Peer-reviewed article
Suspected Paralytic Rabies in an 8 Years 6 Months Old Boy Following Incomplete Post-Exposure Prophylaxis in Rural North Eastern Uganda: A Case Report.
Ochora M, Engoru CE, Emuron J, Akello F, Kasasira PB et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This case report describes an 8-year-old boy in rural northeastern Uganda who died of suspected paralytic rabies 7 days after symptom onset, despite receiving two doses of rabies vaccine. He was bitten by a stray dog but did not receive rabies immunoglobulin, which is critical for high-risk exposures. The case highlights diagnostic challenges with paralytic rabies in children and gaps in health systems that prevent access to complete post-exposure prophylaxis.
Key points
- Child presented with headache, fever and progressive lower-limb weakness 28 days after dog bite
- Received anti-rabies vaccine on days 0.7 and 16 but did not receive rabies immunoglobulin
- Died 7 days after symptom onset despite supportive care
- Paralytic rabies represents only 20% of rabies cases and can be difficult to distinguish from other conditions
- Health system gaps including vaccine stockouts and poor animal health management contribute to preventable deaths
Limitations
This is a single case report and cannot establish causation or prevalence. It provides limited evidence on the effectiveness of incomplete prophylaxis regimens or the comparative risk of different exposure scenarios.
Abstract
Background Rabies is still a public health concern, especially in low resource settings with poor animal health management, stock out of rabies vaccine and immunoglobulin. Only 20% of patients present with paralytic rabies and it is at times difficult to distinguish from Guillain-Barre syndrome. In malaria endemic areas, rabies may have atypical presentation. Rabies encephalitis is almost always fatal. Case presentation We report an 8‑year‑and‑6‑month‑old African boy from Katakwi district in North Eastern Uganda who presented with headache, fever and waist pain followed by progressive lower‑limb weakness 28 days after a bite by a stray dog. There was no trauma, and he had no signs of meningeal irritation. He received anti-rabies vaccine on day 0.7 and 16 but did not get rabies immunoglobulin. He received supportive care including intravenous fluids and antibiotics at the hospital and died 7 days after the onset of symptoms. Conclusion Paralytic rabies in children can be fatal even after vaccination, especially if rabies immunoglobulin is not given when there is a high risk exposure. There are also diagnostic challenges if there is an atypical presentation, particularly in children. Health system gaps around animal health can lead to preventable deaths from rabies.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Anti-rabies vaccine (two doses on days 0.7 and 16) without rabies immunoglobulin, plus supportive hospital care
- Population
- 8-year-6-month-old child in rural northeastern Uganda bitten by stray dog
Key finding
Child died 7 days after symptom onset despite receiving 2 doses of rabies vaccine
M et al. · Europe PMC · 18 Aug 2026