Rabies Watch

Rabies, Animal, Human - Russia (02) : Moscow Region

2009-07-05T12:43:00.000-07:00

RABIES, ANIMAL, HUMAN - RUSSIA (02): (MOSCOW REGION)
****************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 2 Jul 2009
Source: IA Moscow news [trans, abbreviated, Mod.NP, edited]

According to RosSelhozNadzor (The Federal Agency for Veterinary and
Phytosanitary Supervision), the numbers of stray dogs and cats, the vectors
of rabies, have continued to increase throughout the Moscow region.

The number of rabies cases among animals during 2008 was 2.5 times their
number during 2007. 80 per cent of the cases involved wildlife, of which
the population growth is uncontrolled. The other 20 per cent involved pets.

During the 1st 5 months of 2009, 11 000 persons applied for post-exposure
treatment. This is an 11 per cent more than in the same period of 2008.

communicated by:
ProMED-RUS

[According to VmDaily , 13
cases of human rabies have been recorded within the Moscow region since
1987; 9 of them died during the last 5 years. - Mod.NP

Clearly, the reservoirs of the virus in the Moscow region are wild animals;
according to previous postings, these are predominantly raccoon dogs
(_Nyctereutes procyonoides_) and foxes. Stray or unvaccinated pet dogs
(and, to a lesser extent, cats) exposed to wildlife deliver the fatal virus
into the human population.

The reported increase in the number of rabies cases in animals (probably
referring to both wildlife and domestic pets) deserves some explanation; it
could also reflect intensified monitoring. The increased number of exposed
(and subsequently treated) people may, however, reflect a growth in the
stray animal population or deficient vaccination coverage of pets.

Oral vaccination of wildlife is the recommended mode for spatial rabies
control. Several of the vaccines which have been long demonstrated as
highly effective and safe in controlling the disease in foxes -- in western
Europe and elsewhere -- have been tested in raccoon dogs as well, with
similarly satisfactory results. - Mod.AS]

Rabies, Human, Canine - Viet Nam (Lai Chau)

2009-07-04T01:35:00.000-07:00

RABIES, HUMAN, CANINE - VIET NAM (LAI CHAU)
*******************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 1 Jul 2009
Source: VNS, Viet Nam News agency [edited]

Northern Lai Chau Province announced a rabies epidemic after 4 people died
of the disease and at least 500 people had been bitten by rabid dogs in the
last 2 months. "The 500 cases only account for the number of patients who
got a rabies [vaccination] at the province's Preventive Healthcare Centre
after being bitten," said Do Van Giang, deputy director of Lai Chau
Province's Health Department, adding that the actual number of infected
people could be much higher.

Due to the high demand for dog meat, many local people transported dogs
from Phu Tho and Vinh Phuc provinces. These dogs then infected the local
dogs, leading to the rabies outbreak, said Nguyen Cong Huan, director of
the province's Health Department.

"More people will die of rabies because they do not get the vaccine," he
said. The cost for the vaccine is high -- nearly VND one million (USD 56)
for a course of 5 injections -- and 40 per cent of people in the province
have an average monthly income of VND 200 000 (USD 11), according to Giang.

"My pregnant daughter was killed by a rabid dog because she couldn't get
the vaccine in time," said a 64 year old in Lai Chau Town, who recovered
from rabies after several days of treatment in the province's hospital
[presumably as a result of prophylactic immunization before any symptoms of
infection developed. - Mod.CP]. "Authorities should support patients like
us and get us free treatment. If not, we will not be able to afford the
vaccine," said Thanh.

The province recently decreed that the poor would get free rabies vaccines
and others would get 50 per cent of the vaccine cost subsidised, said Huan.
Some local ethnic minorities lack information about the disease and choose
to treat it with herbal remedies instead of getting the vaccine. "Many
people rush around looking for herbal medicine after being bitten by dogs.
However, this is useless and causes more harm because there is no
scientific basis for this treatment," said Bui Tien Thanh, a doctor at the
province's General Hospital.

Local health officers have handed out leaflets about rabies and treatment
to educate people about the disease and have asked anyone who has been
bitten by dogs to go to the Preventive Healthcare Centre for treatment,
according to Nguyen Van Ngoc, deputy director of the Preventive Healthcare
Centre. "In addition, relevant authorities have increased the management of
dog transports from other provinces and are more closely monitoring the
province's current canines," said Huan.

So far, the province's Veterinary Department has vaccinated 4 dogs and cats
in the province. "It has been decades since the last rabies epidemic, and
the province is trying to stop the spread of the disease as quickly as
possible," said Giang.

communicated by:
HealthMap Alerts via
ProMED-mail

[A map of the provinces of Viet Nam can be accessed at:
. The province of Lai Chau
lies in the far western part of the northern region.

Rabies in Viet Nam continues to be a problem partly on account of lack of
regulation of the trade of dog breeding and provision of dog meat for human
consumption (see references below). Comprehensive vaccination of canines
would both protect human health and have long term economic benefits. - Mod.CP]

Rabies, Fox, Human Exposure - USA : (North Carolina)

2009-06-30T05:18:00.000-07:00

RABIES, FOX, HUMAN EXPOSURE - USA: (NORTH CAROLINA)
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 28 Jun 2009
Source: InjuryBoard.com, North-east Carolina [edited]

Rabid animal attacks have been reported recently in Durham and Orange
counties, which underlines the fact that rabies also exists in north
eastern North Carolina's wild animal population. Recently, a 4 year old
Durham girl was bitten by a fox that climbed a fenced-in yard at a day care
center, according to a report by the News and Observer in Raleigh. Another
fox attacked 2 women in Chapel Hill hours later, the paper reported.

Rabies can become a public health issue when a person is bitten or a pet is
attacked by a wild animal. Rabies is very dangerous; left untreated, it is
deadly. Despite its danger, rabies exposure in pets and humans is a
relatively rare occurrence in northeastern North Carolina. Cats are the
most commonly affected domestic animals, according to North Carolina
Department of Health and Human Services. The largest majority of reported
rabies cases each year occur in wild animals like raccoons, skunks, bats
and foxes.

It is imperative to make sure your pets have updated rabies shots.
Potentially exposed pets that have not had a rabies vaccination or a
booster shot within 3 years will be quarantined for 10 days to see if
rabies is present in the animal. Pets thought to be infected must be
quarantined for 6 months. However, most families are unable to afford the
cost of quarantining pets and are forced to have the animal put to sleep.

Rabies is most often transmitted by the bite of a rabid animal, according
to the Centers for Disease Prevention and Control at the US Department of
Health and Human Services website. When a human is exposed to rabies, an
effective method to decrease the chance of infection is to thoroughly wash
the wound with soap and water according to CDC. People exposed to the
disease also may need to have a series of 6 shots over a 28-day period [now
reduced to 4, see: Rabies, human - USA: vaccination protocol change:
20090625.2312. - Mod.CP]

[byline: Randy Appleton]

communicated by:
ProMED-mail rapporteur Susan Baekeland

[The date of these attacks is not given, but they do not appear to have
been recorded previously in ProMED-mail. The fate of the rabid animals and
the treatment of their victims are not revealed.

The adjacent counties of Durham and Orange lie in the north of the state
and can be located using the map of the counties of North Carolina at:
. - Mod.CP]

Rabies, Canine - Angola (03) : (Luanda)

2009-06-28T10:51:00.000-07:00

RABIES, CANINE - ANGOLA (03): (LUANDA)
**************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 23 Jun 2009
Source: OIE, Animal Health Information & Angolan Veterinary Services [edited]

[Re: ProMED-mail Rabies, canine - Angola (02): (LU), RFI 20090611.2164]
-----------------------------------------------------------------------
Quote [edited English]: "Monkeys have been vaccinated because they
were considered as pets. They live in houses in contact with humans
and dogs. After considering the risk of being a source of infection of
certain human cases in Luanda, the decision was to vaccinate this
species as well."

Communicated by:
Karim Ben Jebara

[We requested clarification on monkey vaccination against rabies by
Angola and got this information, which in my opinion makes sense. -
KBJ.]

[I thank Karim for going to the trouble to clarify this question.
Because "trapping" was mentioned, this moderator mistakenly thought
the monkeys involved were wild. - Mod.JW]

Rabies, Antelope - Namibia : Request for Information

2009-06-19T11:40:00.000-07:00

RABIES, ANTELOPE - NAMIBIA: REQUEST FOR INFORMATION
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 19 Jun 2009
From: Herbert Schneider

Rabies in Namibia
-----------------
A massive outbreak of rabies, affecting kudu antelopes, started early
last year [2008] in Namibia. During a helicopter count in the Khomas
highlands during the winter months of 2008 some 500 dead kudu bulls
were counted. Similar outbreaks were observed in the past, with the
largest one during the years 1977-1985 , when an estimated loss of
30-50 000 antelope (20 per cent of the population) was reported,
apparently involving oral spread of rabies infection between
individuals.

It is estimated that over 20 000 antelopes have died during the
current epizootic.

Dr Herbert P Schneider
Namibia

[Dr Schneider's authoritative clinical/epidemiological observation is
gratefully acknowledged. Laboratory confirmation and information on
possible control measures will be anticipated with interest. A
picture of a kudu is available at
.

The major, unique epizootic of 1977-1985, which decimated about 20
percent of the kudu antelope (_Tragelaphus strepsiceros_) population
of Namibia, as well as the later, smaller outbreaks of 2002 and 2006,
provided an example of horizontal spread between individuals by means
of non-bite transmission. The social behavior of kudu was believed to
be the contributing factor, through the exposure of mouth lesions
from the browsing of thorn bushes to the infected saliva.

References
----------
1. Schneider HP: Rabies in South Western Africa/Namibia. In Rabies in
the Tropics. Edited by: Kuwert, Merieux, Koprowski, Bogel. Berlin:
Springer; 1985:520-535.
2. Swanepoel R, Barnard BJH, Meredith CD, Bishop GC, Bruckner GK,
Foggin CM, Hubschle OJB: Rabies in southern Africa. Onderstepoort J
Vet Res 1993, 60: 325-346. Abstract available at
.
3. Mansfield K, McElhinney L, Huebschle O, Mettler F, Sabeta C, Nel
LH, Fooks AR: A molecular epidemiological study of rabies epizootics
in kudu (_Tragelaphus strepsiceros_) in Namibia. BMC Vet Res 2006,
Jan 13; 2:2. Available at
. - Mod.AS]

[The HealthMap/ProMED-mail interactive map of Namibia can be accessed at
. - Sr.Tech.Ed.MJ]

Rabies, Canine - Angola (02) : (Luanda), Request for Information

2009-06-17T12:23:00.000-07:00

RABIES, CANINE - ANGOLA (02): (LUANDA), REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 11 Jun 2009
From: Jack Woodall

Re: Rabies, canine - Angola: (LU) OIE
----------------------------------------
This OIE report states: "Vaccinations in response to the outbreak(s)
in Luanda: 4457 cats vaccinated in all the municipalities of Luanda
province; 108 531 dogs vaccinated in all the municipalities of Luanda
province; ***901 wild monkeys vaccinated***" (my emphasis).

CDC says: "Cases of monkey-transmitted human rabies are rare;
however, one extremely long incubation period (37.5 months) was
reported (Wilson JM, Hettiarachchi J, Wijesuriya LM. Presenting
features and diagnosis of rabies. Lancet 1975;2:1139-40). CDC also
reports a human fatality in 1987 in Australia after a bite from a
monkey in a market in India, but none since (CDC (1988) Imported
Human Rabies -- Australia, 1987 Vol.37(22);351-3
).

The island of Bali, Indonesia has recently been experiencing a rabies
outbreak in dogs, reported by ProMED. Soegiarto, head of the
Denpasar-based Veterinary Main Office in Bali, recently urged local
authorities to monitor areas where tourists go to view wild monkeys,
while admitting that: "In countries affected by rabies outbreaks,
such as India and Pakistan, cases of rabies among monkeys have
***never*** been reported" (my emphasis)
.

As visitors and residents of India and Thailand know, there are many
monkey temples in those countries, wherein feral macaques mix with
stray dogs, which are a major source of human rabies in those
countries, but no rabies has been reported in the monkeys.

I am not aware of such places in Angola. So can anyone explain the
rationale behind spending a considerable amount of money to trap and
vaccinate nearly 1000 wild monkeys there?

Jack Woodall
Associate Editor, ProMED-mail

Rabies, Skunks - USA : (Texas)

2009-06-13T09:23:00.000-07:00

RABIES, SKUNKS - USA: (TEXAS)
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A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: 10 Jun 2009
Source: Fort Bend Now [edited]

Rabid Skunks Near Needville And Beasley
---------------------------------------
The discovery of rabid skunks near Needville and Beasley has prompted
Fort Bend County Animal Control officials to urge that owners make
sure their pets' rabies vaccinations are up to date. Animal control
officers found one skunk that tested positive for rabies in an
unincorporated area near Beasley, and the other inside Needville city
limits, according to a statement issued Wednesday [10 June 2009] by
the Fort Bend County Health and Human Services. No other details
about the discoveries was immediately available.

"Although the incidence of rabies is low among domestic animals in
the United States, with the occurrence of wildlife rabies comes the
increased risk for infection of humans," said County Animal Control
Director Vernon Abschneider.

Abschneider's department is urging pet owners to keep their animals'
rabies vaccinations current.

"It is also important to keep your animals restrained and not allow
them to roam freely, as this will further protect them from
confrontation with wildlife," Abschneider said.

He added that skunks are nocturnal, and if they're active in the
daytime, it's an indication they're rabid. Therefore, any daytime
sightings of skunks should be reported to local animal control officers.

Rabies is a viral disease affecting the central nervous system and
transmitted by the bite of an infected animal. It is almost always
fatal once symptoms in humans or signs in animals appear. Humans and
animals can be exposed to rabies from the saliva or brain and spinal
cord tissue of a rabid animal that bites or scratches them. Wild
animals, such as raccoons, bats, skunks, foxes and coyotes are more
likely to carry rabies. Exposure can also occur if infected saliva or
tissue gets into a fresh wound (one that has bled within 24 hours) or
the eyes, nose or mouth.

Several things can be done if one is exposed to rabies. After being
bitten, it is important to quickly wash the animal bite or scratch
with a lot of soap and water. Then, contact your doctor immediately
to receive rabies immune globulin and a series rabies vaccine to
prevent infection. The rabies immune globulin and the 1st vaccine
should be given as soon as possible after exposure. However, if the
animal can be caught and observed or tested for rabies, it is safe to
wait up to 10 days before starting the series.

The early symptoms of rabies include irritability, headache, fever,
itching or pain at the site of exposure.

Communicated by:
ProMED-Mail Rapporteur Susan Baekeland

[To test for rabies in an animal, the suspect animal must be dead.
Therefore it is advisable for pet owners to protect their pets,
including horses and cattle with rabies vaccination. - Mod.TG

A map of Texas is available at:

- CopyEd.EJP]

Rabies - China (03) : (Shaanxi)

2009-06-10T00:25:00.000-07:00

RABIES - CHINA (03): (SHAANXI)
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A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 9 Jun 2009
Source: Xinhua News Agency [edited]

In Hanzhong city of northwest China's Shaanxi Province, 2 more people
have died of rabies bringing the rabies death toll in the city since
March [2009] to 11. The 2 fatalities were both women, one aged 58 and
the other 56, said a local government official.

The 1st death was reported on 21 Mar [2009], and number of people
injured by dog bites in the city has since reached 6256. So far,
approximately 335 900 pet dogs have been vaccinated in the city, said
the local government official. The city, with more than 370 000
registered dogs, reported 35 deaths of rabies from 1985 to 1992.

Human deaths indicated the rabies virus was very active, posing a
great public health threat, Shi Ruihua, local agricultural bureau
chief, said earlier this month [June 2009]. The city carried out a
rabies prevention campaign from 23 May-1 Jun [2009], implementing
door-to-door compulsory vaccinations of dogs and urging dog owners to
put their pets on a leash or keep them off the streets.

Communicated by:
HealthMap Alerts via ProMED-mail

[These 2 deaths apparently are the 2 individuals hospitalized and
under treatment in the previous rabies report from Shaanxi Province
(see ProMED-mail archive no. 20090607.2105).

Hanzhong is located in the southwest of Shaanxi Province. An
interactive map showing the location of Shaanxi province in
east-central China can be accessed at
.
The HealthMap/ProMED-mail interactive map of China is available at
. - Mod.TY]

Rabies - Mexico : (Jalisco)

2009-06-09T00:29:00.000-07:00

RABIES - MEXICO: (JALISCO)
**************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 21 May 2009
Source: Milenio online [in Spanish, trans. & summ. Mod.TY, edited]

A 63-year-old man residing in a small community in the
Hostotipaquillo municipality became the 2nd fatal sylvatic [wildlife]
rabies victim so far this year [2009] in the state. After inquiries
with family members, the Jalisco Secretariat of Health (SSJ) presumed
that he was bitten by a bat that transmitted the virus.

Yesterday [20 may 2009], the director general of Public Health of the
SSJ [Jalisco Health Secretariat], Elizabeth Ulloa Robles, said the
man indicated to his family that something bit him on the elbow, but
that it was not important. On 10 May [2009], 3 days before going to
the Magdalena Regional Hospital, he began to show general weakness,
paralysis of the hands, and alterations in gait, among other
symptoms; an internist considered that he had neurological
deterioration and sent him to the Juan I Menchaca Civil Hospital of
Guadalajara. Ulloa Robles added that the patient came to [the
Magdalena Regional Hospital] on 17 May [2009], "when he presented
with a 40 deg C [104 deg F] temperature, alterations in the state of
consciousness, ataxia, stiff neck ... when this was evaluated, as
detected by the temperature, it raised [indication of] an infectious
neurological [disease] process.

He underwent tests, including tomography, but he died the same day
[17 May 2009] at 22:50 hours. After discarding diseases such as
tuberculosis and influenza A H1N1, a sample of brain [tissue] was
sent to the state Public Health Laboratory, and it was determined
that he suffered from rabies [virus infection].

Ulloa Robles indicated that epidemiological barriers were established
in La Venta de Mochitiltic, where the man resided, as well as in 8
other localities in Hostotipaquillo [municipality], villages where
other possibly affected individuals are being sought.

This is the 2nd case of sylvatic rabies death in 2009 [in Jalisco].
On 2 Jan [2009], a 4-year-old girl died after being bitten by a bat,
in San Sebastian del Oeste. There have been no [human] rabies cases
transmitted from a dog or a cat in Jalisco since 1995. Given this
case of wildlife rabies, the SSJ requested that SAGARPA [Ministry of
Agriculture, Livestock, Rural Development, Fisheries, and Foods]
analyze the bat population that inhabits caves in the area for
circulation of rabies virus, and if found, to proceed with their destruction.

[Byline: Maricarmen Rello]

Communicated by:
Dr Eduardo Santana C.
Universidad de Guadalajara
Mexico

[It is not clear from this report which species of bat might have
been involved in these 2 cases. However, the bites of vampire bats
(_Desmodus rotundus_), a common transmitter of rabies virus to
livestock and occasionally to humans in the neotropics, are
characteristic and well known to rural people in Mexico. Vampire bat
bites can be discarded in these cases. However, there is evidence of
occurrence of rabies in several species of insectivorous bats in
Mexico (see the following references).

