1/38. Preventing human rabies before and after exposure.Rabies is a viral disease that can be transmitted from animals to humans. Recently, most human deaths from rabies have been caused by transmission from bats, in many cases without a documented bite or exposure. Rabies is fatal if untreated prior to onset of symptoms. Deaths from human rabies in the united states are rare, largely because of animal control measures and postexposure prophylaxis of people who have been bitten or exposed to the virus. Primary care providers play a pivotal role in the prevention of rabies. Preexposure prevention involves education and immunization of persons at high risk for rabies exposure. Rabies is difficult to diagnose antemortem because of the nonspecific presentation of signs and symptoms that may mimic those of respiratory or abdominal infections. Diagnosing rabies once symptoms begin will not save the victim's life but will help to minimize exposure to others, allow for identification and prophylaxis of those who may have been exposed, and identify the animal vector.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
2/38. Trucut needle biopsy through superior orbital fissure for the diagnosis of rabies.Necropsy diagnosis of rabies can be done by taking a brain biopsy specimen with a trucut needle inserted through the superior orbital fissure into the cranial cavity. This technique reduces the number of personnel who require post-exposure prophylaxis and avoids full necropsy if the deceased's relatives are opposed.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
3/38. Survey of rabies preexposure and postexposure prophylaxis among missionary personnel stationed outside the united states.BACKGROUND: Of the 36 cases of human rabies that have occurred in the united states since 1980, 12 (33%) were presumed to have been acquired abroad. In the united states, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack immediate access to appropriate medical care, including vaccine and rabies immune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while stationed in bangladesh highlighted this high-risk group. methods: To assess their knowledge of rabies risk, rabies exposures, and compliance with preventive recommendations, we asked 695 missionaries and their family members to complete questionnaires about their time stationed abroad. RESULTS: Of the 293 respondents stationed in countries where rabies is endemic, 37% reported prior knowledge of the presence of rabies in their country of service. Only 28% of the personnel stationed in rabies-endemic countries received preexposure prophylaxis. Having preexposure prophylaxis specifically recommended increased the likelihood of actually receiving it (O.R. 15.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, another human = 20%), proven or presumed to be rabid. Three of the people exposed received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment. CONCLUSIONS: Although American missionaries stationed abroad are at an increased risk for exposure to rabies, compliance with established preventive measures was low. Prior to being stationed abroad, an educational rabies-prevention briefing, including encouragement to receive preexposure prophylaxis, could be an effective intervention for missionaries to decrease their risk of rabies.- - - - - - - - - - ranking = 5keywords = person (Clic here for more details about this article) |
4/38. Failure of pre- and postexposure rabies vaccinations in a child infected with hiv.We report the case of a 6-y-old hiv-infected girl with severe immune deficiency who failed to respond to intramuscular pre-exposure rabies vaccination using human diploid cell rabies vaccine on days 0, 7 and 28. She also failed to respond to an intradermal postexposure rabies regimen using purified verocell rabies vaccine at 4 sites on days 0, 3 and 7 and at 2 sites on days 30 and 90 (double the usual regimen). Sequentially monitored rabies neutralizing antibody titers were below the WHO minimum acceptable level (> 0.15 IU/ml) in all specimens. Rabies prevention in hiv-infected persons with severe immune suppression requires further study.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
5/38. public health aspects of rabies.environmental health Services personnel are responsible for communicable disease surveillance and control, which includes rabies. They conduct contact investigation on all rabid animals reported by Veterinary Services. A patient admitted to USAF Hospital Clark with a clinical diagnosis of rabies (confirmed on autopsy) presented a more complex investigation problem. Identification of hospital personnel who had significant contact with the patient was relatively easy. There were 21 hospital personnel identified as requiring antirabies prophylaxis. Social contacts of the patient were more difficult to identify. Numerous friends and co-workers were interviewed. Only one person was determined to need prophylaxis as a result of the investigation. One of the most important aspects of any rabies investigation is coordination between all involved personnel. These personnel represent various disciplines including veterinary, medical, and public health (both military and civilian). If all individuals are to be identified, evaluated, and given complete, correct information, there must be open lines of communication between the various disciplines.- - - - - - - - - - ranking = 6keywords = person (Clic here for more details about this article) |
