By Lizette Durand
Setting the Scene
Last August, villagers in a secluded section of Peru fell prey to blood sucking vampire bats infected with rabies. It sounds like the premise for the next vampire movie, but this wasn’t a story line thought up in Hollywood, it was the real deal. Rabies is a deadly disease that affects the central nervous system and is most commonly transferred to humans through a bite from a rabid animal. The early symptoms of rabies in people are similar to that of many other illnesses, including fever, headache, and general weakness or discomfort. As the disease progresses, more specific symptoms appear and may include insomnia, confusion, paralysis, hallucinations, agitation, increased salivation, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms. Fortunately, rabies can be prevented by administering vaccine and immunoglobulin after an exposure occurs. However, this only works if the vaccine is given before symptoms appear. In the remote jungles of the Amazon this can be difficult.
When I first heard about the outbreak in Peru I was studying the herpes virus, a completely different and almost benign virus when compared to rabies. At first glance, the report was terrifying, over 500 people bitten and four deaths, most of which were children. I immediately started wondering: why such a massive outbreak? Why now? Why were so many people bitten, adults and children, yet it seemed that mostly children were dying? This was highly unusual because rabies is normally a fatal virus. So why did it seem that adults were immune, even protected from the virus? With all these questions and more my wonder was soon replaced by excitement about the outbreak investigation that I knew would follow. What were they going to find? How were they going to control the spread? How were they going to help those already sick? After about five minutes of gazing off into space, envying the scientist, epidemiologist, and pathologists who would find the answers to these questions, I returned to my work on what now seemed a rather boring virus.
Dreams of being a Disease Detective
Investigating an outbreak has always been a fantasy of mine. I remember being fascinated watching the old 1970’s movie Andromeda Strain and while most of my classmates took watching the movie as an opportunity to sleep, I watched in awe as the scientists searched for the cause and cure of the outbreak. My fascination for being a “disease detective” stuck with me as I grew older and I focused my schooling on microbiology and Zoonotic diseases (disease that is spread from animals to humans). I came to CDC in March as part of a six week Epidemiology Elective Program where I participate in a current public health project to learn more about public health and applied epidemiology through hands on experience. I never thought in my wildest dreams that I would get to take part in an international outbreak investigation, but that’s exactly what happened!
My Big Break
Vampire bats spreading rabies has become a growing problem in the Amazon. In Peru, outbreaks of rabies have been occurring with increasing frequency with 4 separate outbreaks reported within the last 2 years. Vampire bats continue to bite people in multiple communities in the Amazon due to unknown reasons. Some people think it’s due to deforestation or other ecological or agricultural changes causing a lack of food for the bats while others blame human encroachment. When a new outbreak was identified in January of this year, the Peruvian Government realized they needed help and called on CDC just a few weeks before I started my program there in Atlanta. As luck would have it I was assigned to the rabies research team when I arrived. As soon as I heard about CDC’s involvement in the rabies investigation I told my supervisor I wanted to go. Not only would this fulfill my life-long dream of participating in an outbreak investigation, but I would be going back to the country where my family is from (that’s right, I’m Peruvian!).
Waiting to find out if I would be able to join the team in Peru was a rollercoaster ride. There were all kinds of hurdles to over come and the clock was ticking, we only had a week to get all of my paper work in order. I finally got the green light just three days before we were scheduled to leave. This left little time for me to prepare. Because I was the most novice person on the team I had to read up on everything I could about rabies, how it is spread, how it is treated, and how it can be prevented. I spent the next few days pouring over hundreds of research papers on the subject. In the end I had learned a lot about rabies and this knowledge would come in handy during the meetings in Lima.
Going Back to My Roots
Having been to Lima numerous times, my parents are originally from there, I was thrilled to being going back to do something that would help the citizens of Peru. I have to admit though, it was a little strange not to be greeted by my cousins and the rest of my extended family when I got off the plane, but I reminded myself that I was here to work and help those afflicted by the outbreak.
Once we arrived we joined members of the Peruvian Ministry of Health and National Institute of Health in Lima to talk about how to handle vaccinating the villagers. Staff with the Ministry of Health and doctors who had traveled to the villages briefed our team on what had been happening. I will never forget the description one doctor gave of the symptoms his young patient was experiencing; it was heart breaking and really put our mission into perspective.
As a student participant, I spent most of my time watching, observing and learning. However, once I became more comfortable with the situation, I started to realize how I could actually help and participate. There were questions and concerns about the different vaccines and protocols, having just spent numerous hours reading about the current practices, I was able to offer some advice.
The experience was great because I got to see first-hand how countries respond to outbreaks. The different offices and people involved, how they work together to accomplish a shared goal, the delicate art that is negotiating, a little giving and taking, learning to listen to the concerns of others and how to be diplomatic with those who don’t agree with what you are proposing. The conversations were many and the days were long, but in the end 883 people were evaluated for bat bite exposures and 717 were treated with the rabies vaccine. In addition, Peruvian Ministry of Health officials are planning to broaden their response activities to address the problem of human rabies in the Amazon region as a whole by performing a pre-exposure vaccination campaign among these populations at high risk of exposure to vampire bats. CDC remains involved in the planning and implementation of this pioneering approach to human rabies prevention. Future research hopes to answer some of the remaining questions such as why children are being disproportionately affected and what can we do to prevent further outbreaks.
For me, this opportunity was indescribably amazing, not only because I got to finally experience an outbreak investigation, but also because I got to do it in a country where my family roots are.