Rabies, Fox, Raccoon, Bat - USA : (Pennsylvania, Kentucky, Maryland, Alert)

2009-06-07T09:11:00.000-07:00

RABIES, FOX, RACCOON, BAT - USA: (PENNSYLVANIA, KENTUCKY, MARYLAND), ALERT
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1]
Date: 20 May 2009
Source: WBOC.com [edited]

The Worcester County Health Department is alerting residents that
since 1 May 2009, there have been 6 laboratory confirmed rabid
raccoons in Worcester County.

In the last week, 4 of the confirmed raccoons have been found in
highly populated areas, according to the department.

Those areas include north Ocean City, Ocean Pines, White Marlin Mall
in West Ocean City and South Point. The Health Department says that
although rabies is present to some degree in Worcester County at all
times, these latest cases illustrate that the disease is not only
associated with rural settings but can, in fact, be found in suburban
and town settings.

Raccoons are the most frequently identified carrier of rabies in
Maryland as well as in Worcester County, but the deadly viral disease
has also been found in foxes, cats, bats, skunks and groundhogs.

The Health Department recommends several things you can do to protect
your family and pets from exposure:

-Make sure your dogs and cats are currently vaccinated against rabies
and keep those vaccinations current.

-Do not let your pets roam free. They are more likely to have contact
with a rabid wild animal

-Avoid feeding your animals outside. This draws stray and wild
animals to your doorstep.

-Teach your children not to approach wild animals and animals they don't know.

-Avoid sick animals and those acting in an unusual manner. Report
this behavior to the local law enforcement.

-If your pet has contact with a wild animal, avoid touching your pet
with bare hands and do not touch the wild animal. Report the incident
to local law enforcement and to the Health Department. If you have
questions regarding rabies, you are asked to contact the Health
Department at (410) 641-9559 or consult with your veterinarian.

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[2]
Date: 21 May 2009
Source: Kentucky.com [edited]

Health officials say they've found a rabid bat in Lexington, making
it the 9th animal in the city to test positive for the disease this
year [2009].

The Lexington-Fayette County Health Department announced the findings
Thursday [21 May 2009] and said it has posted signs in the
neighborhood reporting the incident and stressing the importance of
getting pets vaccinated.

Eight other animals in the city have tested positive for the viral
disease this year [2009], including 6 skunks, a fox and a horse.

The number of cases more than doubles the 4 confirmed cases of rabies
in Lexington in all of 2008.

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[3]
Date: 21 May 2009
Source: Pittsburg Live.com [edited]

The adult victim and her son fired several shots at a rabid fox and
finally knocked it unconscious with a mop handle after the animal
attacked the New Sewickley woman's 4-year-old grandson.

The adult victim got out of her truck Saturday [15 May 2009] and was
walking to her daughter's house to get her grandson, when she saw
something dart out from beneath her truck.

"I looked over, and the fox had my grandson pinned up against the
truck, attacking him," The adult victim said. "My grandson wasn't
making any sound. I think he was in shock. I grabbed the fox by the
jaw to make it release, and threw my grandson in the bed of the
truck. But the fox bit the inside of my right arm and then was right
back on my grandson. It wouldn't stop attacking him."

After the adult victim's son fired at the fox, they were able to stop
it with the mop handle, the adult victim said. A township police
officer shot the fox to death. Tests on Tuesday [19 May 2009]
confirmed the animal had rabies.

The adult victim and her grandson began a 28-day course of rabies
vaccination shots [post exposure prophylaxis, PEP] the day they were bitten.

Officials are monitoring the area, which is in Beaver County, for any
other human contact.

Rabies is a viral disease that affects the central nervous system and
usually is transmitted through saliva from an infected animal,
according to the state Department of Health.

Since 2000, between 350 and 500 animals annually have tested positive
for rabies in Pennsylvania.

In 2006, the most recent year for which statistics are available,
raccoons comprised 56 percent of cases, followed by skunks at 12
percent, cats at 11 percent, bats at 8 percent and foxes at 6
percent, according to the Health Department.

State health officials couldn't say how many people are infected with
rabies each year in Pennsylvania. [Couldn't say, or wouldn't say?
They should have records regarding each rabies case, as it is a
reportable disease. - Mod.TG]

The incubation period for rabies typically runs 3 to 8 weeks but can
be as short as one week or as long as 9 years. Symptoms are
irritability, fatigue, headache, fever and pain or itching at the
exposure site.

Untreated, rabies can result in paralysis, spasms of the throat
muscles, seizures, delirium and death.

People who are bitten by an animal they suspect to be rabid should
wash the wound with soap and warm water immediately and get to a
hospital, Health Department officials said.

Treatment involves a series of shots given in the arm, or thigh for
small children.

Health officials caution that people should call an animal control
officer to capture the animal, and it should be observed for 10 days.
Humane officials might euthanize the animal and test the remains at a
laboratory.

[Byline: Jill King Greenwood]

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[In any of these cases, having your pet vaccinated against this
disease is an increased measure of protection for yourself and your family.

It is always wise to not pick up bats and to avoid animals that are
acting strangely, such as the fox. However, in the case reported
above, contact with the fox may have been unavoidable. - Mod.TG]

Rabies, Wildlife - USA (03) : (Arizona) - fast evolving Rabies virus found

2009-06-07T09:05:00.000-07:00

RABIES, WILDLIFE - UNITED STATES OF AMERICA (03): (ARIZONA)
***********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 4 May 2009
Source: National Geographic News [edited]

Fast-evolving rabies virus found -- and spreading
-------------------------------------------------
Evolving faster than any other new rabies virus on record, a
northern-Arizona rabies strain has mutated to become contagious among
skunks and now foxes, experts believe. The strain looks to be spreading
fast, commanding attention from disease researchers across the United
States. It's not so unusual for rabid animals to attack people on hiking
trails and in driveways, or even in a bar as happened 27 Mar 2009, when an
addled bobcat chased pool players around the billiards table at the
Chaparral in Cottonwood. Nor is it odd that rabid skunks and foxes are
testing positive for a contagious rabies strain commonly associated with
big brown bats.

What is unusual is that the strain appears to have mutated so that foxes
and skunks are now able to pass the virus on to their kin not just through
biting and scratching but through simple socializing, as humans might
spread a flu. Usually the secondary species in this case, a skunk or fox
bitten by a bat -- is a dead-end host. The infected animal may become
disoriented and even die but is usually unable to spread the virus, except
through violent attacks.

Skunks have already been proven to be passively transmitting the strain to
each other, as documented in a 2006 study in the journal Emerging
Infectious Diseases [see comment below - Mod.CP]. Genetic studies suggest
foxes are also spreading the new strain to each other, though the results
have not yet been peer reviewed.

When a skunk in Flagstaff, Arizona, died of rabies in 2001, wildlife
specialists thought it was a "freak accident" due to a one-off,
run-of-the-mill bat bite said Barbara Worgess, director of the Coconino
County Health Department. Laboratory tests later showed that the virus had
adapted to the skunk physiology and become contagious within the species.
"It shouldn't have been able to pass from skunk to skunk," Worgess said.

Rabies has continued to crop up in skunks for 8 years now, despite periodic
vaccination campaigns. And so far this year [2009], county officials have
documented 14 [now 33] rabid foxes in the Flagstaff area. Now laboratory
studies at the US Centers for Disease Control and Prevention (CDC) in
Atlanta appear to confirm that the fox and skunk rabies viruses are mutated
forms of the bat strain. "We can see degrees of relatedness and patterns in
their genetic codes," said Charles Rupprecht, chief of the rabies program
for the CDC. This sort of rapid evolution is exactly what worries public
health officials when it comes to all manner of viruses. Virologists
haven't seen such fast adaptation to a new species in rabies before. That's
why Flagstaff is such an interesting story worldwide," said David Bergman,
the US Department of Agriculture's (USDA) state director for Arizona.
"We're watching evolution in action on the ground."

Could rabies become contagious in humans? The Arizona rabies situation is
risky, because the infected species live so close to people. Flagstaff's
sprawl in recent decades has created a perfect opportunity for rabies to
mutate into species-hopping forms, the CDC's Rupprecht said. New-home
construction, often in wooded areas, has actually increased habitat and
food sources for bats, skunks, and foxes. Skunks live under houses, for
example, and as diggers, make themselves at home on golf courses. Bats,
meanwhile, are adept at living in attics and under loose shingles. As more
rabies-susceptible animals congregate in the region, more infections can
take place. And each infection is an opportunity for the virus to mutate
into a more virulent form literally upping the odds of a new strain
developing. "That's a pattern that we see all over the United States,"
Rupprecht said. Similar suburban development in the eastern US in the late
1970s, he noted, led to the spread of raccoon rabies from the Canadian
border to the Deep South.

The risk of such a virulent strain jumping to people "should be a major
concern," said Hinh Ly, a molecular virologist at the Emory University
School of Medicine in Atlanta, who is not involved in studies of the
Arizona outbreak. But no one is expecting the rabies strain to become a
contagious, swine flu-like epidemic among humans. Flu viruses, for one
thing, tend to infect people fast, so "vaccination after exposure would be
too late to prevent infection," said Elisabeth Lawaczeck, the Arizona
Department of Health Services' public health veterinarian. Rabies takes its
time before going from incubation to infection, so post-exposure rabies
vaccinations tend to be effective at stopping the virus. If untreated,
though, rabies, which attacks the central nervous system, is often fatal in
humans.

Rabies cases among animals are expected to increase as the spring and
summer mating seasons bring potential pairs and rivals together. Already,
Flagstaff has declared a 90 day pet quarantine all dogs on leashes and all
cats indoors which began in April [2009]. A wildlife vaccination plan could
stem the virus's spread. Local and state officials enacted vaccination
programs in northern Arizona in 2001 and 2005 but discontinued each effort
after 2 years without rabies, reports the World Health Organization's
standard for declaring an area rabies-free. Now state vaccination funds
have been reallocated, the USDA's Bergman said, and emergency funds are
increasingly rare due to the recession. Adding to the worries, Lawaczeck,
the Arizona veterinary official, said she and other public heath officials
were "very unsettled" when the 1st rabid fox reports came in from Flagstaff
this year and not just because of the evolutionary implications for rabies.
"This means a much wider spread of rabies," she said, "because [foxes]
travel so much farther."

[byline: Anne Minard]

communicated by:
ProMED-mail rapporteur Mary Marshall

[The following extracts from the publication referred to above -- Mira J
Leslie, Sharon Messenger, Rodney E Rohde, Jean Smith, Ronald Cheshier,
Cathleen Hanlon, et al. Bat-associated rabies virus, skunks. Emerg Infect
Dis 2006; 12(8): 1275 (Aug)
-- gives an
account of the background to the current situation in Arizona.

"In North America, more than 90 per cent of cases of rabies in animals
occur in wildlife; several mammalian taxa harbor characteristic rabies
virus variants. In Arizona, skunks (_Mephitis mephitis_) and gray foxes
(_Urocyon cinereoargenteus_) maintain independent rabies enzootic cycles,
and in indigenous bats, rabies has been diagnosed in 14 of 28 species.

"Although skunks live throughout Arizona, until 2001, rabid skunks had been
found only in the southeastern quadrant of the state. In the United States,
bat variant rabies viruses are a source of infection for humans and other
mammals. Typically, interspecies infection produces a single fatal
spillover event; secondary transmission has rarely been observed. Antigenic
typing of rabid carnivores in Arizona from 1996 through 2000 identified bat
variant rabies viruses in one domestic dog and 2 gray foxes. This report
describes the largest documented rabies epizootic among terrestrial mammals
infected with bat variant rabies virus, with perpetuated animal-to-animal
transmission. Coincident with the zoonotic disease significance, this
report provides contemporary insight into pathogen evolution."

"Investigation of this novel outbreak showed evolution in action with the
emergence of a rabies virus variant that successfully adapted from
Chiroptera to Carnivora. Previously documented clusters involving 3-4 to
terrestrial mammals infected with a single insectivorous bat rabies virus
variant did not corroborate sustained transmission. Although more than one
skunk may have been exposed to a single rabid bat, it is highly unlikely
that each skunk was exposed to the same bat or that multiple bat-skunk
exposures occurred. We could not ascertain the complete scope of this
outbreak or whether it was the index event. Phylogenetic analyses support
the evolution of 2 independent lineages, suggesting establishment for
months or years. Additionally, virus isolation from salivary glands of 5
affected skunks and the reappearance of rabid skunks with the same variant
rabies virus in 2004 support the probability of independent transmission."

Rabies in skunks and foxes is now widespread in Arizona (see
) as a
result of sustained transmission of distinct variants of bat rabies virus
genetically adapted to different mammalian hosts. The National Geographic
News article uses the term contagious in an inappropriate manner. The virus
has become modified for tranmission in a new host, but infection still
occurs via exposure to rabies virus-containing saliva. The virus is no more
or no less contagious; it has become genetically adapated for sustained
transmission in an alternate host. Sustained transmission in humans has so
far never been observed. - Mod.CP]

Rabies, CAnine, Human - Angola (07) : (Uige) - 83 Children die in Luanda, Angola from Rabies

2009-06-07T07:17:00.000-07:00

RABIES, CANINE, HUMAN - ANGOLA (07): (UIGE)
*******************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 4 Jun 2009
Source: ANGOP [in Portuguese, trans. & summ. Mod.TY, edited]

Of 830 people bitten by dogs in the city of Uige from January to 4 Jun
of this year [2009], 6 died, the supervisor of the municipal Expanded
Program of Vaccination, Pedro Guilherme Fernando, reported today,
Thursday [4 Jun 2009]. He asked the population to go urgently to the
nearest health unit as soon as one is bitten.

Communicated by:
ProMED-PORT

[Apparently, a significant rabies outbreak, with human fatalities,
continues in Angola. In the 1st 3 months of this year (2009), 93
children died of rabies in the capital, Luanda (see ProMED archive no.
20090314.1051). Now cases are occurring in the nearby province of
Uige. Failure to obtain timely post-exposure treatment may be due, in
part, to scarcity of the vaccine and anti-rabies immunoglobulin and
their relatively high cost. The most effective measure to prevent
human cases such as these is to maintain the canine population rabies
virus immune through a continuous vaccination program.

A map showing the location of Uige city in Uige province in northwest
Angola can be accessed at

The HealthMap/ProMED-mail interactive map of Angola can be accessed at
.
- Mod.TY]

Rabies - China (02) : (Shaanxi) - human deaths reported

2009-06-07T07:14:00.000-07:00

RABIES - CHINA (02): (SHAANXI)
******************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 1 Jun 2009
Source: China View [edited]

Rabies has killed 8 people and left 2 people suspected of being
infected in hospital in Shaanxi Province since March 2009, the local
government said Monday [1 Jun 2009]. The outbreak of rabies has
spread to 11 counties in Hanzhong City since March, where 5523 people
were injured by dogs, said Qin Mingxian, director with the city's
agricultural bureau. The 1st death occurred on 21 Mar [2009], and the
2 people suspected of being infected were being treated in a
county-level hospital, he said at a press conference.

The city, with more than 370 000 registered dogs, reported 35
[human?] deaths of the disease from 1985 to 1992. The outbreak was
spreading at unprecedented speed, said Qin.

The city carried out a rabies prevention campaign from 23 May - 1 Jun
[2009], implementing door-to-door compulsory vaccinations of dogs and
urging dog owners to put their pets on a leash or keep them off the
streets. So far, more than 240 000 pet dogs had been vaccinated.

Human deaths indicated the rabies virus was very active, posing a
great public health threat, said Shi Ruihua, chief of the bureau's
stock breeding department. The city authorities would work out
measures to improve administration of pet dogs, he said.

[Byline: Deng Shasha, editor]

--
Communicated by:
ProMED-mail Rapporteur Dan Silver

[Rabies continues to pop up sporadically in various parts of eastern
China. This is the latest outbreak, and illustrates the need to
maintain the canine population immune through consistent vaccination
programs. One hopes that the aggressive dog vaccination effort
carried out over the past 2 weeks is successful in eliminating the
rabies risk in the city, and is extended to rural areas as well.

Hanzhong is located in the southwest of Shaanxi Province. An
interactive map showing the location of Shaanxi province in
east-central China can be accessed at

- Mod.TY]

RABIES, CATS, HUMAN EXPOSURE - USA (VIRGINIA)

2009-05-11T06:02:00.000-07:00

RABIES, CATS, HUMAN EXPOSURE - USA (VIRGINIA)
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 9 May 2009
Source: The Free Lance-Star [edited]

Three people face treatment for rabies after being bitten by 2 cats
in Spotsylvania County that tested positive for the deadly disease
last month [April 2009].

One incident occurred off Hood Drive in the Four-Mile Fork area on 30
Apr 2009. The other incident happened on Duerson Road on 23 Apr 2009.
The county Health Department is handling both cases. County animal
control officers already have gone door to door to hand out
information on the disease.

Lisa Hill, environmental health supervisor, said that on 30 Apr 2009,
2 men were exposed to rabies when they attended to a cat they thought
was dead. She said one of the men was 85 years old, but she did not
know the age of the other person. On 23 Apr 2009, she said a
26-year-old woman was trying to help a cat hit by a car when she was
bitten on Duerson Road in the western part of the county.

Rabies is caused by a virus that attacks the nervous system. Rabies
is fatal to mammals and humans who are not treated "They are all
currently being treated," Hill said of the 3 people. "Both of these
cats come from an area where there have been cat colonies.
Spotsylvania Animal Control is trying to handle it through
education." Hill warned people not to touch or feed stray cats in
either of these areas. She said she is unaware of any other reported
cases. Rabies can be prevented in cats, dogs, ferrets and some
livestock with rabies vaccinations, she said.

[Byline: Dan Telvock]

Communicated by:
ProMED-mail

[Spotsylvania county can be located to the southwest of
Fredericksburg in the map of the state of Virginia at:
.
Hopefully, Spotsylvania Animal Control will be able to locate the
feral cat colony believed to be associated with these rabies cases
and eliminate the risk of further exposure of the human and animal
population of the county to rabies virus infection. - Mod.CP]

RABIES, BOVINE, HUMAN EXPOSURE - USA (03): (NORTH CAROLINA)

2009-04-18T03:15:00.000-07:00

RABIES, BOVINE, HUMAN EXPOSURE - USA (03): (NORTH CAROLINA)
***********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 17 Apr 2009
Source: Salisbury Post [edited]

Calf dies after exposure to rabies
----------------------------------
A calf on a farm in Gold Hill has died as a result of exposure to
rabies. The diagnosis was made after the calf's owner sent the body
of the animal to a lab in Raleigh for a necropsy. It died last week
[week of 6-10 Apr 2009].

The owner said he has been involved in the raising of cattle for
about 50 years, and this is the 1st time one of his animals has
contracted rabies. He said someone saw a skunk in one of his pastures
last month, and said he thinks the female calf may have contracted
rabies from that animal. "They say they're real bad about carrying
diseases," he said of skunks.

He raises about 15 head of cattle on his farm on Spring Lake Lane. He
admitted that anything he knows about rabies and cattle, he's learned
only since his calf died. "I'm not very familiar with it, and I wish
I wasn't this familiar," he said. "I'd never crossed this bridge
before." He said the diseased calf was only about 2 or 3 months old.
He said most of his cattle are registered and said the calf would
have been registered had it lived.

The calf's owner said that when one of his heads of cattle undergoes
a necropsy, the result typically reveals the animal died of pneumonia
or some similar ailment. It is almost impossible, he said, to know
what killed a head of cattle without a necropsy.

