Tonka
Well-known member
http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88393
Archive Number 20110511.1442
Published Date 11-MAY-2011
Subject PRO/AH/EDR> Rabies - USA: (CA)
RABIES - USA: (CALIFORNIA)
**************************
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: 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]
.................................................sb/tg/mj/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
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############################################################
Archive Number 20110511.1442
Published Date 11-MAY-2011
Subject PRO/AH/EDR> Rabies - USA: (CA)
RABIES - USA: (CALIFORNIA)
**************************
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: 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]
.................................................sb/tg/mj/lm
*##########################################################*
************************************************************
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Donate to ProMED-mail. Details available at:
<http://www.isid.org/ProMEDMail_Donations.shtml>
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org (NOT to
an individual moderator). If you do not give your full name
name and affiliation, it may not be posted. You may unsub-
scribe at <http://www.isid.org/promedmail/subscribe.lasso>.
For assistance from a human being, send mail to:
<postmaster@promedmail.org>.
############################################################
