Rabies Vaccination

To the Editor. —I was surprised to see the article entitled "Human Rabies Despite Treatment With Rabies Immune Globulin and Human Diploid Cell Rabies Vaccine—Thailand" in the LEADS FROM THE MMWR in the Jan 1 issue ofJAMA.1Development of rabies despite treatment is not a rare occurrence. In Choomkasien and Wasi's2review of 707 cases of human rabies deaths between 1979 and 1986 in Thailand, 7% of the patients who died had completed a full vaccine course following exposure. Of this 7%, there were nine patients who appeared to represent failures of tissue-culture vaccines. All nine had completed the full course of vaccine. Five had received human diploid cell rabies vaccine, three had received purified chick embryo cell rabies vaccine, and one had received purified VERO cell rabies vaccine. Of these nine patients, three patients had received equine rabies immune globulin and one had received human rabies