Fran Pepper of Rowan County Animal Control agreed. She said even when
an animal has rabies, there are no sure signs of the disease. "Rabies
doesn't exhibit the same symptoms," Pepper said. "Some will walk the
fence line and bellow and some won't. There's really no tell-tale
signs of the disease." She said that while this is the 1st case of
rabies being diagnosed in cattle in Rowan County this year, it's not
that unusual. Pepper said there have been several instances of rabies
being diagnosed in cattle elsewhere in the state this year.

This was the 5th case of rabies reported in Rowan County this year.
The calf's owner and his wife are undergoing post-exposure rabies
shots due to their handling of the calf just prior to its death.

[Byline: Steve Huffman]

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

RABIES, RAT, HUMAN EXPOSURE - UKRAINE

2009-04-18T03:12:00.000-07:00

RABIES, RAT, HUMAN EXPOSURE - UKRAINE
*************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 15 April 2009
Source: Komsomolskaya Pravda [translated by Mod.NR, edited]

Rabies outbreak in Energodar city
---------------------------------
Basements of apartments in Energodar city are being disinfested from
rats and mice. By the end of the month veterinarians should have
vaccinated all domestic animals against rabies. The reason for these
measures is the result of capture of a rat by taxi drivers. One of
the taxi drivers was attacked by a rat that appeared on on the street
outside an apartment block. The rat was killed and brought for
investigation. Subsequently it was confirmed that the rat had rabies.
The taxi driver [who was attacked] will be getting anti-rabies shots,
while 2 neighborhoods will be under quarantine.

According to Valentina Stulova, the head of the veterinary
department, these measures are being undertaken to prevent the spread
of rabies. However it is not considered an emergency situation. These
measures are standard practice and there is no threat for the
population. However it is quite rare to have rabid rats in this
region since usually rabies is associated with feral and abandoned
dogs. One case of rabies in a bat has been recorded in this region.
Nonetheless strict surveillance will be maintained for 2 months.

Communicated by:
ProMED-RUS

[Rabid rats attacking people is rare in this region. Fortunately
prompt action has prevented further human exposure. According to OIE
there were 8 cases of rabies in Russia in 2007. - Mod.NR]

[Rabies is rarely reported in rats, and rodents are these animals are
unlikely to the primary source of this outbreak. In a city
environment rabies-infected dogs and cats are more likely to be the
primary source of the infection. The city of Energodar is in the
Ukraine and can be located in the interactive map at:
. - Mod.CP]

[At first it is difficult to perceive how a rat would acquire a
rabies infection. If attacked by another rabid mammal the rat would
come off 2nd, i.e dead , even if it did not acquire an overwhelming
infection resulting in a rapid death. Being bitten by another rat
does not solve the question either. This leaves us with the
possibility it found a moribund rabid bat and ate it, just as cats do
and with the same result. It would be interesting to know if the
Ukraine authorities have attempted to type the rat virus and thus
identify a possible source in this unusual case. - Mod. MHJ]

RABIES - RUSSIA: (SARATOV, NISHEGORDSKY, UDMURTIA)

2009-04-15T00:39:00.000-07:00

RABIES - RUSSIA: (SARATOV, NISHEGORDSKY, UDMURTIA)
*************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

******
[1]
Date: 10 Apr 2009
Source: news.sarbc.ru [translated and abbreviated by Mod.NP, edited]

Rabies, animals - Russia (Samara region)
----------------------------------------
In 2008, 305 cases of animal rabies were reported. In addition there
was 1 human case reported in Balashov, and in 2 further human cases
the people were severely attacked by rabid animals -- a girl in
Vyazovka and a guard in the Volsky districts.

On April 9 [presumably in 2009 - Mod.MHJ] the expert council of the
regional government reviewed 2 laws on keeping domestic dogs and cats
and about administrative responsibility for its contravention.

Communicated by:
ProMED-RUS

******
(2)
Date: 10 Apr 2009
Source: IA: "AIF-nn.ru", 2009 [translated and abbreviated by Mod.NP, edited]

Rabies, animals - Russia (Nizhegorodskiy region)
-------------------------------------------------
During the 1st 3 months of this year, 2009, 28 cases of rabies
[presumably animal rabies - Mod.MHJ] have been reported but for the
whole of 2008 there were only 27 animal rabies cases.

Dmitriy Nikulin, Deputy head of bureau of State Veterinary
Supervision, said that the increased incidence is connected with a
rise in the number the carrier infections. For example, the fox
population has grown from 5000 to 8000 animals. In relation to
climatic and ecological factors the most unfavorable areas for rabies
are in the central and southern districts.

During 2001-2009 years rabies has been reported in 338 animals: 227
foxes; 51 dogs; 34 cats; 3 horses; and 3 goats. Because of the
worsening situation funding for rabies vaccinations has been
increased.

[Byline: Olga Petrova]

Communicated by:
ProMED-RUS

******
(3)
Date: 10 Apr 2009
Source: IA: "Media-centre Alfa-PR" [translated and abbreviated by
Mod.NP, edited]

Rabies, animals - Russia (Udmurtia)
-----------------------------------
Acccording to Rospotrebnadzor data as of 9 Apr 2009, 13 cases of
rabies have been recorded this year in Udmurtia, which is more than
for all of last year. About 77 percent of all these cases have been
in foxes. The affected districts are Alnashsky, Uvinsky, Grakhovsky,
Mozhginsky, Vavozhsky, Balezinsky and Karakulinsky.

Communicated by:
Natalia Pshenichnaya, ProMED Russian Moderator

[According to OIE WAHID in 2007 Russia reported 8 human rabies cases;
there were no reports submitted for 2005, 2006 or 2008, which is not
to say that rabies cases did not occur. The disease is widespread in
Russian domestic animals and wildlife with 3679 recorded cases in
2005; 876 in the 1st half of 2006 -- no reports for the latter half;
44572 (2007); 2989 (2008).
- Mod.MHJ]

Rabies, Bovine - USA (Vermont)

2009-04-11T05:36:00.000-07:00

Rabies, Bovine - USA (VERMONT)
******************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 9 Apr 2009
Source: Boston.com

5 cows contract rabies
----------------------
Vermont agriculture officials are urging farmers to vaccinate theiir
cows for rabies after 5 have tested positive for the disease. The
cows were likely infected by a rabid raccoon.

WCAX-TV says it's unclear why rabies cases in cows are increasing.
But one veterinarian suspects farmers may have dropped the vaccine as
a cost-cutting measure.

The rabid cows pose a minimal risk to humans. No one has ever
contracted rabies from drinking milk but the Centers for Disease
Control says people who drink raw milk from a rabid cow are at risk
for the disease. Farm workers also are at risk.

Communicated by:
HealthMap Alerts via ProMED-mail

[It has been a battle to get producers to vaccinate cattle. If the
Vermont veterinarian believes that the vaccinations have been dropped
because of economic reasons, then Vermont has been more successful
than most of us at getting the producer to vaccinate for rabies.

I have long been an advocate of rabies vaccine in all mammalian
creatures that we deal with since it is a very cheap insurance for
us. If that bovine is a show animal or milk animal or a pet and we
are petting, brushing, or in any way having close contact with than
animal, then it should be vaccinated against rabies.

This article does not tell us over what period of time these animals
have been diagnosed with rabies. It also does not allow us to know if
they were all in the same part of the state or if they were owned by
the same owner. It may be part of an epidemiological investigation
regarding who may not be vaccinating, or if there is a perhaps a
change in the strain of rabies present in a particular area.

Rabies in cattle is not uncommon. Cattle are curious creatures if a
raccoon or skunk is not acting quite right, then they will
investigate, frequently being bitten on the nose or occasionally on the leg.

There are a number of diseases capable of passing to the milk. Those
who are insistent about consuming raw milk put themselves at risk of
a number of diseases. While CDC does not report any human contacting
rabies through milk, it may only be that the case was not reported
but it has occurred. If you have consumed raw milk from one of the
locations having a rabid cow, then you should discuss rabies
vaccination with your physician. - Mod.TG

[Back in February 2009, 2 cows died in Vermont and owners were urged
to get their gattle vaccinated -- see 1st ProMED ref. below. - Mod.JW]

[The HealthMap location of Vermont is available at:
- CopyEd.EJP]

Rabies, Wildlife, Equine, Human Exposure - USA (02) : (North Carolina, Georgia)

2009-04-10T17:13:00.000-07:00

RABIES, WILDLIFE, EQUINE, HUMAN EXPOSURE - USA (02): (NORTH CAROLINA, GEORGIA)
******************************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 10 Apr 2009
From: David Dassey

This is regarding the moderator's comment on
Rabies, wildlife, equine, human exposure - USA: (NC, GA) 20090409.1364
on the statement, "[The patient] received 5 [vaccine] shots for rabies and
said he must have 5 more [This must be a mistake; only 5 shots are
needed, spread over 28 days, not just a week -- see below - Mod.CP/JW]."

The patient was probably referring to the number of needle insertions
to administer rabies immune globulin (RIG) in addition to vaccine
dose number 1. This is a common finding when interviewing bite
victims who present to a different healthcare provider for completion
of the PEP series. Many patients are unable to tell what was
administered, only how many sticks they received (a good reason for
giving the patient the package inserts and a written treatment
record). The other clue is the site of the multiple injections -- if
the needles infiltrated the bite wound(s), the substance delivered
was certainly RIG.

David Dassey

[The writer from LA County Public Health is almost certainly correct.
The patient only spoke of shots, not specifically of vaccine shots. I
made the mistake of inserting the word [vaccine] and extrapolated
incorrectly from that. - Mod.JW]

Rabies, Wildlife, Equine, Human Exposure - USA : (North Carolinga, Georgia)

2009-04-09T13:47:00.000-07:00

RABIES, WILDLIFE, EQUINE, HUMAN EXPOSURE - USA: (NORTH CAROLINA, GEORGIA)
*************************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1] North Carolina: wildlife
[2] Georgia: equine

******
[1] North Carolina: wildlife
Date: Tue 7 Apr 2009
Source: The Cherokee Scout [edited]

A rabid fox ran inside a house and bit a man at least twice on 30 Mar
2009. The victim, who lives near Fields of the Wood, was asleep about
7:15 a.m. when he heard scratching at his front door. Thinking it was
his cat, he opened the door. A fox immediately ran in and bit his big
toe. "It was a big fox and madder than hell," the victim said on 1
Apr 2009. "I thought it was my cat. I opened the door, and it
attacked me." He kicked the fox across the room and it went on a
rampage, running all over the house before it came back and grabbed
his other foot. He then kicked the fox again, then grabbed a mop
handle and killed the fox. "It was running wide open," he said. "I
kicked it and it never slowed down. It bit plumb through my big toe."

The victim called [neighbor] Michael Stiles, who looked at his foot
and told him to get to the emergency room. Stiles cut the fox's head
off and made sure it was sent off for testing. The next night, 31 Mar
2009, the victim received news that the fox was rabid. He received 5
[vaccine] shots for rabies and said he must have 5 more [This must be
a mistake; only 5 shots are needed, spread over 28 days, not just a
week -- see below - Mod.CP/JW].

The fox was the 6th confirmed case of rabies in Cherokee County this
year [2009], all occurring since 16 Mar 2008, when a large dog fought
and killed a raccoon in Peachtree. This was the 1st confirmed rabid
fox this year. The others have been raccoons, said Philip Anderson,
who is in charge of the Cherokee County Health Department's rabies
prevention program. There were 20 confirmed cases in the county in
2008. This was the 2nd confirmed case in Hiwassee Dam, the 1st being
a raccoon south of Hiwassee Dam School.

Jim Weller, who lives on Shoal Creek Road, said a fox was sitting at
the end of his driveway during the day. The fox tried to get up but
couldn't. "I could tell it was sick, so I shot it," Weller said. He
called the health department, but since they couldn't send anyone
immediately, he buried the fox. The next day, health department
personnel came and dug the fox up, Weller said.

Rabies cases have been spread all over the county with the exception
of the Andrews and Marble areas, Anderson said. He has collected 36
animals for the U.S. Department of Agriculture for a rabies
surveillance program in an attempt to convince the USDA that an oral
rabies vaccine drop [to immunize wildlife] is needed. Anderson said
USDA has collected 30 of the animals, which are animals that haven't
been proven to have bitten other animals or people and include animals
found dead on the roads. "We haven't heard back from [USDA] on any of
the animals," Anderson said. "We have been doing this [since August
2008]. I didn't expect this [long of a] delay."

The oral vaccination drop consists of plastic packets containing the
Raboral V-RG rabies vaccine which are dropped into selected areas by
airplane. The packets are sprinkled with fishmeal coating or encased
in fishmeal so they are eaten by wildlife. Animals that swallow an
adequate dose of the vaccine develop immunity to rabies. As the
proportion of vaccinated animals in the population increases, they
act as a buffer to stop spread of the disease to other wildlife,
domestic animals and people.

Anderson said rabies cases in Cherokee County seem to be escalating.
At this time last year [2008], there were only 2 confirmed cases of
[wildlife] rabies in the county. He got an e-mail from an USDA
representative who said the incidence of rabies in Polk and Monroe
counties in Tennessee have decreased. A bait drop was done in those
counties in September or October 2008.

Anderson asked people to be careful around strange-acting animals,
especially raccoons and foxes, which are not normally seen during the
day. Anderson said he has received calls from people long after they
killed a strange-acting animal and disposed of it. Anderson urged
people to call the health department in such cases. It will cost them
nothing. There will be a rabies clinic on Sat 16 May 2009 at various
locations across the county. A pet who hasn't been vaccinated for
rabies must be quarantined for 6 months before it is freed. Three
different families in Cherokee County have German shepherd dogs
quarantined because they came in contact with rabid animals. All 3
seem to be doing OK, and one is almost ready to come off quarantine,
Anderson said.

[Byline: Dwight Otwill]

Communicated by:
HealthMap Alerts via
ProMED-mail

[This report reveals a certain lack of urgency on the part of the
responsible authorities to respond to an increased risk of
transmission of rabies virus from wildlife to the human population.
The Raboral V-RG oral vaccine, which is a derivative of the
Copenhagen strain of vaccinia virus engineered to express the
immunogenic G protein of rabies virus, has been used successfully to
control wildlife rabies by air-dropped bait elsewhere in the United
States and to eradicate rabies entirely from much of Western Europe
by targeted habitat seeding.

Contrary to the statement in the preceding text, according to the CDC
website, post-exposure vaccination consists of a regimen of 5 1-mL
doses of HDCV or PCEC vaccines administered intramuscularly to
previously unvaccinated persons. The 1st dose of the 5-dose course
should be administered as soon as possible after exposure. Additional
doses should be administered on days 3, 7, 14, and 28 after the 1st
vaccination. For adults, the vaccination should always be
administered intramuscularly in the deltoid area (arm). For children,
the anterolateral aspect of the thigh is also acceptable. The gluteal
area should never be used for rabies vaccine injections, because
observations suggest administration in this area results in lower
neutralizing antibody titers.

Hiwassee Dam, North Carolina can be located in the
HealthMap/ProMED-mail interactive map of the United States at:
.
- Mod.CP]

******
[2] Georgia: equine
Date: 7 Apr 2009
Source: Independent mail.com [edited]

3 members of a Franklin County family are undergoing treatment
for rabies prevention after it was discovered their horse had the
disease.

The family owns a farm on [route] SR 327 in Franklin Springs and
involves 2 adults and a 7-year-old child.

The news of the county's 1st horse rabies case came Friday [3 Apr
2009] afternoon to the Franklin County Health Department.

"Late Friday [3 Apr 2009], I got a call from the University of
Georgia letting me know they had a horse that had been sent down
there that had tested positive for rabies," said Louis Korff,
Environmental Health manager for the Franklin County Health
Department. "This horse had lived over in the Victoria Bryant Park
area and had never been vaccinated. When I asked the family if the
horse had been vaccinated for rabies, they were surprised you could
vaccinate a horse."

While rabies is relatively rare in horses, Korff said horses as well
as dogs, cats, and other warm-blooded mammals are at risk for rabies
if not vaccinated.

"All horse owners should have their animals vaccinated against rabies
and keep them up because here's a classic example. Some skunk or
raccoon went out there and bit that horse and gave it rabies," he
said. "The horse got sick, and the humans tending to the horse got
themselves exposed. Now I have 2 adults and a 7-year-old child
getting post-exposure shots and going through a lot of emotional
trauma, which could have been avoided by a [horse] vaccination."

The family told Korff the elderly horse was a beloved family pet and
had recently stopped eating and drinking water.

According to the University of Kentucky College of Agriculture's
Cooperative Extension Service, signs of rabies in horses can be hard
to diagnose. The main sign to watch for is any behavioral change in
the horse.

Historically, initial signs have been categorized as "furious" and
"paralytic" or "dumb."

"Horses are more likely to get the "dumb" version of it. This horse
stopped eating and stopped drinking water. That's what led to the
people trying to help the horse. They were feeding it and trying to
get it to drink water and were exposed to the disease while the horse
was shedding the virus," Korff said.

The family is now undergoing a series of 5 expensive injections to
prevent them from contracting rabies, which is always fatal in humans.
"You 1st get a human immuno-globulin shot then a series of 4 [actually
5] post-exposure shots," Korff said. Those shots for humans run about
USD 1500 for the series for each
person, according to Korff.

[Byline: MJ Kneiser]

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[Rabies is more common in horses than the writer of the article realizes.

It is important to understand rabies has different forms, as
mentioned in the article, but the name of the form is not nearly as
important as recognizing a change in your animal's behavior, posture,
and attitude. A normally quiet animal that is suddenly aggressive or
an aggressive animal that is quiet and withdrawn are both major
changes to be noted and respected as possible rabies.

I have always advocated vaccinating horses and even cattle,
especially if they are pets or show animals, because we are around
them so much. A rabies preventative is the cheapest insurance for the
family. It would have prevented the post-exposure shots they are now
taking and would have prevented the loss of the horse. - Mod.TG]

[All suspected rabid animals have to be killed and their brains sent
to a rabies lab for confirmation. - Mod.JW]

Rabies, Canine, Human - Indonesia (08) : Comment on Vaccination

2009-04-05T17:19:00.000-07:00

RABIES, CANINE, HUMAN - INDONESIA (08): COMMENT ON VACCINATION
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 4 Apr 2009
From: Allan Grill

The regimen for an individual receiving rabies pre-exposure
prophylaxis consists of 3 intramuscular doses of rabies vaccine on
days 0, 7 and 21. This is usually recommended for certain groups who
may be at higher risk of exposure to the rabies virus (e.g.
veterinarians, individuals traveling to rabies endemic areas). Should
these individuals have a subsequent exposure to the rabies virus
(e.g. bite from a suspected rabid animal), they would require a
post-exposure prophylaxis regimen consisting of 2 intramuscular doses
of rabies vaccine on days 0 and 3 post-exposure. Rabies immune
globulin (RabIg) would not be required in this case.

For individuals who have not received rabies pre-exposure
prophylaxis, their 1st suspected rabies exposure would require 5
intramuscular doses of rabies vaccine on days 0, 3, 7, 14, and 28
days post-exposure. They would also require a dose of RabIg on day 0
post-exposure as well (given at a different anatomical site from the
1st dose of vaccine). Should these individuals ever have subsequent
suspected rabies exposures requiring post-exposure prophylaxis, the
regimen would be the same as the one mentioned above for individuals
who had received pre-exposure prophylaxis: 2 intramuscular doses of
rabies vaccine on days 0 and 3 post-exposure.

