited text no. 3
Bernard KW, Fishbein DB. Pre-exposure rabies prophylaxis for travellers: are the benefits worth the cost? Vaccine 1991;9:833-6.  Back to cited text no. 4

Correspondence Address:
Dr. Nora Pokee
Pokee-Clinic, Bangkok
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0189-6725.151007

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