Rabies
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www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a1.htm] Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004</ref>//www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a1.htm] Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004</ref>
Structure
The virus is a Lyssavirus. This genus of RNA viruses also includes the Aravan virus, Australian bat lyssavirus, Duvenhage virus, European bat lyssavirus 1, European bat lyssavirus 2, Irkut virus, Khujand virus, Lagos bat virus, Mokola virus and West Caucasian bat virus. Lyssaviruses have helical symmetry, so their infectious particles are approximately cylindrical in shape. This is typical of plant-infecting viruses; human-infecting viruses more commonly have cubic symmetry and take shapes approximating regular polyhedra. Negri bodies in the infected neurons are pathognomonic.
The virus has a bullet-like shape with a length of about 180 nm and a cross-sectional diameter of about 75 nm. One end is rounded or conical and the other end is planar or concave. The lipoprotein envelope carries knob-like spikes composed of Glycoprotein G. Spikes do not cover the planar end of the virion (virus particle). Beneath the envelope is the membrane or matrix (M) protein layer which may be invaginated at the planar end. The core of the virion consists of helically arranged ribonucleoprotein. The genome is unsegmented linear antisense RNA. Also present in the nucleocapsid are RNA dependent RNA transcriptase and some structural proteins.
Longitudinal and cross-sectional schematic view of rabies virus
Differential diagnosis
The differential diagnosis in a case of suspected human rabies may initially include any cause of encephalitis, particularly infection with viruses such as herpesviruses, enteroviruses, and arboviruses (e.g., West Nile virus). The most important viruses to rule out are herpes simplex virus type 1, varicella-zoster virus, and (less commonly) enteroviruses, including coxsackieviruses, echoviruses, polioviruses, and human enteroviruses 68 to 71. A specific diagnosis may be made by a variety of diagnostic techniques, including polymerase chain reaction (PCR) testing of cerebrospinal fluid, viral culture, and serology. In addition, consideration should be given to the local epidemiology of encephalitis caused by arboviruses belonging to several taxonomic groups, including eastern and western equine encephalitis viruses, St. Louis encephalitis virus, Powassan virus, the California encephalitis virus serogroup, and La Crosse virus.
New causes of viral encephalitis are also possible, as was evidenced by the recent outbreak in Malaysia of some 300 cases of encephalitis (mortality rate, 40%) caused by Nipah virus, a newly recognized paramyxovirus.[citation needed] Similarly, well-known viruses may be introduced into new locations, as is illustrated by the recent outbreak of encephalitis due to West Nile virus in the eastern United States.[citation needed] Epidemiologic factors (e.g., season, geographic location, and the patient’s age, travel history, and possible exposure to animal bites, rodents, and ticks) may help direct the diagnostic workup.
Transmission and symptoms
www.nda.agric.za/docs/rabies/rabies.htm]. Transmission may also occur via an aerosol through mucous membranes; transmission in this form may have happened in people exploring caves populated by rabid bats. Transmission between humans is extremely rare, although it can happen through transplant surgery (see below for recent cases), or, even more rarely, through bites or kisses.//www.nda.agric.za/docs/rabies/rabies.htm]. Transmission may also occur via an aerosol through mucous membranes; transmission in this form may have happened in people exploring caves populated by rabid bats. Transmission between humans is extremely rare, although it can happen through transplant surgery (see below for recent cases), or, even more rarely, through bites or kisses.
After a typical human infection by bite, the virus directly or indirectly enters the peripheral nervous system. It then travels along the nerves towards the central nervous system. During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. Once the virus reaches the brain, it rapidly causes encephalitis and symptoms appear. It may also inflame the spinal cord producing myelitis.
The period between infection and the first flu-like symptoms is normally two to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial paralysis, cerebral dysfunction, anxiety, insomnia, confusion, agitation, abnormal behavior, paranoia, hallucinations, progressing to delirium. The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in "hydrophobia", where the victim has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench his or her thirst. The disease itself was also once commonly known as hydrophobia, from these characteristic symptoms. Death almost invariably results two to ten days after the first symptoms; the few humans who are known to have survived the disease were all left with severe brain damage, with the recent exception of Jeanna Giese (see below). It is neurotrophic in nature.
