ProMed-RABIES - USA: (CALIFORNIA) - Patient recovers

[Tonka]

http://www.promedmail.org/pls/otn/f?p=2400%3A1001%3A2992387652328746%3A%3ANO%3A%3AF2400_P1001_BACK_PAGE%2CF2400_P1001_PUB_MAIL_ID%3A1000%2C88393

Archive Number 20110511.1442
Published Date 11-MAY-2011
Subject PRO/AH/EDR> Rabies - USA: (CA)
RABIES - USA: (CALIFORNIA)
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International Society for Infectious Diseases
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Date: Tue 10 May 2011
Source: The Times-Standard [edited]
<http://www.times-standard.com/localnews/ci_18031362>


Humboldt County public health officials launched a full-scale
investigation Monday [9 May 2011] into what may be the 1st ever
confirmed case of human rabies in Humboldt County.

Department of Health and Human Services [DHHS] public health branch
director Susan Buckley said that the victim in the case, a resident of
Willow Creek whose name was not released, remained at the UC Davis
Medical Center on Monday [9 May 2011] in "serious condition." The
Centers for Disease Control and Prevention confirmed that the case was
a rabies infection last Friday afternoon [6 May 2011], Buckley said,
and the strand of the virus was then tested a 2nd time on Saturday [7
May 2011] with the same results.

"We are in full response mode to this, and we are acting proactively
and vigorously to notify people who we think might be affected,"
Buckley said, adding that the incident is the 1st case of human rabies
she is aware of in Humboldt County. "As far as I know, yes."

Health officials remain in contact with the family of the victim,
whose condition stayed the same over the weekend.

Buckley said she expects to have more information on the status of
the investigation today [10 May 2011] once her office has had a chance
to summarize what came out of a conference call with the CDC late
Monday [9 May 2011] afternoon. The office will be sending
notifications to people who they believe could have been in contact
with the victim, Buckley said. She was unable to say how many people
that might be.

There are currently no known cases of human-to-human transfer of
rabies.

"We'll be much clearer on that number soon," Buckley said, adding
that while local health officials lead the investigation they would be
in regular contact with CDC, which is based out of Atlanta. "We're
consulting with them and certainly will be getting help from them."

It remains unclear what type of animal transferred rabies to the
victim, Buckley said, adding that the success of the vaccination
against infection depends on the timing of when it is given. While the
vaccine is almost 100 percent effective in preventing rabies, there is
only one known survivor who did not receive the vaccine before
symptoms were reported.

While Buckley confirmed that there is only one known victim at this
point, she couldn't say how long ago the individual contracted the
virus before being taken to the hospital last week [week of 2 May
2011].

"There is no clear answer on that at this point," Buckley said,
adding that she couldn't comment further on the status of the victim
while the investigation remained ongoing.

Leslie Lollich, the public education and outreach officer for DHHS,
confirmed there is only one victim in the case and said that figuring
out when and how the victim contracted the virus was difficult because
of the myriad ways in which it can be transferred. Lollich said that a
person may be exposed to rabies yet not show symptoms for up to 7
years, something that makes identifying it a challenge for doctors.

"That's why it's so hard down to track down the source," Lollich
said, adding that rabies can be transmitted by bats, skunks, foxes,
and a slew of domestic animals, none of which have been ruled out in
the case. "At this point, the time frame is large. We just don't
know."

While the investigation into the incident continues, Buckley stressed
that there was no risk of rabies exposure for Willow Creek residents
and that she is hopeful that the victim would survive.

While rabies cases are rare in the United States, an estimated 55 000
people die from the infection outside the country each year, according
to the CDC website.

"We're hoping for the best," Buckley said. "Obviously, it's a really
difficult situation, and our hearts go out to the family."

[Byline: Matt Drange]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The state of California can be located on the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/00bF>. Humboldt County in
northwestern California can be seen on the map at
<http://www.digital-topo-maps.com/county-map/california.shtml>. -
Sr.Tech.Ed.MJ]

[Rabies is a preventable viral disease of mammals most often
transmitted through the bite of a rabid animal. The vast majority of
rabies cases reported to the Centers for Disease Control and
Prevention (CDC) each year occur in wild animals like raccoons,
skunks, bats, and foxes.

