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

RABIES - BRAZIL: (GOIAS)
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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, Human - Kazakhstan, Tajikistan

RABIES, HUMAN - KAZAKHSTAN, TAJIKISTAN
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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
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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]