Prevention
links.jstor.org/sici?sici=0093-0334(197804)8%3A2%3C26%3APWORRT%3E2.0.CO%3B2-J] [1]//links.jstor.org/sici?sici=0093-0334(197804)8%3A2%3C26%3APWORRT%3E2.0.CO%3B2-J] [2]
Their vaccine consisted of a sample of the virus harvested from infected (and necessarily dead) rabbits, which was weakened by allowing it to dry for 5 to 10 days. Similar nerve tissue-derived vaccines are still used now in some countries, and while they are much cheaper than modern cell culture vaccines, they are not as effective and carry a certain risk of neurological complications.
The human diploid cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are made using the attenuated Pitman-Moore L503 strain of the virus. Human diploid cell rabies vaccines have been given to more than 1.5 million humans as of 2006. Newer and less expensive purified chicken embryo cell vaccine, and purified Vero cell rabies vaccine are now available. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host.
Some recent works have shown that during lethal rabies infection the blood-brain barrier (BBB) does not allow anti-viral immune cells to enter the brain, the primary site of rabies virus replication.<ref name=Roy_2007a>Modèle:Cite journal</ref> This aspect contributes to the pathogenicity of the virus and artificially increasing BBB permeability promotes viral clearance.<ref name=Roy_2007b>Modèle:Cite journal</ref> Opening the BBB during rabies infection has been suggested as a possible novel approach to treat the disease.
Post-exposure prophylaxis
Treatment after exposure, known as post-exposure prophylaxis or "P.E.P.", is highly successful in preventing the disease if administered promptly, within fourteen days after infection. The first step is immediately washing the wound with soap and water, which is very effective at reducing the number of viral particles. In the United States, patients receive one dose of immunoglobulin and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite. This is much less painful compared with administering immunoglobulin through the abdominal wall with a large needle, which is how it was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations. Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths in the U.S. from rabies has dropped from one hundred or more annually in the early twentieth century, to 1–2 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated.
P.E.P. is effective in treating rabies because the virus must travel from the site of infection through the peripheral nervous system (nerves in the body) before infecting the central nervous system (brain and spinal cord) and glands to cause lethal damage. This travel along the nerves is usually slow enough that vaccine and immunoglobulin can be administered to protect the brain and glands from infection. The amount of time this travel requires is dependent on how far the infected area is from the brain: if the victim is bitten in the face, for example, the time between initial infection and infection of the brain is very short and P.E.P. may not be successful.
Pre-exposure prophylaxis
Currently pre-exposure immunization has been used on domesticated and normal non-human populations. In many jurisdictions, domestic dogs, cats, and ferrets are required to be vaccinated. A pre-exposure vaccination is also available for humans, most commonly given to veterinarians and those traveling to regions where the disease is common, such as India. Most tourists do not need such a vaccination, just those doing substantial non-urban activities. However, should a vaccinated human be bitten by a carrier, failure to receive subsequent post-exposure treatment could be fatal, although post-exposure treatment for a vaccinated human is far less extensive than that which would normally be required by one with no pre-exposure vaccination.
