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

RABIES - BRAZIL (02): (GOIAS)
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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, Human, Bat - Brazil (Goias)

RABIES, HUMAN, BAT - BRAZIL (03): (GOIAS)
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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 .

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

... 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

... 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

... 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

... 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.