I believe it was mentioned in the previous posting [Rabies, canine,
human - Indonesia (07): comment on vaccination 20090404.1300] that
individuals who have had pre-exposure prophylaxis in the past require
3 doses of rabies vaccine post-exposure. As mentioned above, they
would only need 2 doses.

Communicated by:
Allan Grill, M.D., C.C.F.P., M.P.H.
Medical Consultant
Toronto Public Health
Toronto, Ontario, Canada

[ProMED-mail thanks Dr. Allan Grill for this additional
clarification. - Mod.CP]

Rabies, Canine, Human - (07) : comment on vaccination

2009-04-04T11:13:00.000-07:00

RABIES, CANINE, HUMAN - INDONESIA (07): COMMENT ON VACCINATION
********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 4 Apr 2009
From: Stephen Toovey

A comment on rabies vaccination
-------------------------------
With regard to the ProMED-mal post: "Rabies, canine, human -
Indonesia (06): (BA) 20090331.1247, I feel it would be worthwhile
clarifying to subscribers that 3 time separated injected doses of
rabies vaccine post-exposure (as discussed in the cases from Bali) is
the regimen only for individuals who have undergone pre-exposure vaccination.

The regimen otherwise, for previously unimmunised individuals, is 5
time separated injected doses, with rabies immunoglobulin along with
the 1st dose of rabies vaccine.

Dr Stephen Toovey MBBCh PhD FFTM RCPS(Glasg)
Burggartenstrasse 32
CH-4103 Bottmingen
Switzerland

[ProMED-mail thanks Dr Stephen Toovey for this important
clarification. Travellers to Bali should take note. - Mod.CP]

Rabies, via dog/cat butchering - Nigeria

2009-03-29T20:00:00.000-07:00

RABIES, VIA DOG/CAT BUTCHERING - NIGERIA
****************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 29 Mar 2009
Source: Personal communication from the Federal Ministry of
Agriculture and Water Resources Department of Livestock, Kaduna
Nigeria [edited]

Human butchering and consumption of animals potentially infected with
rabies and other zoonotic viruses is not limited to Asia. In Nigeria,
dog eating is very common in states such as Plateau, Akwa Ibom, Cross
River, Kaduna, Kebbi and Ondo. In fact, dog suya (barbequed dog meat)
is sold publicly in the dog eating areas. In some areas such as Jos,
only local and seasoned connoisseurs may easily distinguish
restaurants where dog and other conventional meats are sold. Cat
eating, though not as common as dog eating, can also be encountered,
even in cosmopolitan places such as Lagos. While human consumption of
bats is also common, there seems to have been little or no local
effort (as per the limited information available) to evaluate the
risk of rabies transmission.

Rabies is no doubt underreported and probably misdiagnosed in Nigeria
and elsewhere in Africa (Asselbergs 2007 and the references therein).
Cultural and religious beliefs will also contribute to the
underreporting of human rabies that may arise from the consumption of
infected apparently healthy dogs and cats. The [rabies-related
lyssaviruses] Lagos bat and Mokola viruses still remain
under-diagnosed in the human populace.

The paper by Ajayi, Rabo and Baba (2006) also indicates a disturbing
possibility of transmission of rabies by apparently healthy (free of
overt rabies signs) stray dogs. If their observations are confirmed,
this, in their words, "signifies a new dimension in the epidemiology
of the disease in this environment where the high-risk practices are
prevalent." What's more intriguing epidemiologically and culturally
is that their research was carried out in Maiduguri; the overwhelming
Muslim population in the city provide zero economic incentives for
dog meat restaurants. However, the dogs were slaughtered in
restaurants associated with 2 military barracks in the city.

In summary, the situation reported in Viet Nam, Nigeria, etc. only
reaffirms that rabies is more of a neglected tropical disease than
thought and which deserves attention.

References:
Ajayi BB, Rabo JS, Baba SS. Rabies in apparently healthy dogs:
histological and immunohistochemical studies. The Nigerian
Postgraduate Medical Journal. 2006 Jun;13(2):128-34.

Asselbergs M. Rabies awareness. The Veterinary Record 2007 Sep
22;161(12):4322.

[AbdulKareem Durosinloun; Federal ministry of Agriculture and Water
Resources Department of Livestock; Kaduna Nigeria]

Communicated by:
Shamsudeen Fagbo
Dept. of Tropical Veterinary Diseases
University of Pretoria South Africa

[We appreciate Dr. Fagbo updating us on this situation in countries
other than Asia. Sadly, the underreporting of rabies in animals and
people is a trend not likely to disappear any time soon. - Mod.TG]

Rabies, Wildlife - USA (02) : Arizona

2009-03-29T00:34:00.000-07:00

RABIES, WILDLIFE - USA (02): (ARIZONA)
*************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Disease

Date: 27 Mar 2009
Source: Fox News [edited]

3 Exposed to Rabies After Wild Bobcat Terrorizes Town
-----------------------------------------------------
A total of 3 people in the central Arizona community of Cottonwood
were exposed to rabies after being attacked by a wild bobcat. It all
began when the animal attacked and scratched a woman who had gotten
out of her car after thinking she had hit it.

A short time later, Cottonwood police got a report of a bobcat acting
aggressively toward a woman outside a Pizza Hut. Then, about an hour
later, the bobcat wandered into the Chapparal Bar on Main Street
forcing patrons up on their barstools; 2 men were bitten before
police shot and killed the animal in the parking lot. Tests later
confirmed it was rabid.

Communicated by:
Claude R. Ceccon

[Most of the other rabies exposures in Arizona have been from skunks
and foxes, according to Arizona Department of Health,

which has only confirmed 35 cases, versus the 62 reported earlier.
ProMED-mail appreciates Mr. Ceccon forwarding the information. - Mod.TG]

Rabies, Wildlife - USA : (Arizona) Increased Risk

2009-03-28T15:37:00.000-07:00

RABIES, WILDLIFE - USA: (ARIZONA) INCREASED RISK
************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 24 Mar 2009
Source: KTAR [edited]

Arizona sees surge in rabies outbreak
-------------------------------------
The state of Arizona is being hit with the biggest outbreak of rabies
that it has seen in a while, according to state veterinarian Elisabeth
Lawaczeck. So far this year [2009] there have been 62 animals
confirmed with rabies, according to Lawaczeck.

[A 21-year-old] Phoenix resident learned this the hard way when she
was bitten by a rabid bat at a family get-together in Northern Arizona
[last year? -- see below. - Mod.JW]."Something flew at me, I didn't
know what it was," [she] told KTAR. "I remember fumbling with it a
lot. It was really fury. It bit me and it flew away."

[The woman] was taken to the emergency room where she was treated for
rabies. She had to undergo a series of painful shots that lasted 6
months. "The needle was really long and it was really thick. I
remember the substance that they used was pink, and that was probably
the most painful thing that I've ever had to endure," she said. [But
see comment at end. - Mod.JW]

With the current outbreak of rabies, Lawaczeck says people should take
precautions when they go hiking or camping. "When you're camping you
want to make sure you are sleeping inside a tent and not just on the
ground or on a tarp. When you're hiking on the trails you should take
a hiking stick if you are in an area where there is reported rabies in
the past," Lawaczeck told KTAR [presumably for warding off attacking
animals. - Mod.JW].

Lawaczeck also said most rabies cases occur in skunks and foxes in
Southern Arizona but there have been recent outbreaks in the Flagstaff
area as well.

[Byline: Colton Shone]

Communicated by:
Healthmaps.org

[It would have been nice if the species of the 62 animals had been
listed; were they all skunks and foxes?

This is also a perfect time for the state veterinarian to pitch having
pets, including horses, vaccinated against the disease. Whether you
take your pet camping, or a rabid animal gets into your yard, you
should have your pet current on vaccines. If you don't know, or have
doubts, if your pet is protected, please see your veterinarian.

Rabies is usually a fatal disease. Unless your animal is vaccinated it
has no chance of living, because the authorities will eventually
euthanize the animal.

Arizona needs to update their rabies vaccine. The current CDC
recommendation for both HDCV and PCECV rabies vaccines is 1.0 mL intra
muscularly in the deltoid area, one each on days 0, 3, 7, 14, and 28
only, not 6 months -- see:

- Mod.TG/JW]

[The southwestern state of Arizona can be located on the
HealthMap/ProMED-mail interactive map of the USA at
. - CopyEd.MJ]

Rabes, Canine, Human - Indonesia (05) : (Bali)

2009-03-27T02:08:00.000-07:00

RABIES, CANINE, HUMAN - INDONESIA (05): (BALI)
**********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 25 Mar 20009
Source: The Jakarta Post [edited]

The 8th victim of rabies, a 46-year-old man, died on Monday [23 Mar
2009] afternoon after being treated at the Sanglah General Hospital
in Denpasar since Sunday morning, a hospital official said Tuesday
[24 Mar 2009].

The victim was bitten in November [2008] and was a resident of
Pecatu, South Kuta district in Badung district, which had been
declared a rabies-infected area by the Bali provincial administration
late last year [2008]. "The suspect had shown acute clinical symptoms
and could not be saved," IGB Ken Wirasandhi, the secretary of the
hospital's rabies handling team, said. "We cannot confirm that [he]
positively died of rabies because the results of his blood tests are
not in yet."

The previous 7 suspected victims died after being bitten by rabid
dogs. The 1st victim was a 4-year-old child who died on 17 Sep 2008
[but see ProMED archive 20090106.0050 for a Jakarta Post article
giving his date of death as 30 Dec 2008, 6 months after being bitten.
- Mod.JW]. Other victims were [2 adults aged 32, an adult aged 45,
and 2 children aged 3 and another aged 5]. [So far, only the
45-year-old and one of the 32-year-old patients] have been confirmed
through blood tests to have suffered from rabies.

On Monday [23 Mar 2009], Ken said the 46-year-old patient showed
indications of the clinical symptoms of rabies like the past
suspected victims. "One thing is certain, the victim's diagnosis was
encephalitis," he said. The man's family has refused to divulge any
information. Head of the isolation ward, Ni Made Ratni, said Monday
that the man's wife had been hysterical since her husband was
declared a rabies suspect. "She kept on crying hysterically while her
husband was being treated," she said.

Badung Health Agency head AA Gede Agung Mayun confirmed the victim
suffered from the clinical symptoms of rabies. Ironically, the
46-year-old man had received 2 anti-rabies vaccinations (VARs) after
being bitten by a rabid dog. The 1st shot was given on 27 Nov 2008.
"Unfortunately, he did not continue with the 3rd and 4th vaccinations
after he felt much better," Mayun said. "A complete 4-shot
anti-rabies vaccination is mandatory, especially if a victim is
bitten on the arm or above." Mayun said the case was very surprising
because biting cases in South Kuta were actually decreasing, but he
did not give exact figures. Health authorities have yet to identify
which dog [bit] the deceased.

There have been proposals expressed, during various discussions on how
to handle rabies in Bali, that dog owners should be punished if their
dogs bite people. The aim is to involve the public in preventing the
spread of rabies. The health agency also said that only one of the
3-year-old children of the previous victims had shown rabies' unique
clinical symptoms, such as hydrophobia and hyper-salivation.

Meanwhile, the Badung Animal Husbandry, Fisheries and Maritime Agency
is finding it difficult to administer the booster vaccinations for
dogs, scheduled for April 2009.

[Byline: Luh De Suriyani]

Communicated by:
a correspondent who wishes to remain anonymous

[Little precise information has been reported in recent weeks
concerning the course of the outbreak of canine rabies and consequent
human fatalities in the Indonesian island of Bali. Particular
concerns have been expressed regarding the undeclared number of human
cases, the extent of the dog vaccination program and the availability
of vaccine and immunoglobulin for post-exposure treatment.

The above Jakarta Post report highlights the seriousness of the
current situation, with the declaration of 2 confirmed fatal cases of
human rabies and another 6 suspected fatal cases. Furthermore, the
program for control of canine rabies by vaccination seems to have
stalled. Intending visitors to the island of Bali should take note.

The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
.
A map of the island of Bali showing Denpasar region can be accessed at:
.
- Mod.CP]

Rabbies, via dog/cat butchering - Viet Nam : Probable

2009-03-18T12:04:00.000-07:00

RABIES, VIA DOG/CAT BUTCHERING - VIET NAM: PROBABLE
***************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1]
Date: Tue 17 Mar 2009
Source: inthenews.co.uk [edited]

Eating dog or cat linked to rabies
----------------------------------
A new study has detailed how 2 people in Asia contracted rabies after
eating dog or cat meat.

A report published in the journal PLoS Medicine [see part (2) below]
describes how the 2 patients in Hanoi, Viet Nam, died from
laboratory-confirmed rabies. Health experts claim their symptoms
developed after butchering, preparing, and consuming either a dog or a cat.

The researchers were unable to test the butchered animals for rabies,
so could not be entirely certain the animals were the source of the rabies.

However, they caution that butchering of unvaccinated dogs and cats
in rabies-endemic countries should be considered a risk factor for
rabies transmission.

Communicated by:
ProMED-mail

******
[2]
Date: Wed 18 Mar 2009
From: Heiman Wertheim

Rabies infections highlight dangers of processing dog meat
----------------------------------------------------------
Eating dog meat is common in many Asian countries, but research
conducted as part of the South East Asia Infectious Diseases Clinical
Research Network has discovered a potentially lethal risk associated
with preparing dog meat: rabies. In research published today [18 Mar
2009] in the open access journal PLoS Medicine, Dr Heiman Wertheim
and colleagues from the National Institute of Infectious and Tropical
Diseases and the National Institute of Hygiene and Epidemiology in
Hanoi, Viet Nam, report on 2 patients admitted to hospital showing
signs of rabies infection. Neither patient was thought to have been
bitten by a rabid animal in the preceding months.

Rabies is a very serious -- and in nearly all cases fatal -- disease.
It is estimated to kill more than 30 000 people each year in Asia,
and the number of cases in China and Viet Nam is increasing. Symptoms
include agitation, severe spasms, fever, fear of water and inability
to drink liquids, and eventually death. Humans are usually infected
after being bitten by an infected animal such as a dog or bat.

When the researchers investigated whether the patients had come into
contact with infected animals in the preceding months, they found
that both had been involved in preparing and eating animals that may
have been infected. In the 1st patient's case, he had prepared and
eaten a dog that had been killed in a road traffic accident; rabid
dogs were known to inhabit the neighbourhood. The 2nd patient had
butchered and eaten a cat that had been sick for a number of days.

In both cases seen by Dr Wertheim and colleagues, it is thought that
infection occurred during the slaughtering, and not by eating the
meat, as the meal was shared by others who did not become infected.
In Asia, it is believed that eating dog meat enhances health and
longevity. It is eaten throughout the year in the 2nd half of the
lunar month, particularly in the winter months, when it is believed
to increase body heat.

In Viet Nam, dogs with rabies have been detected in dog
slaughterhouses and workers at dog slaughterhouses are vaccinated
against rabies as part of the national programme for rabies control
and prevention. However, the private slaughter of dogs is relatively
common in the country.

"We need to alert both the general public and clinicians about the
risks around butchering and handling meat," says Dr Wertheim. "People
should not handle animals that may be infected with rabies. Rabies
can be prevented with a vaccine and people exposed to rabies can be
helped with post-exposure prophylaxis, but this needs to be
administered as quickly as possible following the exposure. Once a
person shows symptoms, the disease is almost invariably fatal.

"Vietnamese doctors already consider dog slaughtering a risk factor
for rabies transmission, but it is important that other health care
workers and policy makers, both inside and outside Vie Nam, are aware
of this risk factor."

The South East Asia Infectious Diseases Clinical Research Network is
funded by the Wellcome Trust and the National Institute of Allergy
and Infectious Diseases, National Institutes of Health USA.

References
----------
1. Wertheim, H et al: Furious Rabies after an Atypical Exposure. PLoS
Medicine. 17 March 2009 [available at
].
2. The South East Asia Infectious Diseases Clinical Research Network
[SEAICRN; ] is a multinational
clinical research network that strives to advance the scientific
knowledge and clinical management of infectious disease through
integrated, collaborative clinical research in Indonesia, Thailand
and Viet Nam. The principal sources of funding for the Network are
the US National Institutes of Health's National Institute of Allergy
and Infectious Diseases, USA and the Wellcome Trust, UK.
3. The Wellcome Trust [] is the largest
charity in the UK. It funds innovative biomedical research, in the UK
and internationally, spending over GBP 600 million [approx. USD 840
million] each year to support the brightest scientists with the best
ideas. The Wellcome Trust supports public debate about biomedical
research and its impact on health and wellbeing.

Heiman Wertheim

Rabies, Canine, Human - Angola (06) : (LUANDA)

2009-03-14T14:56:00.000-07:00

RABIES, CANINE, HUMAN - ANGOLA (06): (LUANDA)
*********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 13 Mar 2009
From: Ellicott McConnell

A comment
---------
I don't know whether or not it is of importance in the recent
outbreak in Angola, but in many parts of the developing world there
are a number of often bizarre "remedies" for rabies. It is my
understanding that only about half of rabid dogs shed the virus from
the salivary glands. Thus, half the time the remedies "work," not a
bad average for home remedies, so their use persists. Unfortunately,
by the time the failures get to valid medical assistance, it's too late!

Ellicott McConnell, Ph.D.

Rabies, Canine, Human - Angola (05) : Luanda

2009-03-12T14:31:00.000-07:00

RABIES, CANINE, HUMAN - ANGOLA (05): LUANDA)
*********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 11 Mar 2009
Source: ReliefWeb [edited]

One of the most severe rabies epidemics to hit Angola has claimed the
lives of at least 93 children within 3 months in the capital, Luanda.
"The 93 children were brought to our hospital and are the only ones
we know of, so the number could be higher," said Luis Bernardino,
head of the Hospital Pediatrico David Bernardino in Luanda, the
country's largest referral hospital. "The number of cases has,
however, started declining now." He said the hospital was unable to
save any of the children, as it had run out of doses of rabies
vaccine; in some instances, the children were brought in too late.
"It is a sad moment for us," said Bernardino.

Francois Meslin, the rabies expert at the World Health Organisation
(WHO) headquarters in Geneva, said in the last severe rabies
outbreak, from 1998 to 2003 in Indonesia's Flores Island, 100 people
had died within a year. "The high number of deaths in Luanda within
the short period of time is a cause for serious concern and calls for
a thorough investigation."

Rabies is an incurable viral disease transmitted by close contact
with saliva from infected animals, usually canines or rodents. It can
be prevented by vaccination, either pre-exposure or as part of
post-exposure treatment. However, once the symptoms of the disease
develop, it is fatal in both animals and humans.

Post-exposure treatment comprises 5 doses of the vaccine and has to
start "as soon as possible" to prevent the symptoms from developing,
Meslin said. The disease attacks the respiratory, gastrointestinal
and/or central nervous systems, leading to paralysis followed by coma
and death in all cases, usually due to respiratory failure.

Luanda's large stray dog population has been identified as causing
the spread of the disease. "We have had some sporadic cases in other
provincial capitals in the country; we think the virus was brought
into Luanda and then spread through the dogs; Angolans love dogs,"
said Bernardino.

The capital was built to accommodate around 400 000 people but now
has a population of more than 4.5 million, most of whom live in
unhygienic conditions in "musseques" or slums.