www.raboral.com/ Raboral]. It is harmless to humans and has been shown to be safe for various species of animals that might accidentally encounter it in the wild, including birds (gulls, hawks, and owls).<ref name=Artois_1990>Modèle:Cite journal</ref>//www.raboral.com/ Raboral]. It is harmless to humans and has been shown to be safe for various species of animals that might accidentally encounter it in the wild, including birds (gulls, hawks, and owls).<ref name=Artois_1990>Modèle:Cite journal</ref>
V-RG has been successfully used in the field in Belgium, France, and the United States to prevent outbreaks of rabies in wildlife. The virus is stable under relatively high temperatures and can be delivered orally, making mass vaccination of wildlife possible by putting it in tasty baits. The plan for immunization of normal populations involves dropping bait containing food wrapped around a small dose of the live virus. The bait would be dropped by helicopter concentrating on areas that have not been infected yet. Just such a strategy of oral immunization of foxes in Europe has already achieved substantial reductions in the incidence of human rabies. A strategy of vaccinating "neighborhood dogs" in Jaipur, India, (combined with a sterilization program) has also resulted in a large reduction in the number of human cases.<ref name=Reece_2006>Modèle:Cite journal</ref>
Induced coma treatment
In 2005, the case of Jeanna Giese, a girl of 15 who survived acute, unvaccinated rabies was reported, indicating the successful treatment of rabies through induction of a coma.<ref name=Willoughby_2005>Modèle:Cite journal</ref> This treatment approach was based on the theory that rabies' detrimental effects were caused by temporary dysfunctions of the brain, and that the induction of a coma, by producing a temporary partial stop in brain function, would protect the brain from damage while the body built up an immune response to the virus. After thirty-one days of isolation and seventy-six days of hospitalisation, she was released from the hospital, having survived rabies. Later attempts to use the same treatment have failed.
sciam.com/article.cfm?chanID=sa006&colID=1&articleID=5BCA4D82-E7F2-99DF-33323DF6FF21871F online link])</ref> He notes that subsequent failures of what he calls the Milwaukee protocol did not use the cocktail of drugs used during the treatment. A point he makes for future research is the relationship of the virus to depletion of biopterin in the brain.//sciam.com/article.cfm?chanID=sa006&colID=1&articleID=5BCA4D82-E7F2-99DF-33323DF6FF21871F online link])</ref> He notes that subsequent failures of what he calls the Milwaukee protocol did not use the cocktail of drugs used during the treatment. A point he makes for future research is the relationship of the virus to depletion of biopterin in the brain.
Prevalence
Australia, New Zealand, Fiji, Guam, Hawaii, the United Kingdom, Republic of Ireland, Norway, Sweden, Finland, Iceland, Japan and Taiwan/ROC.
www.who.int/vaccines/en/rabies.shtml | accessdate = 2006-04-20}}</ref> One of the sources of recent flourishing of rabies in East Asia is the pet boom. China introduced the "One-dog policy" in November 2006 to control the problem.<ref>The Toronto Star "China cracks down on rabid dog menace"</ref>//www.who.int/vaccines/en/rabies.shtml | accessdate = 2006-04-20}}</ref> One of the sources of recent flourishing of rabies in East Asia is the pet boom. China introduced the "One-dog policy" in November 2006 to control the problem.<ref>The Toronto Star "China cracks down on rabid dog menace"</ref>
The English Channel, dog licensing, killing of stray dogs, muzzling and other measures contributed to the eradication of rabies from the United Kingdom in the early 20th century. More recently, large-scale vaccination of cats, dogs and ferrets has been successful in combatting rabies in some developed countries.
The rabies virus survives in wide-spread, varied, rural fauna reservoirs. However, in Asia, parts of America and large parts of Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, and this has successfully reduced rabies in rural areas of France, Ontario, Texas, Florida and elsewhere. Vaccination campaigns may be expensive, and a cost-benefit analysis can lead those responsible to opt for policies of containment rather than elimination of the disease.
Many territories, such as the United Kingdom, Ireland, Taiwan, Japan, Hawaii, Mauritius, Barbados and Guam, are free of rabies, although there may be a very low prevalence of rabies among bats in the UK; see below.
epix.hazard.net/topics/animal/rabies.htm] However, in Australia, the Australian Bat Lyssavirus occurs normally in both insectivorous and fruit eating bats (flying foxes) from most mainland states. Scientists believe it is present in bat populations throughout the range of flying foxes in Australia.//epix.hazard.net/topics/animal/rabies.htm] However, in Australia, the Australian Bat Lyssavirus occurs normally in both insectivorous and fruit eating bats (flying foxes) from most mainland states. Scientists believe it is present in bat populations throughout the range of flying foxes in Australia.