The rabies virus infects the central nervous system, ultimately
causing disease in the brain and death. The early symptoms of rabies
in people are similar to those of many other illnesses, including
fever, headache, and general weakness or discomfort. As the disease
progresses, more specific symptoms appear and may include insomnia,
anxiety, confusion, slight or partial paralysis, excitation,
hallucinations, agitation, hypersalivation (increase in saliva),
difficulty swallowing, and hydrophobia (fear of water). Death usually
occurs within days of the onset of these symptoms.

It should be noted that while hydrophobia means fear of water, these
individuals do not have a fear of water, but rather the inability to
swallow the water, or other fluids due to the paralysis of the muscles
of the throat. This also prevents the victims from swallowing their
own saliva and appear to be hypersalivating.

Human rabies is quite rare in the United States. Approximately 27
cases have been reported in people in the United States since 1990.
Yet in some areas of the world (for example, Southeast Asia, Africa,
and Latin America), human rabies is much more common. The incidence of
rabies in people parallels the incidence in the animal kingdom. The
great strides that have been made in controlling the disease in
animals in the United States and in other developed countries is
directly responsible for this decline in human rabies.

Although rabies in humans is very rare in the United States, between
16 000 and 39 000 people receive preventive medical treatment each
year after being exposed to a potentially rabid animal.

The postmortem diagnosis of rabies is made by examination of tissue
from the brain (such as, medulla, cerebellum, and hippocampus).
Autopsies fulfill an important function by diagnosing cases of rabies
and furthering understanding of the disease. By providing a diagnosis
for deceased patients with suspected but unconfirmed rabies, or for
patients in whom the disease was never suspected clinically, autopsies
can 1) aid the public health investigation, 2) help raise public
awareness of rabies associated with specific exposures, 3) emphasize
the importance of seeking medical evaluation after such an exposure
occurs, and 4) add to knowledge about current human rabies incidence.
In patients with confirmed rabies, autopsies provide information about
pathogenesis that might be relevant to investigations of treatment.

Although contact with decedents with confirmed or suspected rabies
can cause anxiety, no confirmed case of rabies has ever been reported
among persons performing postmortem examinations of humans or animals.
Even from living patients with rabies, human-to-human transmission has
been documented only rarely, in cases of organ or tissue
transplantation (1,2). Aerosol transmission of rabies virus has never
been well documented outside of a research laboratory setting (5).
Both CDC and the World Health Organization (WHO) have stated that the
infection risk to health-care personnel from human rabies patients is
no greater than from patients with other viral or bacterial
infections. In addition, rabies PEP is available for exposed
personnel. Nevertheless, because of the nearly universal fatal outcome
from rabies, both CDC and WHO recommend that all personnel working
with rabies patients or decedents adhere to recommended precautions
(3,6).

Even the minimal risk for rabies virus transmission at autopsy can be
reduced by using careful dissection techniques and appropriate
personal protective equipment, including an N95 or higher respirator,
full face shield, goggles, gloves, complete body coverage by
protective wear, and heavy or chain mail gloves to help prevent cuts
or sticks from sharp instruments or bone fragments. Aerosols should be
minimized by using a handsaw rather than an oscillating saw, and by
avoiding contact of the saw blade with brain tissue while removing the
calvarium. Ample use of a 10 percent solution of sodium hypochlorite
for disinfection is recommended both during and after the procedure to
ensure decontamination of all exposed surfaces and equipment.
Participation in the autopsy should be limited to persons directly
involved in the procedure and collection of specimens. Previous
vaccination against rabies is not required for persons performing such
autopsies. PEP (post exposure prophylaxis) of autopsy personnel is
recommended only if contamination of a wound or mucous membrane with
patient saliva or other potentially infectious material (such as
neural tissue) occurs during the procedure (3,7,8). The case described
in this report highlights the need to educate pathologists and other
hospital personnel about appropriate rabies infection control
procedures so that autopsies can be performed safely in cases of
confirmed or suspected human rabies.