The outbreak has raised concerns over the slow reaction of the
Angolan authorities. "When the 1st 10 deaths were reported in
December 2008, we alerted the authorities, but we do not have
veterinary services in the city, no kennels [to keep and observe the
animals] and vaccinate them," said Bernardino. There were also not
enough vaccines available. "I think it was probably that no one was
prepared for such a high case load," he said. A vaccination campaign
is underway. "We now also have enough vaccines in stock. The cases
have started dropping now; we have 12 cases in one week, it dropped
to 4 cases, and this week, it is down to 3," Bernardino told IRIN.

Developing countries are often unable to afford rabies treatment,
which is prohibitively expensive, said Melvin. "One dose costs about
USD 10, and 5 of those have to be administered, which makes the total
cost of treatment USD 50, which is more than what a family can earn
in a month in most developing countries." Besides the vaccine, "in
instances where the person has been heavily exposed, with multiple
bites in the head," that person also has to be given rabies
immunoglobulin to prevent death, which can cost another USD 50. "The
treatment can be a huge drain on public health services, especially
in countries where the vaccines are given free."

Melvin said there was a global shortage of the vaccines. "As there
are few registered manufacturers who meet the WHO guidelines, the
supply cannot keep up with the demand." At least 55 000 people die
from rabies every year in Asia and Africa; most of the victims are children.

[This article does not necessarily reflect the views of the United
Nations or its agencies.]

Communicated by:
ProMED-mail Rapporteur Brent Barrett

[The number of child deaths in this rabies outbreak in Luanda, the
capital city of Angola, has risen from 63 on 18 Feb 2009 to at least
93 known child deaths on 10 Mar 2009. The number of adult deaths is
not reported. The outbreak is now thought to be in decline, as judged
by the number of children admitted to the main referral hospital per
week. Unfortunately, none of the children admitted to hospital has
been saved due to the lack of vaccine and immunoglobulin for
post-exposure treatment, in part due to the global shortage of
vaccine and its high cost. Control of the urban dog population
remains unresolved due to the absence of appropriate veterinary
services, although adequate supplies of canine vaccine are said to be
available. Until progress is achieved in control of the dog
population, it is unlikely that there will be an early end to this outbreak.

The HealthMap/ProMED-mail interactive map of Angola showing the
location of Luanda in the north of the country can be accessed at:
. - Mod.CP]

Rabies, Canine, Human - Indonesia (04) : Bali, Request for information

2009-03-11T19:25:00.000-07:00

RABIES, CANINE, HUMAN - INDONESIA (04): BALI, REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 11 Mar 2009
From: Robert Dedmon

This issue of rabies in Bali and travelers is of concern to those of
us in the USA with patients/clients planning travel to Bali in the
near future. At present, there is no vaccine available for
pre-exposure use in the USA (personal communication C. Rupprecht, CDC
USA yesterday, 10 Mar 2009). What is the situation in other countries?

R.E. Dedmon, MD
Clinical Professor
Medical College of Wisconsin
Milwaukee
333 Park Drive
Neenah WI-94956-2875
USA

[The most recent statement regarding the rabies vaccine supply
situation on the US CDC website dated 9 Feb 2009

gives the following information:

* The rabies vaccine supply situation has not altered since the 8
Oct 2008 update. Novartis continues to be able to deliver RabAvert
vaccine for post-exposure prophylaxis without supply restrictions.
Questions can be directed to Novartis customer service at 1-800-244-7668.
* Sanofi Pasteur continues to have IMOVAX vaccine available for
post-exposure prophylaxis following risk assessment from a state or
local health department official.
* To obtain IMOVAX rabies vaccine, you must 1st contact your Rabies
State/Local Health Official so that a risk-assessment can be
conducted for the suspected exposure. If your Rabies State Health
Official determines that rabies post-exposure prophylaxis is
indicated, they will provide you with a passcode to place on the
Sanofi Pasteur Rabies Post-Exposure Form. The form must be filled out
in its entirety, including the required physician's signature and
passcode provided by your Rabies State Health Official. Please
contact Sanofi Pasteur at 1-800-VACCINE to obtain the required form.
* Rabies immune globulin remains available with no changes in
historical supply.
* Rabies Vaccine for pre-exposure vaccination continues to be
limited to high risk occupations and First Responders.

Why is there an interruption in supply?

* Starting in June 2007, Sanofi Pasteur began renovating its IMOVAX
Rabies vaccine production facility in France to maintain compliance
with the most current requirements from FDA and the French regulatory
body. Prior to these renovations, Sanofi Pasteur established an
inventory based on historical levels of sales and projected market
demand. The facility is scheduled to be approved and operational by
mid-to-late 2009. Until the facility is operational, Sanofi Pasteur
has a finite amount of IMOVAX Rabies vaccine.
* After the renovations began, Novartis, the other supplier of
rabies vaccine for the United States, was unable to meet projected
rabies vaccine supplies.
* Since early 2008, Novartis has been supplying its rabies vaccine,
RabAvert, for post-exposure use only. Consequently, Sanofi Pasteur
has been supplying nearly all of the market for rabies vaccine. The
increase in demand for IMOVAX is outpacing the company's historical
levels of supply.

How does this affect current rabies vaccination recommendations?

* Persons at increased risk for rabies exposure should take
appropriate precautions to avoid rabies exposure.
* Vaccine is available for PEP, and providers should consult with
their local or state public health department to ensure appropriate use of PEP.
* General rabies awareness and prevention messages should be
emphasized to avoid exposure (e.g., avoid wildlife contact, vaccinate
pets/livestock, capture/observe/test exposing animal, etc.).

Dr Dedmon's response to the ProMED-mail RFI is highly relevant, and
in its turn generates a follow-on RFI. Other nationals contemplating
travel to Bali should be aware of their own situation. - Mod.CP]

Rabies, Canine, Human - Indonesia (03) : Bali, Request for information

2009-03-10T05:45:00.000-07:00

RABIES, CANINE, HUMAN - INDONESIA (03): BALI, REQUEST FOR INFORMATION
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 9 Mar 2009
From: Henry Wilde

My personal information from Bali and local press reports indicate
that the rabies outbreak, which started last year [2008] in
previously rabies-free Bali is not being handled as recommended by
the World Health Organization (WHO), using general vaccination of all
dogs (at least 70 percent) on the island.

Bali is still not instituting a dog rabies vaccination program and
only does "ring-vaccination" around identified cases. There have been
several human deaths. Tourists must be aware that any dog or cat or
monkey bite in Bali is a potential rabies exposure and that it needs
to be treated under WHO post exposure guidelines.

Long stay tourists or expats in Bali with rural and extensive street
exposure should consider pre-exposure rabies vaccination. I am also
not sure whether human or WHO standard equine rabies immunoglobulins
are readily available in Bali. This would be an other indication for
pre-exposure vaccination of long-term visitors. It seems now that due
to the long delay by local authorities to act appropriately, this may
be a repeat situation as happened in Flores and later Ambon, Indonesia.

Henry Wilde, MD, FACP
Professor of Medicine
Division of Research Affairs
Faculty of Medicine
Chulalongkorn University
Rama IV Road,
Bangkok,
Thailand 10330

[Little precise information has been reported in recent weeks
concerning the course of the outbreak of canine rabies, and
consequent human fatalities, in the Indonesian island of Bali. In
particular, there is concern about the extent of the dog vaccination
program and the availability of vaccine and immunoglobulin for
post-exposure treatment of humans unlucky enough to be attacked by a
rabid animal. Professor Wilde's call for disclosure of information is
timely and endorsed by ProMED-mail.

The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
. - Mod.CP]

Rabies, Bovine, Foxes - Belarus: (Grodno)

2009-03-08T10:49:00.000-07:00

RABIES, BOVINE, FOXES - BELARUS: (GRODNO)
*****************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 1 Mar 2009
Source: Information Agency "Belorusskiy Portal" [Trans. by Corr.BA, edited]

Unprecedented rabies outbreak in animals in Grodno region
---------------------------------------------------------
A total of 7 laboratory confirmed cases of rabies in wild animals
have been reported in the Zelvenskiy district. A dairy farm has been
placed in quarantine due to the detection of a calf with rabies.

Zelvenskiy, Volkovysskiy and Svislochskiy dictricts are the most
seriously affected territories in the Grodno region. 159 cases of
rabies have been reported in Grodno region during the entire year in
2008, compared to 74 cases during the 2 months January-February 2009.
Foxes are the main reservoir of rabies in this region. Their
population has grown recently.

Communicated by:
ProMED-mail

[A 3-year rabies control program, including oral vaccination of
wildlife, was implemented in Belarus in 2001. This was followed by a
subsequent reduction of rabies cases in animals, as recorded in 2004.
It would be helpful to note whether the oral vaccination was
continued in following years; if not, the observed deterioration of
the rabies situation should not surprise. - Mod.AS]

[A map showing the location of Belarus is available at:
- CopyEd.EJP]

Rabies, Feline - USA (New Mexico)

2009-02-22T17:20:00.000-08:00

RABIES, FELINE - USA (NEW MEXICO)
*********************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 20 Feb 2009
Source: Silver City Sun News [edited]

A 2nd bobcat in the region has tested positive for rabies, the New Mexico
Department of Health reported on Thursday [19 Feb 2009] afternoon. The
bobcat was discovered dead just east of Lake Roberts on 11 Feb 2009 and was
confirmed rabies-positive on Thursday [19 Feb 2009].

The bobcat was the 2nd rabid bobcat found within 5 days. The 1st bobcat
attacked an unvaccinated dog in Mimbres on 6 Feb 2009 and was confirmed
rabies-positive on 11 Feb 2009. The bobcat was shot by the landowner.

"It's unusual to see these kinds of cases," said Chris Minnick, New Mexico
Department of Health public information officer. According to state public
health veterinarian Dr Paul Ettestad, the bobcats were most likely infected
by rabid foxes.

New Mexico Game and Fish wildlife conservation officer John Armijo said he
and his staff have held discussions on the prevention of rabies in foxes
and bobcats but have not yet come to any conclusions. "We haven't come up
with anything affirmative yet," he said. Armijo said he wasn't alarmed by
the 2 rabid bobcats. "Obviously, rabies has been around for awhile," he
said. "It's a lot more prevalent right now" due to the large number of
animals. Two foxes in Grant County have tested positive for rabies in 2009.
Last year [2008], there were 28 cases of rabies in New Mexico, including 18
foxes and one dog in the southwestern area of New Mexico. There were 14
foxes and one dog with rabies in Grant County, 2 foxes in Catron County and
one fox in Sierra and Hidalgo counties, according to the Department of Health.

Rabid foxes have been a problem for decades in Arizona, but were 1st
detected in New Mexico in the Glenwood area of Catron County in 2007.
"Grant County residents need to be vigilant in their efforts to prevent
rabies from affecting their families and their pets," Ettestad said in a
prepared statement. "Rabies is a fatal disease that can be prevented with
vaccination but cannot be cured once it has been diagnosed." If anyone sees
a suspicious looking or dead animal, they are encouraged to call Armijo at
(575) 534-4023 or the Santa Fe central dispatch at (505) 827-9376.

[byline: Holly Wise]

communicated by:
ProMED-mail rapporteur Susan Baekeland

[Inaccurate statements from the above article have been edited out. Rabies
is a viral infection. There are different strains of the virus, but it is
always possible to transmit rabies from an infected animal to a
non-infected animal or person.

Generally with an animal, the brain or the whole head is sent to the state
laboratory for confirmation of rabies. The Centers for Disease Control and
Prevention (CDC) in Atlanta, Georgia usually only does strain typing of the
rabies virus.

There are a number of strains of the virus: skunk strain, raccoon strain,
bat strain and others. No strain is confined to the species it is named
for. For example, the bobcat could have died of raccoon or bat strains of
rabies. It would be useful to know which strains are circulating in the area.

It seems the trend of rabies is increasing in New Mexico. Perhaps the state
should initiate a rabies campaign to remind owners to vaccinate their dogs,
cats, horses and other show animals, as all mammals are susceptible to the
rabies virus. The state may want to consider oral rabies vaccination for
its wildlife. - Mod.TG]

Rabies, Bovine - USA : (Virginia)

2009-02-21T06:51:00.000-08:00

RABIES, BOVINE - USA: (VIRGINIA)
********************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 19 Feb 2009
Source: DNR on line

Calves test positive for rabies near Linville
---------------------------------------------
A total of 3 calves from a farm near Linville recently tested positive for
rabies, according to the farm's owner. Although no specific animal has been
recognized as the carrier, a raccoon was found on the farm that tested
positive for the disease. The family that lives on the farm has been
treated with a series of rabies shots as a preventive measure. Health
officials described the outbreak as an isolated incident.

"We thought we were treating pneumonia," the farm owner, who spoke on
condition of anonymity, said of the 1st case. "But the calf wasn't getting
better, so we called the vet."

The calf's remains were sent to the Virginia animal testing lab, where it
tested positive for the disease. A diagnosis of rabies can be confirmed
postmortem only through a pathology test on the animal's brain. The
following week, a set of twin calves from the farm also developed signs
consistent with rabies, and tests confirmed rabies in them as well. Health
officials said the public is not in any danger from the limited outbreak.

Rabies on farms rare
--------------------
According to the Virginia Department of Health's website, 18 cases of
rabies in cattle have been reported in Rockingham and Augusta counties in
the last decade.

Allen Gutshall, district environmental health program manager for the
Virginia Department of Health, said some people vaccinate horses or prize
bulls, but vaccinating an entire herd of livestock is not practical or
cost-effective. If a rabid animal is found among livestock, Gutshall
recommended calling a veterinarian before taking further action.

Sometimes something as simple as separating and observing the animals
exposed to the rabies carrier will determine whether the animals are sick
or if further action needs to be taken.

Getting rabies information
--------------------------
For a complete list of animals diagnosed with rabies in Virginia in the
past decade, log on to .

[byline: Regina Cyzick Harlow]

communicated by:
ProMED-Mail rapporteur Susan Baekeland

[The article above implies that clinical signs of rabies in cattle are easy
to recognize. In fact, the early signs in cattle can mimic a number of
other more mundane disease conditions. Just as this article states, they
thought they were dealing with pneumonia. Most producers will not call a
veterinarian for something they are comfortable treating. And this article
clearly implies that several to all the members of the family were exposed
to the calf or the calves before finding it was rabies.

Even if the raccoon had been found, and believed to have rabies, it is
still likely the 1st calf would have been treated by the producer for
pneumonia as rabies is not always easily recognized in cattle.

The idea expressed in the article above, that vaccinating a whole herd for
rabies may not be practical or cost effective, should be considered in
comparison with the value of a human life. Rabies vaccinations are very
cheap insurance because rabies can occur anywhere, does not announce itself
and can mimic other diseases.

There are states in the USA who believe they are free of rabies, but one
case, which could be human, will prove to them that rabies is no respecter
of state lines or regulatory rules. - Mod.TG

A map of Virginia is available at
- CopyEd.EJP]

Rabies, Human - United Arab Emirates ex India

2009-02-21T06:12:00.000-08:00

RABIES, HUMAN - UNITED ARAB EMIRATES ex INDIA
*********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 17 Feb 2009
Source: Gulf News online [edited]

Patient's death is 1st rabies fatality in UAE in 10 years
---------------------------------------------------------
A man being treated for rabies at a local hospital died on Monday [16 Feb
2009], the 1st such death in the United Arab Emirates (UAE) in a decade.
Gulf News reported the labourer from India was admitted to Al Baraha
Hospital on 8 Feb 2009 after he started showing symptoms. Rabies is
transmitted through saliva and blood from an infected animal. The most
common method of transmission is through bites, and globally more than 90
per cent of infections come from bites from rabid dogs.

Dr Ali Al Marzouqi, director of public health at the Department of Health
and Medical Services, told Gulf News it was the 1st rabies case in the UAE
in a decade. "The last case was 10 or more years ago. I have been in the
public health sector for 9 years and this is the 1st case we've got," he said.

Dr Ali Shakar, director-general at the Ministry of Health, told Gulf News
the man's hand was bitten 6 months ago, prior to his arrival in the UAE.
"If he had sought treatment immediately after the bite, or even after he
arrived in the UAE, maybe he would have been okay," he said.

Treatment for rabies involves cleaning and disinfecting the wound, and
giving the victim a post-exposure vaccination as soon as possible. Rabies
is almost always fatal when symptoms show up. Dr Shakar said there was no
need to vaccinate anyone as the man's contacts in the UAE have not shown
signs of exposure to the virus. Exposure refers to a case where infected
saliva enters an open wound. "The main thing is this is not a public health
scare so there is no need to panic. It can happen anytime, anywhere in the
world," he said. "It doesn't transfer like other [infectious] diseases.
It's not bird flu," he added.

He also said the body would be buried according to the World Health
Organisation (WHO) procedures, which dictates the immediate burial or
cremation of the body. No special containers are required for the body,
although embalming is discouraged. Despite the case, health authorities are
unlikely to require incoming residents and workers to be screened for rabies.

"We have other more important diseases to watch out for like HIV,
tuberculosis and sexually-transmitted diseases, which are more infectious,"
Dr Marzouqi said. "And if someone gets rabies here, so what? Transmission
is rare and we have vaccines to treat people after they are bitten," he said.

Facts about rabies: Rabies is a zoonotic disease that kills 55 000 people a
year worldwide, mostly in rural areas in Asia and Africa. It 1st shows up
with flu-like symptoms, including fever, headache, and fatigue. Then it
progresses to involve the respiratory, gastrointestinal, and the central
nervous systems. It also leads to hydrophobia or fear of water, due to
spasms in the throat. The patient develops hyperactivity, called furious
rabies, or paralysis, called dumb rabies.

UAE regulations: Pets are required to be vaccinated. Rabies is a notifiable
disease under the public health laws, requiring all sectors to report an
encounter.

[byline: Nina Muslim]

communicated by:
ProMED-Mail rapporteur Susan Baekeland

[An unfortunate accompaniment of the global migration of populations.

The HealthMap/ProMED-mail interactive map of the United Arab Emirates is
accessible at . - Mod.CP]

Rabies, Canine, Human - Angola (03) : Luanda - 69 children reported dead from rabies

2009-02-20T02:54:00.000-08:00

RABIES, CANINE, HUMAN - ANGOLA (03): LUANDA
*********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 18 Feb 2009
Source: Independent Online [edited]

The number of children killed from rabies in Luanda rose to 69 on
Wednesday [18 Feb 2009], up from 50 last month, prompting authorities
to launch a new drive to round up hundreds of stray dogs in Angola's
capital city. The Health Ministry said health workers were rounding
up hundreds of strays in Luanda to counter the deadly virus that is
transmitted to humans through the bite of an infected animal. Almost
a 1000 dogs have already been collected since the rabies outbreak
began in November [2008]. Those that test positive for rabies are
killed; the others are released. "This is a tragedy because despite
all the efforts to control the rabies outbreak, things aren't getting
any better," Luis Bernardino, the director of Luanda's largest
children's hospital, told Reuters.

Children aged between 3 and 10 have been the main victims, as they
cannot protect themselves from dogs. Bernardino said the children are
usually from poor districts surrounding Luanda's urban core, where
thousands of stray dogs roam. Authorities in Luanda carried out a
city-wide vaccination campaign last month [January 2009] in which 100
000 animals -- dogs, cats and monkeys -- were inoculated in a city
that is home to more than 1/3rd of Angola's 16.5-million-strong
population. But this has failed to prevent the rabies death toll
among children from climbing in a country that already has one of the
worst infant mortality rates in the world. Two out of every 5
children die before reaching the age of 5, according to the United Nations.