The UK is not completely free of rabies, as a new form of the lyssavirus has been found in some bats which could possibly affect humans. There has been one case of a bite from an infected bat, but the victim showed no symtoms of the virus and was vaccinated quickly as a precaution.
Rabies in the United States
www.cdc.gov/mmwr/preview/mmwrhtml/rr5505a1.htm}}</ref>//www.cdc.gov/mmwr/preview/mmwrhtml/rr5505a1.htm}}</ref> www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a4.htm|accessdate=2006-06-30}}</ref><ref name=Humane Society_2006> Rabies and Wildlife
. The Humane Society of the United States
(2006)
. Retrieved on 2006-06-30. </ref> This does not include, however, the greatly increasing rate of prophylactic rabies treatments in cases of possible exposure, which numbered fewer than one hundred humans annually in the state of New York before 1990, for instance, but rose to approximately ten thousand annually between 1990 and 1995. At approximately $1,500 per course of treatment, this represents a considerable public health expenditure. Raccoons do constitute approximately 50% of the approximately eight thousand documented non-human rabies cases in the United States.<ref name=Krebs_1996>Modèle:Cite journal</ref> Domestic animals constitute only 8% of rabies cases, but are increasing at a rapid rate.<ref name=Krebs_1996 />//www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a4.htm|accessdate=2006-06-30}}</ref><ref name=Humane Society_2006> Rabies and Wildlife
. The Humane Society of the United States
(2006)
. Retrieved on 2006-06-30. </ref> This does not include, however, the greatly increasing rate of prophylactic rabies treatments in cases of possible exposure, which numbered fewer than one hundred humans annually in the state of New York before 1990, for instance, but rose to approximately ten thousand annually between 1990 and 1995. At approximately $1,500 per course of treatment, this represents a considerable public health expenditure. Raccoons do constitute approximately 50% of the approximately eight thousand documented non-human rabies cases in the United States.<ref name=Krebs_1996>Modèle:Cite journal</ref> Domestic animals constitute only 8% of rabies cases, but are increasing at a rapid rate.<ref name=Krebs_1996 />
0-www.cdc.gov.mill1.sjlibrary.org/rabies/publications/mmwr_4618.html Human Rabies — Kentucky and Montana, 1996], May 9, 1997/Vol. 46/No. 18</ref> Similar reports among spelunkers led to experimental demonstration in animals.<ref name="cons"/> This inability to recognize a potential infection, in contrast to a bite from a dog or raccoon, leads to a lack of proper prophylactic treatment, and is the cause of the high mortality rate for bat bites.//0-www.cdc.gov.mill1.sjlibrary.org/rabies/publications/mmwr_4618.html Human Rabies — Kentucky and Montana, 1996], May 9, 1997/Vol. 46/No. 18</ref> Similar reports among spelunkers led to experimental demonstration in animals.<ref name="cons"/> This inability to recognize a potential infection, in contrast to a bite from a dog or raccoon, leads to a lack of proper prophylactic treatment, and is the cause of the high mortality rate for bat bites.
www.reuters.com/article/scienceNews/idUSN0741162020070907 Reuters, U.S. free of canine rabies virus]</ref>.//www.reuters.com/article/scienceNews/idUSN0741162020070907 Reuters, U.S. free of canine rabies virus]</ref>.
Recently publicized cases
Transmission by bite
| This section does not cite any references or sources. Please improve this section by adding citations to reliable sources. Unverifiable material may be challenged and removed. (December 2007) |
Several recently publicized cases have stemmed from bats, which are known to be a vector for rabies. See the Rabies and bats section below.
In October 2004 a female brown bear killed one human and injured several others near the city of Braşov in Central Romania. The bear was killed by human hunters and diagnosed with rabies. More than one hundred humans were vaccinated afterwards.
Transmission through organ transplants
Rabies is known to have been transmitted between humans by transplant surgery.
