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

RABIES, WILDLIFE, EQUINE, HUMAN EXPOSURE - USA (02): (NORTH CAROLINA, GEORGIA)
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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, Canine, Human - Indonesia (04) : Bali, Request for information

RABIES, CANINE, HUMAN - INDONESIA (04): BALI, REQUEST FOR INFORMATION
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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 - Angola: (Luanda)

RABIES, CANINE, HUMAN - ANGOLA: (LUANDA)
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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
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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, 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.