6/38. A local outbreak of paralytic rabies in Surinam children.A rapidly fatal encephalomyelitis, which was in most cases characterized by ascending paralysis, developed in seven children of the age of 3 to 10 years in a bushnegro village in the interior of Surinam. rabies virus was recovered from the central nervous system of three autopsied children. Although the source of infection has not been detected, there is an indication that, at least in some cases, the disease has been transmitted by rat-bite rather than by vampire bats. During the same period a few cases of minor febrile illness occurred in the same community. Since virological and serological evidence of a wide-spread distribution of Coxsackie A virus type 4 was obtained, the latter illness may presumably be attributed to this virus.- - - - - - - - - - ranking = 0.008352472775146keywords = illness (Clic here for more details about this article) |
7/38. Neurologic illness following post-exposure prophylaxis with purifiled chick embryo cell antirabies vaccine.Clinical details of a neurologic illness simultating Guillain Barre syndrome developing in a patient after post-exposure prophylaxis with purified chick embryo cell (PCEC) anti-rabies vaccine is reported. Neurologic complication following PCEC vaccination has not been reported earlier.- - - - - - - - - - ranking = 0.020881181937865keywords = illness (Clic here for more details about this article) |
8/38. Human rabies--california, georgia, minnesota, new york, and wisconsin, 2000.On September 20, October 9, 10, 25, and November 1, 2000, persons who resided in california, new york, georgia, minnesota, and wisconsin, respectively, died of rabies. This report summarizes the case investigations.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
9/38. Human rabies--tennessee, 2002.On August 31,2002, a boy aged 13 years residing in Franklin County, tennessee, died from rabies encephalitis caused by a rabies virus variant associated with silver-haired and eastern pipistrelle bats. This report summarizes the investigation by the tennessee Department of Health (TDH). persons should avoid direct contact with bats, other wildlife, and stray or ill domestic animals; however, if direct contact with bats has occurred, exposed persons should see their health-care provider, and the exposure should be reported to local public health officials.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
10/38. risk factors associated with travel to rabies endemic countries.Increased travel to exotic destinations around the world is escalating the risk that an emerging virus may be imported into the UK. Rabies should be considered in the differential diagnosis of any encephalitic illness presenting in an appropriate epidemiological context. Molecular diagnostic tests that can rapidly discriminate rabies from other suspected infections will influence the use of anti-rabies prophylaxis for potential contacts with the victim. In 2001, the UK had two confirmed human rabies cases, imported from the philippines and nigeria, respectively. In case one, hemi-nested reverse transcriptase polymerase chain reaction (hn-RT-PCR) and automated sequencing confirmed the presence of rabies virus (RABV) within both the saliva and skin specimens within 36 h of sample submission. Subsequent phylogenetic analysis using a partial sequence of the nucleoprotein (N-) gene segment demonstrated that the virus was closely related to that of canine variants currently circulating in the philippines. In the second case, the fluorescent antibody test and reverse transcriptase polymerase chain reaction (RT-PCR) confirmed the diagnosis on post-mortem tissue. Phylogenetic analysis of two genomic segments of this isolate confirmed that it was a classical RABV (genotype 1) of the africa 2 subgroup. These cases have highlighted the capability of molecular diagnostic tests for the rapid identification and subsequent genotyping of RABV to host and geographical location. In the first instance, rabies diagnosis often rests on clinical and epidemiological grounds. Negative tests, even late in the illness, do not exclude the diagnosis as these tests are never optimal and are entirely dependent on the nature and quality of the sample supplied. For this reason, rapid molecular detection and virus typing will be essential in considering the appropriate medical treatment regimen for a patient. In addition, an early diagnosis may decrease the number of unnecessary contacts with the patient and reduce the requirement for invasive and costly interventions. Rabies should form part of a differential diagnosis for any patient presenting with a history of travel to a rabies endemic country and displaying an undiagnosed encephalopathy.- - - - - - - - - - ranking = 0.008352472775146keywords = illness (Clic here for more details about this article) |
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