Infections by corneal transplant have been reported in Thailand (2 cases), India (2 cases), Iran (2 cases),<ref name=Javadi_1996>Modèle:Cite journal</ref> the United States (1 case), and France (1 case).<ref>Modèle:Cite journal</ref> Details of two further cases of infection resulting from corneal transplants were described in 1996.
"[The surgeons] thought he had suffered a fatal crack-cocaine overdose, which can produce symptoms similar to those of rabies. 'We had an explanation for his condition,' says Dr. Goran Klintmalm, a surgeon who oversees transplantation at Baylor University Medical Center, where the transplants occurred. 'He'd recently smoked crack cocaine. He'd hemorrhaged around the brain. He'd died. That was all we needed to know'. Because of doctor-patient confidentiality rules, doctors involved with this case would not talk about it on the record, but a few did say that if no cocaine was found in the donor's blood, the E.R. doctors might have investigated his symptoms more aggressively instead of assuming he had overdosed. (Because no autopsy was done, doctors have not been able to establish whether the rabies or the drugs actually killed him.)"<ref> Modèle:Cite journal</ref>
In February 2005, three German patients in Mainz and Heidelberg were diagnosed with rabies after receiving various organs and cornea transplants from a female donor. Two of the infected people died. Three other patients who received organs from the woman have not yet shown rabies symptoms. The 26 year old donor had died of heart failure in December 2004 after consuming cocaine and ecstasy. In October 2004, she had visited India, one of the countries worst affected by rabies worldwide. Dozens of medical staff were vaccinated against rabies in the two hospitals as a precautionary measure. Associated Press reports that "Donated organs are never tested for rabies. The strain detected in the victims' bodies is one commonly found in bats, health officials said." According to CNN "Rabies tests are not routine donor screening tests, Virginia McBride, public health organ donation specialist with the Health Resources and Services Administration, said. The number of tests is limited because doctors have only about six hours from the time a patient is declared brain-dead until the transplantation must begin for the organs to maintain viability."
Transport of pet animals between countries
Rabies is endemic to many parts of the world, and one of the reasons given for quarantine periods in international animal transport has been to try to keep the disease out of uninfected regions. However, most developed countries, pioneered by Sweden, now allow unencumbered travel between their territories for pet animals that have demonstrated an adequate immune response to rabies vaccination.
Such countries may limit movement to animals from countries where rabies is considered to be under control in pet animals. There are various lists of such countries. The United Kingdom has developed a list, and France has a rather different list, said to be based on a list of the Office International des Epizooties (OIE). The European Union has a harmonised list. No list of rabies-free countries is readily available from OIE.
However, the recent spread of rabies in the northeastern United States and further may cause a restrengthening of precautions against movement of possibly rabid animals between countries.
Rabies and dogs
Image:Dog with rabies.jpg Rabies has a long history of association with dogs. The first written record of rabies is in the Codex of Eshnunna (ca. 1930 BC) (written prior to the Code of Hammurabi), which dictates that the owner of a dog showing symptoms of rabies should take preventative measure against bites. If a person is bitten by a rabid dog and later died, the owner was fined heavily.<ref>Modèle:Cite book</ref>
Three stages of rabies are recognized in dogs. The first stage is a one to three day period characterized by behavioral changes and is known as the prodromal stage. The second stage is the excitative stage, which lasts three to four days. It is this stage that is often known as furious rabies due to the tendency of the affected dog to be hyperreactive to external stimuli and bite at anything near. The third stage is the paralytic stage and is caused by damage to motor neurons. Incoordination is seen due to rear limb paralysis and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by respiratory arrest.<ref name=Ettinger_1995>Modèle:Cite book</ref>
Rabies and opossums
Experimental studies of rabies infection in the Virginia opossum have shown the importance of the mode of transmission. Opossums became infected when exposed to air-borne virus but were found to be fairly resistant to intramuscular inoculations <ref>Constantine DG, Woodall DF. Related Articles, Links
Transmission experiments with bat rabies isolates: reactions of certain Carnivora, opossum, rodents, and bats to rabies virus of red bat origin when exposed by bat bite or by intrasmuscular inoculation.
