For the first time in nearly 40 years, a U.S. servicemember died last year from rabies because of an overseas exposure to an infected dog, according to the national Centers for Disease Control, which emphasized that overseas travelers, including deployed military, need to be warned of the risks.
In a recent issue of the Morbidity and Mortality Weekly Report (MMWR), CDC said the case “highlights the importance of rabies risk awareness for all travelers, including servicemembers, and the need for prompt medical care, including [ post-exposure prophylaxis (PEP)], for potential exposures.” 1
Last August, a soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety and dysphagia was admitted to an emergency department in New York for suspected rabies. An Afghanistan canine rabies virus variant was identified, and the patient told clinicians he had been bitten by a dog while deployed there. He had not received effective rabies PEP, however, and an experimental treatment protocol was tried unsuccessfully at the hospital in New York.
As a result, 29 close contacts and healthcare personnel received PEP because of proximity to the patient.
Canine rabies virus transmission is considered eliminated in the continental United States but still affects travelers to canine rabies-enzootic areas. During a 15-year time period ending in August 2011, 10 of 45 reported U.S. human rabies cases were associated with canine-variant viruses, and all resulted from dog exposures occurring overseas, the CDC noted.
Worldwide, CDC reports that canine rabies from dog bites in Africa and Asia make up more than 95% of all human rabies deaths.
“With the exception of transmission through transplantation, human-to-human rabies transmission has not been laboratory-documented but is possible theoretically because rabies virus can be present in saliva, CSF, neural tissue and tears,” according to the MMWR article. It recommended that caregivers of patients with suspected or confirmed rabies wear goggles, gowns, gloves and face masks, particularly during activities with risk for saliva contact, such as intubation and suctioning.
The article also said travelers should be informed of rabies risks in rabies-enzootic countries and encouraged to keep a safe distance from wild and feral animals. In the case of the soldier, who had traveled since exposure, local, state, federal and international parties collaborated to do risk assessments of anyone who potentially had contact with infectious secretions in transit. None of the potential contacts required PEP.
- Waleed J, Amzuta I, Amritpal N, Johnston T, et al.. Imported Human Rabies in a U.S. Army Soldier — New York, 2011. MMWR May 4, 2012 / 61(17);302-305.