Sir,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:The problem on determination of wound severity and,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]