Am J Vet Res. 1966 Jan;27(116):24-32. No abstract available. PMID: 5913032 [PubMed - indexed for MEDLINE] </ref><ref>Constantine DG 1967 Rabies transmission by air in bat caves. US Pub Health Serv, Publ. 1617</ref><ref>1: Am J Vet Res. 1960 May;21:507-10.Links Resistance of the opossum to rabies virus.BEAMER PD, MOHR CO, BARR TR. PMID: 13797881 [PubMed - indexed for MEDLINE]
</ref>.The aerosol transmission of rabies in opossum was investigated following the death from rabies of two men who had visited the Frio Caves, Texas, and did not remember any direct contact with bats.
The spatial and temporal distribution of opossum rabies
Rabies cases in the Virginia opossum are spillover cases from other wildlife species such as bats,skunks and the raccoon epizootic in the eastern United States. Cases have been reported across the United States from California to New York <ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.Rabies surveillance in the United States during 1996. J Am Vet Med Assoc. (1997) 211(12):1525-39. Review. Erratum in: J Am Vet Med Assoc. (1998) 212(8):1280. PMID: 9412679</ref><ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.(1999) Rabies surveillance in the United States during 1998. J Am Vet Med Assoc. (1999) 215(12):1786-98. Erratum in: J Am Vet Med Assoc 2000 216(8):1223</ref><ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.Rabies surveillance in the United States during 1996. J Am Vet Med Assoc. (1997) 211(12):1525-39. Review. Erratum in: J Am Vet Med Assoc. (1998) 212(8):1280. PMID: 9412679 </ref>. In New York state, the Wadsworth Center lists laboratory confirmed cases in opossums 5 years out of 10 from 1989 to 1998.
Rabies and domestic skunks in the United States
There is currently no USDA-approved vaccine for the strain of rabies that afflicts skunks. When cases are reported of pet skunks biting a human, the animals are frequently killed in order to be tested for rabies.
Humans exposed to the rabies virus must begin post-exposure prophylaxis before the disease can progress to the central nervous system. For this reason, it is necessary to determine whether the animal, in fact, has rabies as quickly as possible. Without a definitive quarantine period in place for skunks, quarantining the animals is not advised as there is no way of knowing how long it may take the animal to show symptoms. Destruction of the skunk is recommended and the brain is then tested for presence of rabies virus.
Skunk owners have recently organized to campaign for USDA approval of both a vaccine and an officially recommended quarantine period for skunks in the United States.
Rabies and bats
The problem of bat-transmitted rabies is found over most of North and South America but was first closely studied in Trinidad in the West Indies which had a dreadful reputation for bat rabies, which took a significant toll of livestock and humans alike. In the 10 years from 1925 and 1935, 89 people and thousands of livestock had died from it - "the highest human mortality from rabies-infected bats thus far recorded anywhere.".<ref>Goodwin G. G., and A. M. Greenhall. 1961. "A review of the bats of Trinidad and Tobago." Bulletin of the American Museum of Natural History, 122, p. 196</ref>
In early 1931, Dr. H. Metivier, a Veterinary surgeon, established the connection between the bites of bats and paralytic rabies. In September 1931, Dr. J. L. Pawan, a Government Bacteriologist found Negri bodies in the brain of a bat with unusual habits. In 1934 the Trinidad and Tobago Government began a program of vampire bat control, shooting, netting, trapping and poisoning, while encouraging the screening off of livestock buildings and free vaccination programs for exposed livestock.
