Skip to main content Skip to main navigation menu Skip to site footer

An 8-year-old child with encephalitis rabies due to delayed case finding, proper post-exposure prophylaxis for rabies infection: a case report


Background: Until April 2023, it has been documented about 31,113 cases of animal rabies-borne bites, of which 23,211 cases were given Post Exposure Prophylaxis (PEP) Anti Rabies Vaccine and 11 death cases in Indonesia, and 95% of them were caused by dog bite. This case report was conducted to describe a rare case of an 8-year-old child presenting with the late complication of encephalitis in Borong General Hospital due to the delayed case finding, management, and proper prophylaxis for Rabies infection.

Case Presentation: One day before admission, an 8-year-old girl with irritability, aggressive behavior, and severe speech abnormalities was reported to the emergency room. These symptoms quickly escalated to confusion and disturbed mental status. One month before to presentation, the patient's parents stated that his right arm had been bitten by a stray dog. Because there were no obvious bite marks and the family was not aware of the dog bite, PEP was not requested. In the previous five days, her parents described experiences of hydrophobia, photophobia, and aerophobia. The patient's health deteriorated two hours after admission, and palpating the carotid artery revealed that there was no pulse. Despite performing cardiopulmonary resuscitation, ROSC was not reached.

Conclusion: Animal rabies control and surveillance are essential, particularly in locations where the disease is endemic. PEP is extremely effective and ought to be given as soon as possible following exposure to reduce the high fatality rate.


  1. Mani CS, Murray DL. Rabies. Pediatr Rev. 2006;27(4):129–36. Available from:
  2. JACKSON AC. Rabies: a medical perspective. Revue Scientifique et Technique de l’OIE. 2018;37(2):569–80. Available from:
  3. Kementerian Kesehatan Republik Indonesia. Buku Saku Petunjuk Teknis Penatalaksanaan Kasus Gigitan Hewan Penular Rabies Di Indonesia. 2019.
  4. BANYARD AC, TORDO N. Rabies pathogenesis and immunology. Revue Scientifique et Technique de l’OIE. 2018;37(2):323–30. Available from:
  5. Desai AN. Dog Bites. JAMA. 2020;323(24):2535. Available from:
  6. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2021. 2021.
  7. Al-Mustapha AI, Bamidele FO, Abubakar AT, Ibrahim A, Oyewo M, Abdulrahim I, et al. Perception of canine rabies among pupils under 15 years in Kwara State, North Central Nigeria. PLoS Negl Trop Dis. 2022;16(8):e0010614–e0010614. Available from:
  8. Tetchi MS, Coulibaly M, Kallo V, Traoré GS, Issaka T, Joseph BBV, et al. Risk factors for rabies in Côte d’Ivoire. Acta Trop. 2020;212:105711. Available from:
  9. N’dilimabaka N, Koumba Mavoungou D, Soami V, Bohou Kombila L, Mouguiama RM, Mondjo A, et al. Molecular analyses of human rabies virus associated with encephalitis in two children in Gabon. IJID regions. 2022;2:180–3. Available from:
  10. Blackburn D, Minhaj FS, Al Hammoud R, Orciari L, Miller J, Maness T, et al. Human Rabies - Texas, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(49):1547–9. Available from:
  11. Jochmans D, Neyts J. The path towards effective antivirals against rabies. Vaccine. 2017/12/24. 2019;37(33):4660–2. Available from:
  12. Sikana L, Lembo T, Hampson K, Lushasi K, Mtenga S, Sambo M, et al. Dog ownership practices and responsibilities for children’s health in terms of rabies control and prevention in rural communities in Tanzania. PLoS Negl Trop Dis. 2021;15(3):e0009220–e0009220. Available from:
  13. Wera E, Warembourg C, Bulu PM, Siko MM, Dürr S. Loss of binding antibodies against rabies in a vaccinated dog population in Flores Island, Indonesia. PLoS Negl Trop Dis. 2021;15(9):e0009688–e0009688. Available from:
  14. Janewongwirot P, Jantarabenjakul W, Anugulruengkitt S, Anunsittichai O, Saengseesom W, Buranapraditkun S, et al. A randomized open-label trial of 2-dose or 3-dose pre-exposure rabies prophylaxis among Thai children. Vaccine. 2019;37(36):5307–13. Available from:
  15. Wera E, Warembourg C, Bulu PM, Siko MM, Dürr S. Immune Response After Rabies Vaccination in Owned Free-Roaming Domestic Dogs in Flores Island, Indonesia. Front Vet Sci. 2022;9:868380. Available from:
  16. Soentjens P, Berens-Riha N, Van Herrewege Y, Van Damme P, Bottieau E, Ravinetto R. Vaccinating children in high-endemic rabies regions: what are we waiting for? BMJ Glob Health. 2021;6(2):e004074. Available from:
  17. Kapur V. Is Pre-Exposure Prophylaxis a Cost-Effective Intervention to Avert Rabies Deaths among School-Aged Children in India? Comment on Royal et al. A Cost-Effectiveness Analysis of Pre-Exposure Prophylaxis to Avert Rabies Deaths in School-Aged Children in India. Vaccines 2023, 11, 88. Vaccines (Basel). 2023;11(3):677. Available from:
  18. Khalsi F, Ayari A, Romdhane M Ben, Tinsa F, Boussetta K. Rabies encephalitis in children: a resurgence of a fatal anthropozoonosis. Afr Health Sci. 2018;18(3):539–41. Available from:
  19. Christopher PM, Cucunawangsih C, Adidharma AAGB, Putra IPDK, Putra DGS. Knowledge, attitudes and practices regarding rabies among community members: a cross-sectional study in Songan Village, Bali, Indonesia. Int Marit Health. 2021;72(1):26–35. Available from:

How to Cite

Andri, A. (2023). An 8-year-old child with encephalitis rabies due to delayed case finding, proper post-exposure prophylaxis for rabies infection: a case report. Intisari Sains Medis, 14(3), 1152–1155.




Search Panel