A magazine for friends of the Warren Alpert Medical School of Brown University.

Ask the Expert: James Linakis


What’s the significance of the first rabies treatment tested in kids?

Rabies, once symptoms appear, is almost 100 percent fatal—but it’s also almost 100 percent preventable if treated promptly. A critical part of the treatment is human rabies immunoglobulin (HRIG), which keeps the virus from infecting the nervous system before the vaccine can take effect. Yet even though 40 percent of those bitten by suspected rabid animals are under age 15, no HRIG was ever clinically tested in children—until February, when Human Vaccines & Immunotherapeutics published a study showing that the HRIG known as KEDRAB is safe and effective in kids. Senior author James Linakis, MD, PhD, professor emeritus of emergency medicine and retired associate director of pediatric emergency medicine at Hasbro Children’s Hospital, explains the importance of the trial.

As a pediatric emergency physician, one of my pet peeves is that so many medications that we use in kids have not explicitly been tested in kids. There are three rabies immunoglobulins used in the US, and they were all used in kids because that was the only option; it’s a lifesaving therapy. This study provides, finally, an human rabies immunoglobulin that has been explicitly studied for safety in kids, as well as whether it works or not.

Rabies is a horrible disease. It kills about 59,000 people each year, mostly in Africa and Asia. But the good news is that it is preventable with post-exposure prophylaxis (PEP), which consists of three primary steps: really good wound cleansing, then local infiltration with HRIG, and finally a series of doses of rabies vaccine. The immunoglobulin is an important step because it holds you over until your vaccine kicks in.

In the US, we do a pretty good job of vaccinating our domestic animals. The majority of cases in the Hasbro emergency department are bat exposures—up to five or six a week during mating season in the fall—but dog bites are why people most commonly seek PEP throughout the world. However, globally, there is a lack of awareness and a lack of access to PEP. As we get education out there about post-exposure prophylaxis and human rabies immunoglobulin, especially now this one that’s proven safe in kids, I hope that will make a dent globally.



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