After the opening of the Trinidad Regional Virus Laboratory in 1953, basic research on bats and rabies progressed rapidly under the able direction of Arthur Greenhall, who demonstrated that at least 8 species of bats in Trinidad had been infected with rabies - particularly the Common Vampire Bat, Desmodus rotundus (which "will attack any warm blooded creature"), the rare White-winged Vampire Bat, Diaemus youngi, (which "appears to have a special preference for birds and goats"), as well as two abundant species of Fruit Bats: the Seba's Short-tailed Bat or Short-tailed Fruit Bat, Carollia perspicillata, which commonly roosts with Vampires, and the Jamaican Fruit Bat, Artibeus jamaicensis.<ref>Greenhall, Arthur M. 1961. Bats in Agriculture. Ministry of Agriculture, Trinidad and Tobago.</ref>
www.pubmedcentral.nih.gov/picrender.fcgi?artid=1914752&blobtype=pdf Constantine, D. G. 1962. "Rabies transmission by nonbite route."] Public Health Reports 77, pp. 287–289.</ref> In 1967, rabies virus was isolated from the air in the same cave,<ref>Winkler, W. G. 1968. "Airborne Rabies Virus Isolation." Bull. Wildlife Disease Assoc. Vol. 4, April, 1968, pp. 37-40. Available online at: http://www.jwildlifedis.org/cgi/reprint/4/2/37</ref> presumably passed by the bats urinating, potentially forming a source for infection of other susceptible animals, and presenting a hazard to researchers and spelunkers. While the risks may be low, they are deserving of further study and monitoring.<ref>Messenger, Sharon L., Jean S. Smith, and Charles E. Rupprecht. 2002. "Emerging Epidemiology of Bat-Associated Cryptic Cases of Rabies in Humans in the United States." Clinical Infectious Diseases. 2002; 35, pp. 738–747. Available on line at: journals.uchicago.edu</ref>//www.pubmedcentral.nih.gov/picrender.fcgi?artid=1914752&blobtype=pdf Constantine, D. G. 1962. "Rabies transmission by nonbite route."] Public Health Reports 77, pp. 287–289.</ref> In 1967, rabies virus was isolated from the air in the same cave,<ref>Winkler, W. G. 1968. "Airborne Rabies Virus Isolation." Bull. Wildlife Disease Assoc. Vol. 4, April, 1968, pp. 37-40. Available online at: http://www.jwildlifedis.org/cgi/reprint/4/2/37</ref> presumably passed by the bats urinating, potentially forming a source for infection of other susceptible animals, and presenting a hazard to researchers and spelunkers. While the risks may be low, they are deserving of further study and monitoring.<ref>Messenger, Sharon L., Jean S. Smith, and Charles E. Rupprecht. 2002. "Emerging Epidemiology of Bat-Associated Cryptic Cases of Rabies in Humans in the United States." Clinical Infectious Diseases. 2002; 35, pp. 738–747. Available on line at: journals.uchicago.edu</ref>
The United Kingdom, which has stringent regulations on the importation of animals, had also been believed to be entirely free from rabies until 1996 when a single Daubenton's bat was found to be infected with a rabies-like virus usually found only in bats – European Bat Lyssavirus 2 (EBL2). There were no more known cases in the British Isles until September 2002 when another Daubenton's bat tested positive for EBL2 in Lancashire. A bat conservationist who was bitten by the infected bat received post-exposure treatment and did not develop rabies.
news.bbc.co.uk/1/hi/scotland/2509375.stm] from EBL2 rabies on November 24 2002[3].//news.bbc.co.uk/1/hi/scotland/2509375.stm] from EBL2 rabies on November 24 2002[4].
In November 2004, Jeanna Giese, a fifteen-year old girl from Fond du Lac, Wisconsin, became one of only six humans known to have survived rabies after the onset of symptoms, and the first known instance of a human surviving rabies without vaccine treatment. Giese's disease was already too far progressed for the vaccine to help, and she was considered too weak to tolerate it. Doctors at the Children's Hospital of Wisconsin in Wauwatosa, a suburb of Milwaukee, achieved her survival with an experimental treatment that involved putting the girl into a drug-induced coma, and administering a cocktail of antiviral drugs. Giese had symptoms of full-blown rabies when she sought medical help, thirty-seven days after being bitten by a bat. Her family did not seek treatment at the time because the bat seemed healthy. Jeanna regained her weight, strength, and coordination while in the hospital. She was released from the Children's Hospital of Wisconsin on January 1, 2005.