Communicated by:
HealthMap Alerts via
ProMED-mail

[The effort to control urban rabies in the Angolan capital by a
combination of killing rabies-virus-infected feral dogs and
vaccination of urban dogs, cats and monkeys has had little impact on
the number of young children dying as a result of rabies virus
infection. A more sustained effort to control rabies by these means
will have to be implemented in combination with a more effective
education effort to inform the population of the hazard of rabies.

The HealthMap/ProMED-mail interactive map of Angola showing the
location of Luanda in the north of the country can be accessed at:
.
- Mod.CP]

Rabies vaccine - China; Recall of 300,000 + doses of Rabies vaccine

2009-02-20T02:50:00.000-08:00

RABIES VACCINE - CHINA: RECALL, REQUEST FOR INFORMATION
******************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 11 Feb 2009
Source: Xinhua News Agency [edited]

China recalls more than 320 000 doses of flawed rabies vaccine
--------------------------------------------------------------
More than 320 000 doses of rabies vaccine found to contain a banned
ingredient have been recovered in China after regulators ordered a
recall, an official said Wednesday [11 Feb 2009]. Among 360 200 doses
of the flawed vaccines for human use, 323 200 had been recovered by
Monday afternoon [9 Feb 2009] by the manufacturer, Dalian
Jingang-Andi Bio-products Co. Ltd. in northeast China's Liaoning
Province, said Yan Jiangying, spokeswoman for the State Food and Drug
Administration (SFDA). She said she believed the rest of the
vaccines, where not used, had been held for recall. There has been no
report of vaccine-related illness so far.

The SFDA asked the province's drug administration department to make
sure all products were recovered, Yan said at a press conference. The
agency ordered the company to recall all rabies vaccine it produced
in 2008, totaling 3.389 million does, soon after the department
received a report from the National Institute for the Control of
Pharmaceutical and Biological Products (NICPBP) in early January [2009].

The institute found in a test that 360 200 doses of the company's
vaccines contained nucleic acid, which was not supposed to be added
until its safety had been proven. Nucleic acid acts as an adjuvant,
or a substance used to enhance the effectiveness of anti-viral drugs.
However, China hasn't yet approved it for use in rabies vaccine, said
Dong Guanmu, a researcher at the NICPBP. Dong said although animal
tests showed the acid did enhance the effectiveness of the vaccine,
it had to undergo clinical trials before it could be used on humans.

The company said on its website that it now supplies 20 percent of
the rabies vaccine in China's market. The company could not be
reached immediately for further information on the recall because the
telephone number it published online was no longer in use.

Communicated by:
ProMED-mail

[The expanded use of rabies vaccine for both pre- and post-exposure
immunisation has created a requirement for vaccines of higher
potency. The production of vaccines in cell culture is complicated by
the need to exclude animal serum from the final product and addition
of adjuvants is one approach to enhancement of vaccine potency. The
report above does not identify the nature of the nucleic acid present
in the rejected vaccine, but if it is not merely indicative of a
contaminant it may be an adjuvant which has not yet received approval
from a regulatory organisation.

For example, in China Wang et al have described a CpG
oligodeoxynucleotide, which acts as a potent adjuvant for inactivated
rabies virus vaccine (Vaccine. 2008 Mar 28; 26(15): 1893-901;
abstract available at ).
Their data indicated that the CpG oligodeoxynucleotide could be used
as a promising adjuvant to replace or combine with aluminum for
developing more effective rabies vaccines. Their data show that the
CpG oligodeoxynucleotide could be used as an effective adjuvant in
experimental animals (mice) to replace of or combine with aluminum
for development of more effective rabies vaccine.

Further information on the reason for the withdrawal of the rabies
vaccine batches described in the preceding report would be welcomed. - Mod.CP]

Rabies, Bovine, Feline - USA : (Vermont, Montana)

2009-02-15T11:54:00.000-08:00

RABIES, BOVINE, FELINE - USA: (VERMONT, MONTANA)
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1] Vermont
Date: 14 Feb 2009
Source: Burlington Free Press [edited]

Rabies killed 2 cows at a Charlotte dairy farm this week, prompting
state officials to encourage vaccination of dairy herds.

The rare rabies incident presents no danger to the public milk
supply, assuming the milk is pasteurized, said Kelly Loftus, an
Agency of Agriculture spokeswoman. Pasteurized milk is heated to a
temperature that kills viruses and bacteria.

The infected cows died Monday and Tuesday [9-10 Feb 2009], Loftus
said. Tests confirmed the animals died of rabies. The rabies might
have been contracted from a raccoon that was killed by a farm dog
before the cows became ill, Loftus said. The dog had its rabies
vaccination and was unharmed, Loftus said.

The 2 cows were part of a 30-head herd at Judy and Robert Albu's
dairy farm in Charlotte, she said.

Joe Klopfenstein, owner of Vergennes Large Animal Associates in
Vergennes, said he was called to the Charlotte farm Sunday [8 Feb 2009].

"The 1st cow was down. She was stuck in her stall. She couldn't get
up. She was obviously not responsive. She was blind. She was not
responding to me. She had a low body temperature, dry stool,"
Klopfenstein said. "There were a lot of very unusual signs."

At first, Klopfenstein thought the cow had low-blood calcium. "But
the systems were not consistent," he said. The 2nd cow, he said, was
"hyper-aware. She looked like she was startled. Her eyes were wide
open, and her ears were up like something had frightened her,"
Klopfenstein said.

One cow was a Jersey and one was Holstein. He suspected both cows
would die. "The prognosis was poor," he said, and he encouraged
rabies tests be conducted because of the unusual neurological signs.

These aren't the 1st animals with rabies Klopfenstein has come across
during his 25-year career. He has evaluated similar cases in cows in
Monkton and Shoreham, a pig in Hinesburg, and a sheep in New Haven.
But those were exceptions. "Rabies is so rare," he said.

"It is unusual, but it does happen," Loftus said, noting Vermont had
one such case last year [2008]. Throughout the country, 150 cows
contracted rabies last year, she said.

State officials were initially concerned some of the people at the
Charlotte farm might have consumed raw milk that could have
transferred the rabies, which can be fatal. By Friday [13 Feb 2009]
afternoon, however, officials no longer believed farmers had drunk
the tainted milk, she said.

"Cows -- or any warm-blooded animal -- can pass rabies to people,
although there is no documented case of a human becoming infected
with rabies by drinking raw milk from a rabid cow. However, out of an
abundance of caution, the Health Department recommends that anyone
exposed to the virus should discuss possible treatment with their
health care provider," said Patsy Kelso, the state's acting
epidemiologist. "Because human rabies is fatal and the vaccine is
nearly 100 percent effective, we want to make sure that anyone who
may have consumed raw milk from the cow meet with their medical
provider to make an informed decision about whether or not to get vaccinated."

Since 1987, federal regulations have required all milk packaged for
human consumption be pasteurized before delivery into interstate commerce.

The Health Department and Agency of Agriculture are encouraging
anyone who had close contact with the cows or may have consumed raw
milk between 25 Jan and 8 Feb 2009 to discuss vaccination with their
health care provider.

The farm's remaining cows were vaccinated Wednesday [11 Feb 2009] and
are expected to remain healthy, Klopfenstein said.

Communicated by:
ProMED-mail

*********************************************************************************

[2] Montana
Date: 13 Feb 2009
Source: Helena Independent Record [edited]

Officials with the Lewis and Clark County Health Department confirmed
a case of rabies in a "semi-feral" cat near East Valley Middle School
Thursday [12 Feb 2009].

The cat, which has since been euthanized, was brought to a local
veterinarian by the owner, said Laurel Riek, an environmental health
specialist with the health department. Health department officials
presume the test will come back positive for rabies, and confirmation
is expected on Friday [13 Feb 2009].

In the interest of protecting the public, Riek said, notices about
the incident were sent out prior to that confirmation. A note was
sent home with students attending East Helena Public Schools on
Wednesday [11 Feb 2009], and text messages circulated Thursday
morning, Superintendent Ron Whitmoyer said.

"We can be proactive in our approach," he said.

Other unvaccinated cats from the East Helena home have been captured,
and animal control is assessing their threat, said Mike Henderson,
the health department communicative-disease control division administrator.

Rabies is an infectious viral disease that affects the nervous system
of humans and other mammals. People primarily get rabies from the
bite of an animal with rabies through the saliva of the infected animal.

It's not uncommon for wild animals to be rabid, Henderson said, but a
domestic animal with rabies hasn't been reported in the county since 1994.

Officials say if a person is bit by an animal suspected of having
rabies, they should wash the wound thoroughly with soap and water,
seek medical attention, and report any animal bites to the health
department at 447-8355 or the Lewis and Clark's Sheriff's office.

Communicated by:
ProMED-Mail Rapporteur Susan Baekeland

[All animals that we come into contact with should be vaccinated
against rabies. Rabies is a virus that is fatal for animals and is
almost always fatal in humans. It is extremely cheap insurance to
vaccinate your horses and cattle, cats and dogs.

Cattle with rabies are often hyper-alert with an odd ear twitch and a
very odd bellow that more often than not makes the hair on one's neck
stand up. Farm animals with rabies often have unusual signs (animals
have signs not symptoms) that may mimic other common diseases.

In the case with the cats, this is an excellent opportunity to remind
all owners to vaccinate their animals. - Mod.TG]

Rabies, Equine, Skunk - USA : (Kentucky)

2009-02-14T13:02:00.001-08:00

RABIES, EQUINE, SKUNK - USA: (KENTUCKY)
********************************
Date: 12 Feb 2009
Source: The Horse.com [edited]

Rabid Horse Found in Kentucky
-----------------------------
A horse in the Hamilton Lane/North Yarnallton Pike area of Lexington,
Kentucky, has tested positive for rabies, according to a statement
from the Lexington-Fayette County Health Department.

Department Spokesman Kevin Hall said the thoroughbred began showing
clinical signs similar to colic on 5 Feb 2009. The horse was admitted
to an equine hospital and underwent exploratory surgery. While in
isolation following surgery, the animal started having violent
seizures and was euthanized. Testing confirmed rabies in the animal
11 Feb 2009. Hall said the investigation into the level of human
exposure is under way.

"Right now we're looking to see the level of exposure," Hall said.
"We're visiting with the farm and with any workers that might have
been exposed."

A skunk near Abbeywood Road also tested positive this week 8-14 Feb
2009]. Earlier this year, another skunk that tested positive for the
disease was found in a pasture near Spurr Road. In that case, a man
was bitten while trying to dispose of the animal. These bring the
total of rabies cases in the county in 2009 to 5 -- already one more
than in all of 2008.

Kentucky state law requires that dogs, cats, and ferrets maintain
annual rabies vaccinations.

Clinical signs of rabies in a horse can look like many different
things, including colic. The CDC reported 53 cases of rabies in
horses in 2006. A Webinar (Web-based seminar) on rabies, along with a
transcript, presented by Steve Reed, DVM, Dipl. ACVIM, is available
at the Source URL, noted above.

[Byline: Erin Ryder, News Editor]

Communicated by:
ProMED-mail Rapporteur Susan Baekeland

[This moderator has long been an advocate of rabies vaccination in
horses and any farm animal that is shown or handled. It is very cheap
insurance compared to losing a human life or even a prized animal.
Unfortunately, when a large animal is exposed to rabies there are
often many people exposed before the diagnosis is made. The reason is
because rabies mimics other diseases in our large animals. - Mod.TG]

[A map of the state of Kentucky is available at:

- CopyEd.EJP]

Rabies - Brazil (03) : (Pernambuco), Recovery from Rabies using the Wisconsin Protocol

2009-02-14T07:43:00.000-08:00

RABIES - BRAZIL (03): (PERNAMBUCO), RECOVERY
********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 12 Feb 2009
From: Gustavo Trindade Henriques Filho

[In response to a ProMED inquiry about the status of the Pernambuco,
Brazil, surviving rabies patient, the following was received from Dr.
Henriquez Filho, the attending physician. - Mod.TY]

Our patient is alive. He was discharged from the critical care unit
last Wednesday (4 Feb [2009]). He is conscious, but with motor
limitations. He is conscious and speaking, with a good cognitive function.

Gustavo Trindade Henriques Filho, MD
Critical Care Unit of Infectious Diseases,
Oswaldo Cruz University Hospital
Pernambuco State University
Brazil

[This patient was treated following the Wisconsin protocol, and
represents a 2nd survival after the development of clinical disease
following treatment using the the Wisconsin protocol. ProMED thanks
Dr. Henriques Filho for this report, and will be interested in future
information about the patient's progress. The details relating to
this case and the original one in Wisconsin, as well as the
discussion it engendered concerning the efficacy of the Wisconsin
protocol in survival of rabies patients, can be found in the ProMED
archives listed below. - Mod.TY]

Rabies, Canine, Human - Angola (02) : (Huambo)

2009-02-04T19:46:00.001-08:00

RABIES, CANINE, HUMAN - ANGOLA (02): (HUAMBO)
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 3 Feb 2009
Source: Agencia AngolaPress [Portugese, trans. Mod.MPP, edited]

The Health Department of the Caala municipality, which is located 23
km from the provincial capital, reported 5 cases of people being
bitten by rabid dogs that were roaming in the main streets of the
city during the month of January [2009].

This fact was given to the Angop [Angola Press] today [3 Feb 2009] by
the head of the Health Division in the municipality of Caala, Ernesto
Albino Ndumbo, and thanks to prompt intervention of hospital
services, they [the people bitten by the rabid dogs] are out of
danger [presumably as a consequence of post-exposure vaccination].

Furthermore, the head of the municipal Health department in Caala
said the municipal health technicians have increased actions to raise
the awareness of residents on preventive measures against rabies. He
stressed that in addition to conducting talks in health centers, the
health technicians have also conducted door to door sensitization
activities to encourage the population to take their animals to the
vaccination centers.

The Angop knows that in the entire township of Caala, since January
2009, the veterinary services have immunized approximately 500
animals with rabies vaccine including dogs, cats and monkeys.

Communicated by:
ProMED-mail

[Unfortunately, such incidents have not been rare in Angola, and the
efforts of the authorities have been reactive rather than preemptive.
In January 2007 (see archive reference below), a similar outbreak
occurred in another township (Ukuma), also close to the provincial
capital, in which 21 people were bitten by dogs, one of whom died}

The location of Caala, a community of approximately 7000 persons in
the province of Huambo, can be found at:
.

A map of the provinces of Angola can be accessed at:

showing Huambo in the centre of the country. - Mod.CP]

Rabies, Canine, Human - Indoensia (02) ; Bali, Alert

2009-02-01T01:45:00.000-08:00

RABIES, CANINE, HUMAN - INDONESIA (02): BALI, ALERT
***************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 30 Jan 2009
Source: The Telegraph online [edited]

Bali tourists warned about rabies
---------------------------------
The authorities in Bali are battling a rabies outbreak that has
spread across the island and is threatening its tourism industry. The
1st cases were reported in Denpasar and Badung districts last
November [2008], but this month it spread to Kuta, one of the main
tourist resorts.

Since the beginning of January [2009], the number of infected people
has increased from a "handful" a week to at least 10 a day, hospital
staff have said. A total of 6 deaths have been reported. More than 24
000 pet dogs have been vaccinated, while more than 1000 strays have
been culled.

"It could be that in the past few months there were a number of cases
that weren't reported," said Ken Wirasandhi, the director of services
at Sanglah, Bali's largest hospital. "We've received calls from
tourists asking about the rabies situation, but we haven't received
reports of any tourists being bitten by dogs," said Gede Nurjaya, the
head of the Bali Tourism Authority.

Tour operators report that the outbreak has not yet led to
cancellations, but admit it is vital that the spread of the disease
is contained quickly. A spokesman for the tour operator Kuoni, which
reported this week that Indonesia had moved up from 20th in 2007 to
16th in its annual list of popular long-haul destinations, said it
was making passengers aware of the risks, but that no one had cancelled.

Since the onset of the financial downturn, Bali has struggled to
attract visitors. The number of tourists has failed to reach the
levels experienced before the bombings in October 2002, which killed
202 people. A further setback has been the banning of Indonesia's
main carrier, Garuda, from European territory, because of safety concerns.

The Foreign Office has joined the United States and Australia in
issuing a warning to travellers about rabies in Bali. Rabies has been
reported on the Indonesian islands of Java and Flores [see ProMED
refs. below. - Mod.JW], but this is the 1st time it has been recorded
on Bali.

The World Health Organisation estimates that more than 40 000 people
die from rabies every year. Most deaths take place in developing
countries, particularly in South-East Asia. Since 1946, there have
been 23 deaths among Britons infected with rabies abroad. A woman,
from Belfast, was the last Briton killed by the virus. She died
earlier this month [January 2009] in a hospital.

Byline: Charles Starmer-Smith]

Communicated by:
ProMED-mail

[The Indonesian authorities' efforts to contain the outbreak of
canine rabies to a restricted region of the island of Bali do not
appear to be succeeding, since the identification of a handful of
suspected human cases in late 2008/early January 2009 to the current
10 infected [bitten?] people a day, and a total of 6 fatalities, is a
measure of the lack of success in controlling the spread of canine
rabies on the island. Previous experience on other neighboring island
indicates that canine rabies cannot be controlled in the absence of a
comprehensive and systematic vaccination programme.

A map of the island of Bali showing the location of the endangered
tourist area of Kuta at the base of the southernmost peninsula, is
available at:
.

The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
. - Mod.CP]

Rabies - Brazil (02) : (Goias) .. Wisconsin treatment - additional information

2009-01-30T03:31:00.000-08:00

RABIES - BRAZIL (02): (GOIAS)
*****************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 29 Jan 2009
From: Michael Donnenberg

Regarding the Brazilian boy who died despite treatment with the
"Wisconsin Protocol," this brings to at least 3 the numbers of
patients who received this treatment and died. Two were reported in
MMWR [CDC Morbidity and Mortality Weekly Report]. Thus far, only the
original patient survived and it should be noted that the virus was
never recovered from that patient. Thus, it may well be that her
remarkable recovery was due to infection with a defective virus
rather than the treatment. It would be very helpful if the readership
could post additional cases in which the protocol was attempted.

Michael S Donnenberg, MD
Professor of Medicine
Associate Chairman for Research, Department of Medicine
University of Maryland School of Medicine
20 Penn Street, HSF2 S403D
Baltimore, MD 21201
USA

[In fact, the Pernambuco, Brazil case is still alive following
the Wisconsin protocol. - Mod.MPP]

[ProMED-mail thanks Dr Donnenberg for his comments, which were
prompted by the report in ProMED-mail archive no. 20090128.0394
posted 28 Jan 2009.

If the virus was significantly defective, it would not have
replicated at all. Unfortunately, rabies virus RNA was not detectable
by reverse transcriptase polymerase chain reaction assay in samples
taken from the Wisconsin patient, so the rabies virus variant was not
identified in this case (see ProMED-mail archive no. 20041223.3390).
Nor was the rabies virus isolated so that tests for relative
neurovirulence were not possible either.

The Wisconsin patient developed very high titers of rabies antibody in
blood and cerebral spinal fluid, which makes one wonder if she mounted
an unusually vigorous and rapid antibody response to her infection,
that resulted in her clearing the virus quickly that contributed to
her survival. Comments would be welcome from others who have employed
the Wisconsin protocol, especially Dr RE Willoughby and colleagues who
treated the surviving US patient. - Mod.TY].