References
----------
1. Helmick CG, Tauxe RV, Vernon AA: Is there a risk to contacts of
patients with rabies? Rev Infect Dis 1987; 9(3): 511-8; abstract
available at <http://www.ncbi.nlm.nih.gov/pubmed/3299636>.
2. CDC: Investigation of rabies infections in organ donor and
transplant recipients-Alabama, Arkansas, Oklahoma, and Texas, 2004.
MMWR 2004; 53(26): 586-9; available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm53d701a1.htm>.
3. CDC: Human rabies prevention-United States, 2008: recommendations
of the Advisory Committee on Immunization Practices. MMWR 2008;
57(RR-3): 1-28; available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5703a1.htm>.
4. CDC: Use of a reduced (4-dose) vaccine schedule for postexposure
prophylaxis to prevent human rabies: recommendations of the Advisory
Committee on Immunization Practices. MMWR 2010; 59(RR-2): 1-9;
available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm>.
5. Gibbons RV: Cryptogenic rabies, bats, and the question of aerosol
transmission. Ann Emerg Med 2002; 39(5): 528-36; abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/11973559>.
6. World Health Organization: WHO expert committee on rabies. World
Health Organ Tech Rep Ser 2005; 931: 1-121.
7. CDC: Human rabies-California, 1987. MMWR 1988; 37(19): 305-8.
8. CDC. Human rabies-Miami, 1994. MMWR 1994; 43(42): 773-5; available
at <http://www.cdc.gov/mmwr/preview/mmwrhtml/00033192.htm>.

Portions of this comment have been extracted from
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5913a3.htm>,
<http://www.cdc.gov/rabies/>. and
<http://www.emedicinehealth.com/rabies/article_em.htm>. - Mod.TG]

[see also:
2010
----
Rabies, human - USA: (LA) ex Mexico 20100825.2992
Rabies, animal - USA (03): (TX, NY) feline, raccoon, human exp.
20100514.1569
Rabies, human exposure - USA (02): (FL) 20100509.1516
Rabies, human - USA: vaccination protocol change 20100320.0890]
.................................................s b/tg/mj/lm
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[Shiloh]

Re: ProMed-RABIES - USA: (CALIFORNIA)

Source: http://www.times-standard.com/localnews/ci_18111085

Feral cats identified as possible Willow Creek rabies source; victim currently in stable condition
Jessica Cejnar /The Times-Standard
Posted: 05/21/2011 08:34:50 AM PDT

Feral unvaccinated cats may be behind a rabies infection that sent a Willow Creek resident to the hospital two weeks ago, according to local health officials. But health officials also say that they may never know how exactly the victim contracted the disease.

The victim is currently in stable condition at UC Davis Medical Center and is improving, according to the Humboldt County Department of Health and Human Services. The patient's family and medical personnel who came into contact with her are being vaccinated against the disease. Officials also vaccinated two other individuals who were at risk from animal bites.

Even though feral cats may be the primary source of the disease, county health officer Ann Lindsay said officials are investigating other wild and domestic animals for signs of rabies as well.

The Centers for Disease Control and Prevention confirmed the case was a rabies infection on May 6. It is thought to be the first-ever confirmed case of human rabies in Humboldt County, according to health officials...

[alert]

Re: ProMed-RABIES - USA: (CALIFORNIA) - patient possibly recovering

Recoveries from rabies are EXTREMELY rare...

http://www.promedmail.org/pls/apex/f?p=2400:1001:2863230104376180::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88568

Archive Number 20110524.1576
Published Date 24-MAY-2011
Subject PRO/AH/EDR> Rabies - USA: (CA) human, RFI

RABIES - USA: (CALIFORNIA), HUMAN, REQUEST FOR INFORMATION
************************************************** *********
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 21 May 2011
Source: The Time-Standard [edited]
<http://www.times-standard.com/localnews/ci_18111085>


Feral cats identified as possible Willow Creek rabies source
------------------------------------------------------------
Feral unvaccinated cats may be behind a rabies infection that sent a
Willow Creek resident to the hospital 2 weeks ago, according to local
health officials. But health officials also say that they may never
know how exactly the victim contracted the disease.

The victim is currently in stable condition at UC Davis Medical
Center and is improving, according to the Humboldt County Department
of Health and Human Services. The patient's family and medical
personnel who came into contact with her are being vaccinated against
the disease. Officials also vaccinated 2 other individuals who were at
risk from animal bites.

Even though feral cats may be the primary source of the disease,
county health officer Ann Lindsay said officials are investigating
other wild and domestic animals for signs of rabies as well.