On May 12, 2006 Harris County Texas. U.S.A. Health Department officials reported that a teenage boy, Zachary Jones of Humble, Texas, had died of rabies at Texas Children's Hospital in Houston, Texas. Zachary had contracted the disease after a bat flew in his bedroom and bit him in his sleep. He was unaware he had been bitten and was not hospitalized until he developed symptoms several weeks later. He died at Texas Children's Hospital after an attempt to cure the disease through a drug-induced coma, similar to that of Jeanna Giese.
On November 2, 2006 a 10 year old girl in Bourbon, Indiana, U.S.A. died of rabies. The Indianapolis Star reports that she was bitten by a bat in June 2006.
In August of 2006, a 73 year old rural resident located east of Edmonton, Alberta, Canada was bitten by a bat while he slept. He ignored the bite and became symptomatic in January 2007. Diagnosed with rabies in March of 2007, he was treated with the Milwaukee protocol, but died April 26, 2007.
www.cdc.gov/ncidod/dvrd/rabies/Professional/publications/Surveillance/Surveillance01/Table2-01.htm//www.cdc.gov/ncidod/dvrd/rabies/Professional/publications/Surveillance/Surveillance01/Table2-01.htm |accessdate=2006-11-10}}</ref>
See also
References
Further reading
- Waterman, James A. 1965. "The History of the Outbreak of Paralytic Rabies in Trinidad Transmitted by Bats to Human Beings and the Lower Animals from 1925." The Caribbean Medical Journal. 1954. Vol. XXVI, Nos. 1–4, pp. 164–169.
- Fleming, Theodore H. 2003. A Bat Man in the Tropics: Chasing El Duende. University of California Press. ISBN 0-520-23606-8.
External links
Modèle:External links www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]
Sources
www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.manbir-online.com/rabies_m.htm#11 Manbir Online] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.cnn.com/2004/HEALTH/07/01/rabies.organ.transplant/ CNN News report of CDC news release - July 1, 2004]. www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.chron.com/cs/CDA/printstory.mpl/metropolitan/2660998 Associated Press report: Families of rabies transplant victims react to deaths - July 3, 2004] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//news.bbc.co.uk/2/hi/europe/3756078.stm BBC News Europe Report: Romanian killer bear had rabies - 19 October, 2004]. www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//health.dailynewscentral.com/content/view/000258/58/ First Unvaccinated Rabies Survivor Goes Home - January 3, 2005]
Other links
www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.cdc.gov/ncidod/dvrd/rabies/ Centers for Disease Control and Prevention] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.who.int/mediacentre/factsheets/fs099/en/ World Health Organization factsheet on Rabies] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.who.int/vaccines/en/rabies.shtml World Health Organization factsheet on Rabies vaccine] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.defra.gov.uk/animalh/quarantine/index.htm Rules for importing pets to the United Kingdom] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.rabiesfreeworld.com/ A Rabies-Free World, Inc.] - NPO dedicated to fighting rabies worldwide www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.kids4rabiesfreeworld.com/ Kids4RabiesFreeWorld] - RFW's site for kids & students www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//europa.eu/eur-lex/pri/en/oj/dat/2003/l_146/l_14620030613en00010009.pdf Rules for importing pets to the European Union] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.defra.gov.uk/animalh/quarantine/quarantine/regulation/eu_reg_qa.htm Rules for importing pets to the European Union Q&A] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.aspenskunk.org/ Aspen Skunk Rabies Research] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//fieldandstream.com/fieldstream/columnists/article/0,13199,724624,00.html "When Raccoons Attack" from Field & Stream Online] www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.usatoday.com/news/health/2005-12-24-rabiessurvivor_x.htm "Only Known Unvaccinated Rabies Survivor Thrives"] (USA Today) Progress report on the one known survivor of rabies www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles]//www.metacafe.com/watch/388523/poor_filipino_child_with_rabies/ "Filipino Child with Rabies"] (metacafe.com) Disturbing video of a small child, exhibiting the advanced stages of rabies mentioned above
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