Rabies - Brazil : (Goias) -- an update of a previous report

2009-01-29T00:10:00.000-08:00

RABIES - BRAZIL: (GOIAS)
**********************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 25 Dec 2008
Source: O Globo [Portuguese, trans. & summ. Mod.TY, edited]

A boy 12 years of age died this morning [25 Dec 2008] in Brasilia,
confirming the suspicion of rabies. The boy had cardio-respiratory
arrest and did not respond to attempts at resuscitation. The child
lived in Sao Domingo, in northern Goias, where he had contracted the
disease, and was taken to the Hospital de Base in Brasilia for
medical treatment.

The boy played with a bat when he was bitten in the foot. He was
hospitalized a month ago and [treatment of his case] was advised by a
doctor of the United States via videoconference. The boy's
[treatment] was carried out according to a method developed recently
using antivirals and inducing a coma in the patient.

The Secretary of Health Surveillance, Disney Antezana, reminds [the
public] that rabies can be contracted in both urban as well as rural
settings.

Communicated by:
ProMED-mail

[This case appears to be the same one reported in ProMED archive no.
20081224.4057, although the reported ages of the patient vary (9
years previously versus 12 years in this report). The previous
report indicated that the child was put into a medically-induced
coma, with treatment according to the Wisconsin protocol.
Unfortunately, the child did not survive after 3 weeks of
hospitalization. When admitted to hospital, his condition was
serious, and there is no indication of how many days had elapsed from
the time of 1st exposure to the development of symptoms and
hospitalization.

A map of Brazil showing the location of Goias state and the Federal
district can be accessed at
.
A HealthMAP/ProMED interactive map of Brazil can be accessed at
.
- Mod.TY]

Rabies risk, Bats, Urban - Brazil : (Rio de Janiero)

2009-01-26T10:42:00.000-08:00

RABIES RISK, BATS, URBAN - BRAZIL: (RIO DE JANEIRO)
***************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sat 24 Jan 2009
Source: O Globo Rio [in Portuguese, trans. & summ. Mod.JW, edited]

In late December 2008, a 70-year-old woman was bitten near the right
eye by a bat inside her house in the Fonte de Saudade district of Rio
de Janeiro, Brazil. Since then, she and her neighbors sleep with the
windows closed. At first she did not realize she had been bitten, but
after a few days the spot became inflamed and very itchy. Doctors
told her it was a bat bite and have been treating her with
anti-rabies serum and rabies and tetanus vaccines.

Another woman, aged 38, living in the Leblon district of the city,
said that last year [2008] she was bitten in the foot while sleeping
in her apartment, and bled profusely.

Professionals at the RioZoo Foundation said that vampire bats
(_Desmodus rotundus_) bite mammals, but that the commonest bat in Rio
is the fruit bat (_Artibeus lituratus_). The mountainous areas of
Alto da Boa Vista and Gavea [where there are forests and caves. -
Mod.JW] are other parts of Rio where bats have been known to attack
people.

They said that bat bites can lead to 3 types of disease: tetanus,
mild infections, and rabies. They recommend that if a bat enters a
room, the lights should be turned off and the windows left open so
that it can get out again. In case of a bat bite, the victim should
go to a health post to be treated with anti-rabies serum and rabies
and tetanus vaccines, and antibiotics.

Communicated by:
ProMED-mail

[The initially painless bite inflicted on the 1st victim sounds like
a small insectivorous bat, which is unlikely to bite a human unless
it is rabid. The profusely bleeding wound on the foot of the 2nd is
characteristic of a vampire bat bite, and it is hoped that the victim
is also receiving the appropriate treatment, although not every
vampire bat is infected with rabies virus. Fruit bats are large and
very noticeable (see image below), and unlikely to have been involved
in these 2 cases, but can also transmit rabies if infected in the
roost.

Image of insectivorous bat (_Myotis_ sp.):

Image of a vampire bat (_Desmodus_):

Image of a fruit bat (_Artibeus_):
. - Mod.JW

Rio de Janeiro can be located on the HealthMap/ProMED-mail interactive
map of Brazil at
. - CopyEd.MJ]

Rabies, Canine, Human - Angola: (Luanda)

2009-01-25T06:30:00.000-08:00

RABIES, CANINE, HUMAN - ANGOLA: (LUANDA)
****************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 20 Jan 2009
Source: Diario Digital [trans. by Mod.MPP, edited]

Outbreak of rabies has killed 42 children in Luanda
---------------------------------------------------
An outbreak of rabies in the Angolan capital has resulted in the
death of 42 children since October [2008], Luis Bernadino, the
Director General of the Pediatric Hospital of Luanda, revealed today
[20 Jan 2009]. The Health Services of the Provincial Government of
Luanda has not yet provided data on the total number of cases,
including adults.

Luis Bernardino told the Lusa News Agency that the number of deaths
[42] refers to the total number of children admitted to the hospital
that were infected with rabies virus. The doctor stated that that the
majority of victims are male children, between 4 and 10 years old.
According to the Director General of the Luanda Pediatric Hospital,
the high number of [cases], is due to the fact that they are admitted
'too late' when it is no longer possible to save lives. "The vaccines
are only effective if administered within 24 hours after infection
[the bite]," he stressed. The report advises that, 'when there is the
knowledge that a child (and perhaps also adults), has been bitten by
animals -- mostly dogs, cats or monkeys -- the child she should be
taken immediately to a medical post so they can be vaccinated and monitored.'

To combat the rabies outbreak, during the past 12 days, the Luanda
Provincial Government has implemented a campaign involving mass
vaccination of animals and collection of strays. This campaign ends
next Friday [23 Jan 2009] and data currently indicate that more than
50,000 animals have been vaccinated. In statements to Lusa, the
Provincial Director of Agriculture and Rural Development, Maria
Galeia da Paz, said that the campaign is going well, having already
vaccinated in 8 days, the number of animals that, in normal years,
took 45 days to vaccinate. A total of 25 brigades, with 100
vaccinators for each municipality were formed, with the exception of
the municipality of Maianga which has only 80 vaccinators. Luanda has
9 municipalities. There are already 9 cars, one for each municipality
that are being used for the collection of animals. Each municipal
government has the task of preparing a place where the animals can be
held temporarily pending identification by owners. "People have no
more than 24 hours to make the claims, so after that period [24
hours] animals that have not been claimed by owners will be killed,"
he stressed.

Communicated by:
ProMED-PORT

[The HealthMap/ProMED-mail interactive map of Angola is available at:
. The capital, Luanda,
is situated on the northern coast of Angola, some 200 miles to the
north of Huambo where a similar large scale outbreak of rabies
occurred in 2007. The authorities in Luanda appear to be responding
with vigor to control the domestic and feral dog population, but the
balance between vaccination and killing is not clear from the
report. - Mod.CP]

Rabies, Canine, Human - South Africa : (Eastern Cape) Suspected

2009-01-18T06:42:00.000-08:00

RABIES, CANINE, HUMAN - SOUTH AFRICA: (EASTERN CAPE) SUSPECTED
**************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 16 Jan 2009
Source: Independent online, SAPA report [edited]

Suspected rabies outbreak in Eastern Cape
-----------------------------------------
The Eastern Cape Department of Health officials were attending to a
suspected rabies outbreak in Mgwenyane village near Libode on Friday 16 Jan
2009, the department said. Spokesperson Sizwe Kupelo said the department
had dispatched an outbreak team to the village after at least 8 people were
bitten by 2 dogs in the village.

One of the dogs attacked its owner and then bit 5 other people before
running away. The other dog bit 2 people and also ran away. The dogs were
believed to have fled into a nearby forest. All the people who had been
bitten were identified and taken to a nearby hospital where they were being
treated for dog bites and receiving anti-rabies medication.

The outbreak team was on the scene informing people to treat all dogs in
the area with suspicion. "We are urging those who had been bitten to come
forward and be treated with immediate effect," Kupelo said. The suspected
outbreak was reported to the Eastern Cape Department of Agriculture. The
Department was responsible for immunising dogs in the area and would help
with further investigations. Kupelo said that the Department only suspected
that the dogs suffered from rabies but that further investigation would
reveal the facts. The ages of the people bitten ranged from 4 to 66 years old.

communicated by:
HealthMap Alerts via ProMED-mail

[Although the diagnosis of rabies virus infection has not been confirmed by
laboratory tests, it is highly probable that the diagnosis will be
confirmed in view of the frequency of reports of rabies from this province
of South Africa. That said, this report suggests that the risk of
contracting rabies virus infection from feral dogs may be of no greater
concern than some of the social practices prevalent in the region.

The HealthMap/ProMED-mail interactive map of South Africa is available at
. A map showing the provinces
of south Africa can be accessed at
, and the
location of the city of Libode can be found at
. - Mod.CP]

Rabies, Human - UK (05): (Northern Ireland) Ex South Africa

2009-01-17T02:28:00.000-08:00

RABIES, HUMAN - UNITED KINGDOM (05): (NORTHERN IRELAND) EX SOUTH AFRICA
***********************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1]
Date: Wed 14 Jan 2009
Source: The Nursing Times online [edited]

Rabies death in Northern Ireland sparks Health Protection Agency investigation
------------------------------------------------------------------------------
The Health Protection Agency [HPA] has launched an investigation following
the death of a young woman from rabies in Northern Ireland last week [5-9
Jan 2009]. Officials from the agency are attempting to trace volunteers who
have worked at the Riverside Wildlife Rehabilitation and Environmental
Education Centre in Limpopo, South Africa.

The woman, who died last week, is thought to have acquired rabies following
a bite from a dog while working at the animal sanctuary in December 2006.
The centre has written to all those who volunteered there since July 2006
as a precaution and it is estimated that around 230 UK citizens have worked
there since that date. Volunteers are being advised that if they have been
bitten or scratched by a dog or mongoose within the centre or surrounding
area, they should seek medical advice.

Rabies vaccine is extremely effective at preventing the disease even if it
is given some time after an exposure. Dr David Brown, HPA rabies expert,
said: 'This is a tragic event and is a very real example of the need to get
health advice before you travel to countries where rabies is common or if
you know you will be working with animals. "Talk to your doctor or nurse
about whether or not a rabies vaccine is appropriate."

(byline: Richard Staines)

communicated by:
ProMED-mail
via HealthMap alerts

******
[2]
Date: Fri 16 Jan 2009
Source: HPA. Health Protection Report [edited]

Rabies, Fox, Human - Russia: (Moscow Region)

2009-01-15T13:55:00.000-08:00

RABIES, FOX, HUMAN - RUSSIA: (MOSCOW REGION)
********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 12 Jan 2009
Source: Life.ru News Agency [in Russian, trans. & summ. Corr.BA, edited]

Fatal rabies case in the Moscow region
--------------------------------------
An emergency situation has been declared in the Noginsk area of the Moscow
region [oblast] where a fatal case of rabies has been reported. All those
who have had contact with the fatal case are under observation.

It is inferred that the deceased patient, a 42 year old man, contracted
rabies in August 2008 when he was bitten by a sick fox. He did not
immediately seek medical treatment and was admitted to hospital only much
later, when his condition had deteriorated. He died on 31 Dec 2008.

communicated by:
ProMED-RUS

[There has been an increase in the number of human cases of rabies in
several Russian regions. According to official statistics the number of
[fatal] cases of rabies virus infection increased from 5 during 11 months
of 2007 to 15 for the same period of 2008. - Mod.NP

An interactive map of the regions of Russia can be accessed at
. The HealthMap/ProMED-mail interactive map
of Russia is available at
- Mod.CP]

Rabies - China : (Shandong)

2009-01-15T01:04:00.000-08:00

RABIES - CHINA: (SHANDONG)
**************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Mon 12 Jan 2009
Source: GoogleNewsZH [Chinese, trans. Angela Song-En Huang, edited]

According to the Yantai City Disease Control Center, the number of
infectious diseases reported in Yantai [Shandong Province] continues to
fall steadily. But there has been a rise in the number rabies cases.

For the 9 years following 1998, Yantai City reported no locally-acquired
rabies cases. With the keeping of pets becoming more and more popular after
2007, there has been much trading and exchange of animals between cities.
Yentai began to report rabies occasionally, resulting in an expansion of
affected areas.

In addition, the rat population has increased, resulting in increases of
[hantaviral] hemorrhagic fevers. Although cases of AIDS and tuberculosis
are falling, they may increase in the future. Experts warn that people must
continue to protect themselves from infectious diseases.

communicated by:
ProMED-mail via
HealthMap

[Further information on measures being taken to control the spread of urban
rabies in Yantai city and Shandong province, such as the policy regarding
vaccination of household pets, would be welcomed.

A map of Shandong province, showing the city of Yantai on the north coast,
is available at . The
HealthMap/ProMED-mail interactive map of China can be accessed at
. - Mod.CP]

Rabies, Bat, Feline & Human Exposure - USA: (Illinois)

2009-01-13T07:04:00.001-08:00

RABIES, BAT, FELINE AND HUMAN EXPOSURE - USA: (ILLINOIS)
********************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 11 Jan 2009
Source: Shavedlongcock.blogspot.com [edited]

The discovery of a rabid bat in the Lincoln Square neighborhood prompted
the city late on Saturday [10 Jan 2008] to issue a warning against any
contact with bats or other wild animals. On Wed 7 Jan 2009, a house cat
discovered the bat in an apartment near Lawrence and Western Avenues and
woke up a man and woman in the dwelling, according to the Chicago
Department of Public Health. The couple saw the bat lying on the floor and
trapped it with a bucket, and then called staff from Chicago Animal Care
and Control to remove it.

Analysis of the bat's carcass this week by the Illinois Department of
Public Health showed the bat had rabies, and, as a precaution, the man and
the woman are undergoing medical treatment, a series of 5 vaccinations
spread out over a 28 day period. "Rabies should never, under any
circumstances, be taken lightly," CDPH [Chicago Department of Public
Health] commissioner Terry Mason said in a release sent Saturday [10 Jan
2008] night. "This is a deadly viral disease that attacks the nervous
system. There is no effective treatment for rabies once symptoms have
started. At that point, it is fatal." But a rabies infection can be
prevented with early treatment, "so that makes it vitally important that
anyone exposed to a bat seek medical care right away," he said.

People can get rabies from the bite of an infected warm-blooded animal,
such as a bat, raccoon, skunk, coyote, feral cat, or domestic animals. In a
typical year, about 2 or 3 rabid bats are detected in the city, according
to the CDPH. People who find a bat in their house should immediately leave
the room where the bat is, close the door behind them and call 911.

communicated by:
ProMED-Mail rapporteur Susan Baekeland

[The species of the bat and fate of the cat are not disclosed. - Mod.CP]

Rabies, Human - United Kingdom (04) : (Northern Ireland) ex South Africa

2009-01-07T22:53:00.000-08:00

RABIES, HUMAN - UNITED KINGDOM (04): (NORTHERN IRELAND) ex SOUTH AFRICA
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Wed 7 Jan 2009
Source: Daily Telegraph online [edited]

A woman who contracted rabies while working in an African animal
sanctuary has become the 1st Briton to die from this virus infection
in the past 4 years. The woman, from Northern Ireland, had been in a
critical condition in the intensive care unit of Belfast's Royal Victoria
Hospital since the condition was diagnosed in December [2008]. It is
thought she was infected with the virus -- which is invariably fatal
if not treated immediately -- after being scratched or bitten by a
rabid dog she had been helping to look after.

The woman had traveled to Africa a number of times over the last
couple of years but began to feel unwell after being home for several
months after her last trip in March 2008.

A statement from her brothers said: "We are devastated by the loss of
our sister. We are extremely proud not only of all she achieved in
life but also of the bravery with which she fought her illness. Her
courage was inspiring and typical of the passionate and determined
way in which she led her life. Her loss will leave a huge hole in all
our lives, and her family and friends will miss her terribly."

Since 1946, there have been 23 deaths among Britons infected with
rabies abroad. The most recent human case was in 2005 when a woman
became infected after being bitten by a dog in Goa, India and later
died in hospital in Liverpool. It is believed the Belfast patient may
have been infected as far back as December 2006 while working in an
animal sanctuary in South Africa. She sent home emails at the time
detailing how she had been scratched while separating 2 dogs. One of
the animals later had to be put down after it started foaming at the mouth.

The woman, who was in her 30s, worked as an adoption manager at the
Cats Protection centre at Dundonald [in Northern Ireland]. She is
believed to be the 1st person in Northern Ireland to have contracted
rabies for 70 years. The Eastern Health and Social Services Board in
Belfast led a multi-agency investigation into her case and insisted
the risk to the community was negligible; there is no documented case
of human-to-human transmission of rabies anywhere in the world. In
the UK, the last human death from [canine] rabies contracted
domestically was in 1902. The World Health Organization has estimated
the annual number of human rabies deaths to be between 40 000 and as
high as 70 000. Most of these deaths take place in developing
countries, particularly in South and Southeast Asia.

Communicated by:
ProMED-mail

[The length of the presumed incubation period is surprising but not
exceptional and probably contributed to the late diagnosis of the
unfortunate woman's condition. The vaccination status of the victim
is not revealed, but it must be presumed that she had not sought or
been offered post-exposure vaccination after sustaining a bite from a
aggressive canine while working in South Africa. The deceased woman
should have been offered protective anti-rabies vaccination prior to
her employment in an animal sanctuary, a high risk environment in a
rabies-endemic country.

Northern Ireland and the city of Belfast can be located on the
HealthMap/ProMED-mail interactive map of the United Kingdom at:
.
- Mod.CP]

Rabies, Canine, Human -Indonesia: (Bali), Suspected

2009-01-07T02:13:00.000-08:00

RABIES, CANINE, HUMAN - INDONESIA: (BALI), SUSPECTED
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Tue 6 Jan 2008
Source: The Jakarta Post online [edited]

A 4-year-old boy, who was suspected of contracting rabies after a dog
bit him 6 months ago, died in Sanglah Hospital last Tuesday [30 Dec
2008?]. The Badung health authority did not inform the press about
the boy's death. The Jakarta Post learned about it from a source who
declined to be named because he was not authorized to speak to
journalists. The Post managed to get official confirmation of the
death on Monday [5 Jan 2009].

The boy was a resident of Kutuh village, South Kuta, which has been
classified as a rabies-prone area. It is not yet clear whether the
boy had in fact died of rabies, as hospital officials could not
provide laboratory results yet, but observations indicated the boy
had shown symptoms similar to rabies-infected patients prior to his
death, including fear of water, uncontrollable convulsions and
excessive drooling.

"Public testimonies and the physician in the South Kuta public health
center said the boy was exhibiting symptoms of rabies infection, but
he died before the laboratory results had come back," said I Ketut
Suiadnyana, head of Disease Observation and Prevention at the Badung
Health Agency. "We are currently working to gather the boy's medical
history." Kutuh village Chief I Wayan Litra confirmed the boy had
been bitten by a dog 6 months ago, and the dog that had bitten him
died a week later. "Soon after, the boy came down with a high fever
but was nursed back to health. Then last week, he began convulsing
uncontrollably, so his parents took him to Sanglah Hospital, where he
died," Litra said.

Head of South Kuta's public health center, Sastrawan, said he planned
to interview the boy's parents to verify whether the boy had been
bitten a 2nd time and to gather other relevant medical information.

Four people are believed to have died from rabies in the past few
months. The alleged victims all died after being bitten by dogs. Of
the 4, only one showed clinical symptoms specific to rabies-infected
patients. The discovery of a rabid canine on 26 Nov 2008 [see
ProMED-mail references below] and the number of deaths have prompted
Bali Governor Made Mangku Pastika to declare south Kuta a rabies-prone area.