The Centers for Disease Control and Prevention (CDC) confirmed the
case was a rabies infection on Fri 6 May 2011. It is thought to be the
1st-ever confirmed case of human rabies in Humboldt County, according
to health officials. Bats and gray foxes are the usual carriers of
rabies in Humboldt County, said Dave Lancaster, a wildlife biologist
with the California Department of Fish and Game. According to county
public health, which tests animals for rabies, about 5 gray foxes and
one bat tested positive for rabies last year [2010] in Humboldt
County. In 2009 more than 35 gray foxes in the county tested positive
for rabies. Almost 40 skunks also tested positive for rabies in 2009.
So far this month, Humboldt County Animal Control received 5 calls for
potentially rabid animals, said Officer Andre Hale. The calls turned
out to be false alarms, she said.

Usually, foxes will contract a passive form of the virus, Lancaster
said. In that instance, the animal may have motor control problems and
may just be looking for a place to die. Skunks are also susceptible to
the passive rabies strain [reaction?], he said. Last year, though,
Lancaster and officers with the Arcata Police Department encountered a
fox with the aggressive form of rabies. "It had been chasing bicycles
and cars in the street in Bayside," he said. "It's very simple with
the aggressive strain, it's just aggressive behavior. If it's chasing
you, and you try to run away, there you go."

If a potential rabies case is reported, usually local law enforcement
will go to the area and kill the animal. In some cases, Fish and Game
wardens will also be called in, Lancaster said. Many people who have
problems with animals will take it upon themselves to trap and move
them. According to Lancaster, this is illegal and often makes a
disease outbreak worse. Leaving pet food and water outside can also
spread diseases between domestic animals and wildlife. "It can also
increase the density of wild animals," Lancaster said. "The higher the
numbers, the greater chance of disease because (the animals) get
stressed." People shouldn't handle wild animals, Lancaster said. If a
resident finds a dead animal, they should bury it next to where it was
found, using rubber gloves and filling the hole with the soil the
animal was laying on, he said. After that, residents should wash the
tools they used.

Residents who come into contact with a potentially rabid wild animal
should contact their doctors. If the animal is dead, residents can
call the county Division of Environmental Health.

[Byline: Jessica Cejnar]

--
Communicated by:
Mourad Gabriel UCD
<mwgabriel@ucdavis.edu>

[This reports is devoid of clinical data and specific information on
the source of the victim's infection. It would appear that a feral cat
has been identified as the source of the victim's rabies virus
infection by a process of exclusion of other potential vectors. It
would be relevant to know if there has been any genetic analysis of
the infecting virus that might substantiate the conclusion that the
vector was a feral cat.

It is not stated when the patient's exposure occurred or whether (and
when) she received post-exposure prophylaxis. The patient's condition
is reported to be stable. Further information is awaited.

Humboldt County is a county in the state of California, located on
the far North Coast 200 miles north of San Francisco. Its location is
shown in the map at:
<http://en.wikipedia.org/wiki/Humboldt_County,_California> - Mod.CP]

[alert]

Re: ProMed-RABIES - USA: (CALIFORNIA) - Patient recovers

http://www.promedmail.org/pls/apex/f?p=2400:1001:2944694013887319::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88619

Archive Number 20110527.1619
Published Date 27-MAY-2011
Subject PRO/AH/EDR> Rabies - USA (02): (CA) human, survival

RABIES - USA (02): (CALIFORNIA) HUMAN, SURVIVAL
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 26 May 2011
Source: The Journal, Humboldt County, California [edited]
<http://www.northcoastjournal.com/news/2011/05/26/rabies-survivor/>


A Willow Creek girl becomes one of the few who've ever lived through
the deadly virus. It started with a stomachache. An 8-year-old who
lives in Willow Creek with her grandparents, 3 siblings, and a cousin,
had been complaining about tummy troubles, so her grandfather took her
to the local clinic. Assuming she had the flu, her doctor advised the
usual treatment -- rest, fluids -- and sent her home.

Soon, new symptoms began to appear. Around 3 in the morning on Sat 30
Apr 2011, the 8-year-old woke her grandparents complaining that her
neck and back were hurting. "I thought she might have just slept on it
wrong, so I told her to go back and lay down," her grandmother, told
the Journal by phone Tuesday [24 May 2011]. Come daylight, however,
the girl wasn't any better, so her grandpa drove her over the hill to
Mad River Hospital.

