So todays, CDC Mortality and Morbidity Report (MMR 61(04);61-65) included a fascinating report of a young 8 year old girl who survived a case of clinical rabies. Survival from clinical rabies is extremely rare if postexposure prophylaxis (PEP) is not administered before the onset of signs or symptoms, even when advanced supportive care is provided.
In May 2011, a girl aged 8 years from a rural county in California was brought to a local emergency department (ED) with a 1-week history of progressive sore throat, difficulty swallowing, and weakness. After she developed flaccid paralysis and encephalitis, rabies was diagnosed based on 1) detection of rabies virus–specific antibodies in serum and cerebrospinal fluid (CSF), 2) a compatible clinical syndrome in the patient, and 3) absence of a likely alternative diagnosis. The patient received advanced supportive care, including treatment with therapeutic coma. She was successfully extubated after 15 days and discharged from the hospital 37 days later to continue rehabilitation therapy as an outpatient. The public health investigation identified contact with free-roaming, unvaccinated cats at the patient’s school as a possible source of infection. Several of these cats were collected from the school and remained healthy while under observation, but at least one was lost to follow-up. A total of 27 persons received rabies postexposure prophylaxis (PEP) for potential exposures to the patient’s saliva. No further cases of rabies associated with this case have been identified. Rabies prevention efforts should highlight the importance of domestic animal vaccination, avoidance of wildlife and unvaccinated animals, and prompt PEP after an exposure.
What are the implications for public health practice? Clinicians caring for patients with acute progressive encephalitis should consider rabies in the differential diagnosis and pursue laboratory diagnostic testing when indicated. Rabies prevention education should emphasize the importance of domestic animal vaccination, avoidance of wildlife and potentially unvaccinated animals, and prompt PEP after an exposure. This is critical in areas where there are large populations of feral cats, raccoons and other small mammals. Public education should emphasize avoidance of all wild and potentially unvaccinated animals and the importance of seeking medical evaluation for exposures to suspect rabid animals.
Happy Groundhog Day!