The province conducted a mass culling and vaccination program in the
area, which was recently expanded to include south Denpasar, the area
adjacent to south Kuta. The program is called Lirikan Indah,
literally meaning a beautiful glance. It stands for kenali
(identify), hindari (avoid), laporkan (report), vaksin (vaccinate)
and rumahkan (leash). Banners and billboards have been put up in the
area to warn people against transporting dogs, cats, or primates into
and out of Bali until the rabies situation is under control.

Also, 503 wild dogs have been culled from south Kuta since the
outbreak. I Gusti Ngurah Mahardika, a veterinarian and rabies
management team member, said rabies was 100 percent preventable if an
infected person was immediately vaccinated and the bite wound
immediately cleaned with soap. "The most important thing is to not
let dogs roam wild outside the house. One infected dog can transmit
the disease to 10 other dogs within a week," he said.

[Byline: Luh De Suryani]

Communicated by:
Thomas Schmidt
CEO mediScon worldwide
International Institute for Travel and Health
Kaulbachstr. 25
30625 Hannover - Germany

[Commendable efforts are being made to alert the population of the
southern part of the island of Bali to the dangers of rabies
infection in the canine population and to achieve control and
eradication by a combination of culling and vaccination. Strangely,
the medical authorities seem reluctant to employ post-exposure
vaccination to protect the human population. As of yet, none of the
suspected cases of human rabies have been confirmed by laboratory
diagnosis. The outcome of these investigations is awaited.

A map of the island of Bali showing the location of Kuta at the base
of the southernmost peninsula, the site of the rabies outbreak, is available at
.
The location of the island of Bali can be found using the
HealthMap/ProMED-mail interactive map of Indonesia at:
.
- Mod.CP]

Rabies, Human - Kazakhstan, Tajikistan

2008-12-29T13:26:00.000-08:00

RABIES, HUMAN - KAZAKHSTAN, TAJIKISTAN
**************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

[1] Kazakhstan South
Date: Tue 23 Dec 2008
Source: Kazakhstan Today News Agency [trans. by Corresp.BA, edited]

Fatal case of rabies in a child in Chimkent in Southern Kazakhstan
------------------------------------------------------------------
According to the Press Service of the Kazakhstan Ministry of
Emergency Situations a 4-year-old boy has been admitted to hospital
as a result of rabies in Chimkent. The information came from the
Sanitary Epidemiological Surveillance Center confirming that a child
had been hospitalized on 13 Dec 2008 with a preliminary diagnosis of
rabies. Despite intensive therapy, the child died on 22 Dec 2008 with
a confirmed diagnosis of rabies; 6 people who were in contact are
under observation.

--Communicated by:
ProMED-RUS

[This is the 3rd case of rabies in Chimkent during the past 3 months.
The previous 2 cases were reported in October [2008]; a 52-year-old
woman and a 21-year-old man died as a result of rabies virus
infection. The worst epizootic situation for rabies virus infection
is in the southern part of Kazakhstan (Chimkent in particular).
During the last 10 years more than 30 people have died as a result of
rabies in Kazakhstan. - Corresp.BA]

The HealthMap/ProMED-mail interactive map of Kazakhstan is available at:
-, showing the location
Chimkent close to the southern border with Kirgistan. - Mod.CP]

******
[2] Tajikistan
Date: Sat 27 Dec 2008
Source: AP Asia Plus News Agency [edited]

Tajik medical authorities concerned over increasing rabies cases
----------------------------------------------------------------
Tajik medical authorities are concerned over incre
asing number of rabies cases in the country. According to Navrouz
Jaffarov, head of the center for sanitary and epidemiologic
supervision within the Ministry of Health (MoH), 13 cases of rabies
have been registered in the country over the first 10 months of this
year [2008], which is 7 cases more than in the same period of last
year. Specialists note that in 70-80 percent of cases, the [fatal
outcome] is caused by delay in seeking medical aid [i.e. post-exposure
vaccination]. Another reason is insufficient financing of medical
facilities for purchase of necessary medical preparations and rabies
vaccines.

Rabies, also known as hydrophobia, is a viral zoonotic neuroinvasive
disease that causes acute encephalitis (inflammation of the brain) in
mammals. It is most commonly caused by a bite from an infected
animal, but occasionally by other forms of contact. If left untreated
in humans it is almost invariably fatal. In some countries it is a
significant killer of livestock.

The rabies virus makes its way to the brain by following the
peripheral nerves. The incubation period of the disease depends on
how far the virus must travel to reach the central nervous system,
usually taking a few months. Once the infection reaches the central
nervous system and symptoms begin to show, the untreated infection is
almost inevitably fatal within days.

In non-vaccinated humans, rabies is almost invariably fatal after
neurological symptoms have developed, but prompt post-exposure
vaccination may prevent the virus from progressing. Rabies kills
around 55 000 people a year, mostly in Asia and Africa.

[Byline: Mavjouda Hasanova]

Rabies, Human, Bat - Brazil (Goias)

2008-12-25T00:53:00.000-08:00

RABIES, HUMAN, BAT - BRAZIL (03): (GOIAS)
***************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Thu 18 Dec 2008
Source: Globo.com [Portuguese, trans. Mod.TY, edited]

This Thursday [18 Dec 2008], the Health Secretariat in the Federal
District confirmed a case of human rabies in a child 9 years of age
hospitalized for 3 weeks in the Base Hospital. The disease was
confirmed by laboratory tests.

The boy is from Goias state and had been bitten by a bat in that
state. He was brought to the hospital in Brasilia, and his condition
was considered serious. He is in an induced coma in the pediatric ICU
and is undergoing a treatment developed by U.S. doctors.

According to Dr Antezana Disney, Secretary of Health Monitoring in
the DF, the hospitalization of the child does not bring risks of
transmission of the disease.

The Department of Health does not have numbers of human rabies cases
attended to in other states, only those cases of rabies contracted in
the DF; there is only one record from 1978. At the time, the person
died.

--
Communicated by:
ProMED-PORT

[It will be interesting to see whether the patient survives, and, if
so, without serious neurological sequelae. A previous case in October
2008 (see ProMED archive no. 20081122.3689) did survive and was
treated according to the Wisconsin protocol that was developed to
treat a rabies case in Wisconsin, USA, who also survived (see ProMED
archive no 20041231.3459).

A map of Brazil showing the location of Goias state and the Federal
district can be accessed at
.
A HealthMAP/ProMED interactive map of Brazil can be accessed at
.
- Mod.TY]

submitted in the interests of improved public health by: Walter M Woolf, V.M.D. Air Animal Pet Movers .

Rabies, Human - United Kingdom : (Norther Ireland) ex South Africa

2008-12-21T17:03:00.000-08:00

RABIES, HUMAN - UNITED KINGDOM (03): (NORTHERN IRELAND) ex SOUTH AFRICA
***********************************************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Fri 19 De 2008
Source: Health Protection Agency Report, Vol. 2, No. 51 [edited]

Case of imported rabies in the UK
---------------------------------
A case of imported human rabies has been identified in Northern
Ireland. The diagnosis was confirmed by tests on samples sent to the
United Kingdom National Reference Laboratory for Rabies at the
Veterinary Laboratory Agency, Weybridge, Surrey. The patient had
worked as a volunteer with animals in South Africa for short periods
during the past 2 years, and had close contact with various animals
including dogs. Rabies is endemic in South Africa where bites from
infected dogs are the main source of rabies in humans.

In the last 10 years there have been 3 previous cases of imported
human rabies in the UK. Although an estimated 55 000 cases of
classical rabies occur worldwide each year, there has never been a
virologically confirmed case of natural human to human transmission
of rabies. Despite the lack of evidence for human to human
transmission, some people who have been exposed to the secretions of
a patient with rabies may be offered post-exposure immunisation,
purely as a precautionary measure.

If bitten, scratched, or licked by a warm blooded animal in a
rabies-endemic country, people should wash the wound or site of
exposure (e.g., mucous membrane) with plenty of soap and water and
seek medical advice without delay, even if previously vaccinated. If
they do not seek medical treatment while abroad, they should still
seek it when they come home, even if some time after the event.

Following exposure an individual risk assessment should be undertaken
to determine the need for post-exposure prophylaxis (PEP) with rabies
vaccine and/or immunoglobulin. PEP is highly effective in preventing
rabies if given promptly and there have been no cases of rabies in
the UK in people who have received rabies post exposure prophylaxis.

Travellers should always be advised to seek travel health advice well
in advance of their visit overseas to ensure that the risks of all
travel associated illness, not just rabies, have been explained.
Although rabies vaccine is not routinely advised for all travellers,
pre-exposure immunisation is recommended for those:
- working abroad (e.g., veterinary staff or zoologists) who by the
nature of their work are at risk of contact with rabid animals;
- living in or travelling for more than one month to rabies-enzootic
areas unless there is reliable access to prompt, safe medical care;
- travelling for less than one month to enzootic areas but who may
be exposed to rabies because of their travel activities;
- those who would have limited access to post-exposure medical care.

This advice should be specifically brought to the attention of those
planning to do voluntary work with animals in rabies-endemic areas.

Further information on rabies prevention for the traveller is
available from the National Travel Health Network and Centre at:
. Detailed
information on rabies is available in chapter 27 of the Green Book [1].

Reference:
----------
(1) DH. Immunisation against infectious disease ("the Green Book").
Available at:
.

posted in the interest of the traveling public; by Walter M Woolf, V.M.D. .. Principal Owner & Managing Director - Air Animal Pet Movers .. providing relocating pet owners with pet moving logistics and solutions.

Rabies, Human, Canine - Kyrgyzstan (Jalal-Abad_

2008-12-21T08:02:00.000-08:00

RABIES, HUMAN, CANINE - KYRGYZSTAN (JALAL-ABAD)
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: 17 Dec 2008
Source: Regnum News Agency [trans. by Corr.BA, edited]

Fatal case of rabies
--------------------
In the south of Kyrgyzstan a teenager who contracted rabies has died.
A 12-year-old boy from Sahaydan village in the Jalal-Abadsky Oblast
had been bitten by a rabid dog.

The press service of the Emergencies Ministry stated that physicians
have screened 657 families, and the veterinary service has vaccinated
a total of 158 cattle, 83 small ruminants, and 646 dogs and cats.

--
Communicated by:
ProMED-RUS

[This is not 1st case of rabies in a child in Kyrgyzstan in 2008.
This year 8 children and 2 adults have died of rabies in southern
Kyrgyzstan. It testifies to insufficient awareness of the population
concerning prevention of this disease. - Corr.BA.

A map of Kyrgyzstan showing Jalal-Abad in the south of the country is
available at:
. - Mod.CP]

submitted in the interest of global pet health issues by: Walter M Woolf, V.M.D. .. the principal owner & managing director of Air Animal Pet Movers .... based in Tampa, Florida ... providing relocating pet owners with pet moving solutions as they relocate.

Rabies, Russia .. sobering numbers to consider

2008-12-19T11:23:00.000-08:00

RABIES, ANIMAL - RUSSIA: (NOVOSIBIRSKAYA OBLAST
***********************************************
A ProMED-mail post

ProMED-mail is a program of the
International Society for Infectious Diseases

Date: Sun 14 Dec 2008
Source: Gorod54 News Agency [translated by Corr.ATS, edited]

Animal rabies and rabies control in the Novosibirskaya Oblast
-------------------------------------------------------------
In total 128 000 cats and dogs and more than 70 000 cattle have been
vaccinated in the Novosibirkaya Oblast. Since the beginning of this
year 64 rabies cases have been registered among wild and domestic
animals in the Novosibirskaya Oblast. These cases are from 56 places
in 20 rural regions and in the Novosibirsk [city] region itself.
Rabies has been laboratory confirmed in 39 foxes, 10 dogs, 8 cattle,
3 cats, 2 rats, 1 sheep and 1 raccoon dog. Most cases were observed
in the Toguchinski region.

The incidence of rabies in foxes has increased in the Moshkovsoe,
Kupinsoe, Tatarskoe regions compared to data for the previous month.
For the 1st time a case has occurred in the the Kuybishevskoe region.
According to surveillance data released by the Oblast branch of
Rosselkhoznadzor [the Federal Service for Veterinary and
Phytosanitary Surveillance] 128 000 dogs and 70 000 cattle have been
vaccinated as a preventive measure.

--
Communicated by:
ProMED-RUS

[The detection of rabies virus infection in rats is unusual and
further details of the circumstances would be appreciated.

An interactive map of Russia showing the location of the
Novosibirskaya Oblast can be accessed at:
. - Mod.CP]

provided by Air Animal Pet Movers for relocating pet owners to understand the global ramifications and implications of Rabies in the wildlife.

Rabies, canine, human - Indonesia (Bali Alert)

2008-12-11T23:28:00.001-08:00

... Bali, previously conisedered as "Rabies Free", no longer can make that claim.

... Western Auatralis health authorities have warned visitors to Bali to avoid direct contact with animals (dogs, monkeys, cats, etc) while on the island.

... the Kuta area is noted to have incidences of confirmed cases in both dogs and several humans .. the disease being always fatal to those infected with the Rabies virus, from either a direct bite or from a scratch. Once symptoms develop -- headaches, fevers, tingling, confusion, and difficulty in swallowing -- the outcome is pedictable ---- death results.

... submitted by Walter M Woolf, V.M.D. .. principal owner & managing director .. Air Animal Pet Movers, of Tampa,Florida .. the relocating pets best friend since 1977.

... source of information: ABC News online (edited)

Indonesia & attempts to control Rabies

2008-12-07T02:37:00.000-08:00

... ny good friend, Dr Deborah Briggs, the executive director of the Alliance for Rabies Control in Edinburgh, Scotland, along with Dr Henry Wilde of the Chulalongkorn Univerity in Bangkok, Thailand commented recently in a posting to Pro-Med Mail of the failed attempts to control rabies outbreaks by the mass culling of dogs in enzootic areas of Rabies outbreaks.

... experience has shown over the years of attempts to cull large dog populations, e.g. 500,000 at a time are to no avail. Rabies continues to be a problem especially on those islands where extermination programs have taken place. Not only is the culling of large dog populations gruesome and barbaric, it will not reduce the incidence of Rabies.

... what does work is the vaccination of at least 70 % of the prevailing dog population along with the continual monitoring of disease outbreaks.

... the above is an abstract of an original article: Pro-Med posting 20081204.3821
"Rabies, canine, human - Indonesia (03):(Bali)"

... submitted in the interests of better animal health & Rabies control by Walter M Woolf, V.M.D. .. Principal Owner, and Managing Director ... Air Animal Pet Movers, Tampa, Florida

Rabies, Human, Argentina ( Jujuy ) .... origin Bolivia

2008-11-18T12:21:00.000-08:00

. July of 2008 saw a dog entering Argentina from Bolivia, where a case of Rabies in a human was reported for the first time in 20 years.

.. a bite from the dog to a young boy resulted in the death of the child on 16 November 2008, after neurological symptoms developed in the boy on 10 November 2008.

... this is the first case of reported Rabies in Buenos Aires, Argentina since 1981.

.... isolation of the rabies virus indicated it to be the classical street strain of the virus.

..... ring immunization of dogs along with continued survelliance is being carried out to prevent further cases of Rabies in both animals and people.

submitted by Dr Walter Woolf, the veterinarian founder of Air Animal Pet Movers, the relocating pets best friend since 1977.

Human survival, Bat Bite - Brazil - Milwaukee protocol

2008-11-16T05:29:00.000-08:00

. what appears to be a survival from an aggressive bat bite, loaded with Rabies virus, has been reported in the municipality of Floresta, in the state of Pernambuco, Brazil.

.. a 15 year old boy bitten by a an aggresive bat, reported symptoms of Rabies on 06 October 2008, with transfer to a medical center on 10 October 2008.

... on 11 October 2008 the young lad was transferred to the intensive care unit, and was placed in a drug induced come, known as the Milwaukee protocol, where in 2004 the protocol was used on a patient (a 15 year old girl with neurogical symptoms) to become the first recorded case of recovering from Rabies where neurological symptoms had developed.

.... on 30 October 2008, the patient was brought out of the drug induced coma; now reported on 11 November 2008 to be unsedated and clinically stable.

..... reported by Dr Walter Woolf (V.M.D.).. the veterinarian owner and founder of Air Animal Pet Movers, of Tampa, Florida, the relocating pets best friend. The source of this information can be found on the following web site --- http://www.promedmail.org ----

Fox Rabies, north eastern Italy, Friuli-Venezia-Giulia area

2008-10-25T23:44:00.000-07:00

... the border close to Slovenia & Austria has yielded a rabid fox, according to reports from the national reference laboratory in Italy.

.... a person hiking in the forested area was attacked by the fox. Although uncommon to find rabies in this part of Italy, the last reported case was 1992. Presently, Italy has been determined to be rabies free since 1995.

.... authorities believe the rabid fox entered the forested alpine area from either Slovenia or Austria.

..... control measures, i.e., oral rabies vaccine for the areas foxes, restriction of the movement of dogs, and compulsory vaccination of domestic animals in the area who graze the forested regions are being implemented.

...... submitted by Walter M Woolf, V.M.D. .. principal owner, & managing director, Air Animal Pet Movers .. www.airanimal.com

Cattle Rabies, Colombia, human exposure, vampire bats

2008-10-23T01:28:00.000-07:00

... four farms have reported the incidence of cattle rabies, spread by vampire bats. The cases have been reported in the rural area of San Cayetano (San Juan Nepomuceno) and in the adjacent area of Montes de Mario region.

... the feeding habits of vampire bats who harbor the rabies virus are such that when the bats feed upon either cattle or horses, the saliva of the vampire bat is loaded with rabies virus, subsequently infecting the animals.

... ocassional human exposure takes place; as cases of vampire bats who have inflicted wounds upon humans has resulted in reported cases of rabies in humans.

... farmers and cattlemen in the affected regions have been urged to vaccinate their livestock with suitable rabies vaccine.

..... submitted by Walter M Woolf, V.M.D. ..... principal owner and managing director, Air Animal Pet Movers, Tampa, Florida ... www.airanimal.com ...

Metro Denver reports skunk rabies - Sloan's Lake area

2008-10-19T15:08:00.000-07:00

... a rabid skunk has been identified having originated from the Sloan's Lake area -- northwest of Denver.

.... the rabies virus found in the skunks brain tissue was that of bat variant strain.

..... the skunk is a highly efficient transmitter of rabies virus; as the skunks saliva contains large amounts of the live rabies virus.

...... pet owners in the norhtwest Denver metro area are urged to be vigilant as well as having their domestic pets current on their Rabies immunizations.

submitted by Walter M Woolf, V.M.D. ... , director ... Air Animal Pet Movers

Rabies, Bat, Human Exposure - Montana, USA

2008-10-09T19:22:00.000-07:00

... a well intentioned mom brought a dead bat to her child's school in Montana recently. The result is that over 90 students who had touched the bat in 5 separate classrooms will undergoe the anti-Rabies vaccine at the Stevensville Elementary School.

... the cost of the six doses of Rabies vaccine per child could surpass a cost of USD$150,000 .. with the school paying up to USD$70,000 through its liability insurance.

... suffice it to say, the school district has set a policy of having school visitors obtain a pass to enter the school and its classrooms.

... submitted by: Walter M Woolf, V.M.D. .. veterinarian, and the owner of Air Animal Pet Movers, Tampa, Florida .. the relocating pets best friend, since 1977.