Doctors performed tests but, given her stomachache and muscle
soreness, they, too, assumed the girl had the flu. Once again her
grandfather brought her home. "At lunch time, I was fixing all the
kids lunch, and she said she felt like she was going to get sick to
her stomach," he recalled. "She got up from the table and her legs
just collapsed on her. She looked at me surprised. She just wasn't
functioning right." The family helped the girl onto the couch, and
over the next few hours they kept offering her water. But every time
the girl took a sip she would vomit it back up. By 8 p.m. she couldn't
talk and was barely moving. Around 10 p.m. her grandfather tried to
prop the girl upright on the couch, but she immediately slumped over,
"like she was paralyzed." That's when he knew something was seriously
wrong. "I said, 'This is no **** flu.'" Indeed it wasn't. The
following morning, the girl was flown 200 miles [322 km] south to the
UC [University of California] Davis Medical Center where, almost a
week later, doctors determined that she had contracted rabies.

Human rabies cases have become exceedingly rare in the United States,
thanks in large part to vaccinations of domestic animals. The most
recent human case in California was 9 years ago, according to the
California Department of Public Health (CDPH). The girl's case is the
1st from Humboldt County.

The viral disease affects the central nervous system and is typically
transmitted to humans from the bite of a rabid animal (bats and skunks
are most common, though any mammal can contract the disease). After
infection, symptoms can appear in as little as 9 days, or they can
take a year or more to show up. At first these symptoms are typical of
many illnesses -- fever, headache, general malaise -- but as the
disease progresses it starts to cause neurological problems. These
vary dramatically from case to case, but they can include insomnia,
anxiety, confusion, fear of water, partial paralysis, difficulty
swallowing, hallucinations, and more. Once these symptoms appear,
death from respiratory failure is usually imminent.

"Up until a few years ago we would have said quite definitively that
rabies is 100 percent fatal," said Dr Curtis Fritz, a public health
veterinarian with the CDPH. The 1st human ever to survive rabies
without a vaccination was a Wisconsin teenager. This 15-year-old made
worldwide headlines in 2004 after doctors saved her life by medically
inducing a coma to protect the brain while her body fought off the
virus. This method, which came to be called the Milwaukee protocol, is
exactly what doctors at UC Davis used to save Humboldt 8-year-old.

[Byline: Ryan Burns]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[This report fills in some details missing from the preceding report
of this case in ProMED-mail (archive no 20110524.1576). It does not
reveal, however, the source of the child's infection or the lapse of
time between exposure and development of symptoms of rabies virus
infection. The present condition of the patient is not revealed.

The Milwaukee protocol is an experimental course of treatment of an
acute infection of rabies in a human being. The treatment involves
putting the patient into a chemically induced coma and administering
antiviral drugs. It was developed and named by Rodney Willoughby Jr
following the successful treatment of a Wisconsin teenager bitten by a
bat. The Wisconsin teenager became the 1st of only 5 patients now
known to have survived symptomatic rabies without receiving rabies
vaccine.

There were 2 survivors out of 25 patients treated under the original
Milwaukee protocol. A further 10 patients have been treated under a
modified protocol and there have been another 2 survivors. Further
details of the protocol used to treat the Humboldt County patient and
the present condition of the patient are awaited. - Mod.CP]

[Willow Creek can be located via the HealthMap/ProMED-mail
interactive map at <http://healthmap.org/r/0TZE>. - Sr.Tech.Ed.MJ]

[alert]

Re: ProMed-RABIES - USA: (CALIFORNIA) - Patient recovers

This is curious. I believe there are at least 4-5 known rabies survivors, including the cases mentioned below, but I was unaware of this possible issue, and it seems unlikely to me at this point.

http://www.promedmail.org/pls/apex/f?p=2400:1001:1962412946833629::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88773

Archive Number 20110606.1728
Published Date 06-JUN-2011
Subject PRO/AH> Rabies - USA (03): (CA) human, survival

RABIES - UNITED STATES OF AMERICA (03): HUMAN, SURVIVAL
************************************************** *****
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<http://www.isid.org>

Date: Sun 5 Jun 2011
From: Martin Haditsch <leonding@travelmed.at> [edited]

re: ProMED-mail Rabies - USA (02): (CA) human, survival
20110527.1619
----------------------------------------------------------------------
To my knowledge, until now nobody with a naive immune system survived
classical rabies virus disease. In the girl 9 years ago rabies virus
never was proven -- the hints for rabies being the cause for disease
were a bat bite and a (significant) increase in rabies antibodies.
(All? of) the others surviving a probable contact with classical
rabies virus had received at least one rabies shot before the contact,
which might have conferred partial immunity (as was in the one and
only survivor of organ transplant recipients from a rabies positive
donor a few years ago in Germany).

