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

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

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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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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:
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[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)

RABIES RISK, BATS, URBAN - BRAZIL: (RIO DE JANEIRO)
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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:
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[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)

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

RABIES, CANINE, HUMAN - SOUTH AFRICA: (EASTERN CAPE) SUSPECTED
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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:
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[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

RABIES, HUMAN - UNITED KINGDOM (05): (NORTHERN IRELAND) EX SOUTH AFRICA
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[1]
Date: Wed 14 Jan 2009
Source: The Nursing Times online [edited]


Rabies death in Northern Ireland sparks Health Protection Agency investigation
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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:
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via HealthMap alerts

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

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

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

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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
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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:
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[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]