So not to raise unjustified hope that one might survive infection
with classical rabies virus when treatment is started after onset of
symptoms, I would strongly recommend exact wording (such as, using
"rabies-like disease" instead). And in this report, it is also not
indicated whether classical rabies virus was isolated from the girl's
body (just saying: "doctors determined that she had contracted
rabies").

Nevertheless, it is so good to hear that she obviously is improving
-- so let us hope for the best and congratulations to the colleagues
treating the child in this life-threatening situation.

--
Dr Martin Haditsch
Travel Medical Centre
Linz
Austria
<leonding@travelmed.at>

[ProMED-mail thanks Dr Haditsch for this comment. Perhaps some
informed reader can provide further information relevant to the
questions posed by Dr Haditsch. - Mod.CP]

[alert]

Re: ProMed-RABIES - USA: (CALIFORNIA) - Patient recovers

http://www.promedmail.org/pls/apex/f?p=2400:1001:521327662544397::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88885

Archive Number 20110613.1802
Published Date 13-JUN-2011
Subject PRO/AH/EDR> Rabies - USA (04): human, survival

RABIES - USA (04): HUMAN, SURVIVAL
**********************************
A ProMED-mail post
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ProMED-mail is a program of the
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<http://www.isid.org>

Date: Sun 12 Jun 2011
Source: Health Canal [edited]
<http://www.healthcanal.com/surgery-rehabilitation/17953-Davis-Childrens-Hospital-patient-becomes-third-person-survive-rabies.html>


[This report provides some additional details on this case reported
in ProMED-mail archive no. 20110527.1619. Mod.TY]

An 8-year-old resident of rural Humboldt County, has become the 3rd
person in the United States known to have recovered from rabies
infection without receiving the rabies vaccine, through the efforts of
a team of dedicated physicians, nurses, and therapists at UC Davis
Children's Hospital.

The hospital team was led by Jean Wiedeman, associate professor of
pediatric infectious diseases. Wiedeman coordinated the patient's care
with state, local, and federal officials at the US Centers for Disease
Control and Prevention (CDC), the California Department of Public
Health's Encephalitis and Special Investigations Section, and county
health departments in Humboldt and Sacramento counties.

While it is not known how she became infected, public health
officials suspect she may have encountered a feral cat near her
elementary school in the tiny town of Willow Creek, California, near
the Humboldt County border with Trinity County, though the infected
animal never was found. She did not receive post-exposure prophylaxis
[PEP], a series of antiviral inoculations administered following
infection, because the date and nature of her exposure is not known.
Rabies is virtually always fatal without PEP.

Samples of the girl's blood and spinal fluid were provided to the
state Encephalitis and Special Investigations Section of the
California Department of Public Health, directed by Carol Glaser, a
physician and veterinarian and associate professor of pediatric
infectious diseases at UC San Francisco. Test results returned on 5
May [2011] indicated that the girl had rabies.

The girl was first admitted to the intensive care unit and then she
graduated to the step-down unit. As time passed, however, the girl's
immune response gave Wiedeman and the rest of her health-care team and
family reason for hope.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[There has been controversy about the effectiveness of the Wisconsin
protocol. It certainly appeared to work well in this case, no doubt
aided by the patient's vigorous immune response, as the attending
physicians noted. The patient survived and her condition improved
sufficiently to be released from the intensive care unit.

The type of confirmatory laboratory test used is not indicated in
this report, but presumably was serological. Presence of
rabies-specific antibodies in blood and CSF is indicative of exposure
to rabies virus. ProMED-mail will be interested to know if the girl
suffers sequelae from her infection.

Dr Martin Haditsch cautioned in ProMED-mail archive no. 20110606.1728
that there is not a reasonable expectation that people infected with
rabies virus and develop clinical disease will survive. This
underscores the need for timely post-exposure treatment (PET) of
animal bites. Unfortunately, in the case above there was no history of
the patient being bitten, so PET was not applied.

A HealthMap/ProMED-mail interactive map showing the location of
Humboldt county in California, USA can be accessed at
<http://healthmap.org/r/0uKe> Mod.TY]