Imported Human Rabies Cases

Posted on by JD Blanton

A black and white picture of a Mexican freetail bat being held by a heavy glove.

In the U.S., human rabies is rare, thanks mostly to the availability of rabies vaccination and the elimination of dog rabies. But in many other countries around the world, dog rabies is very common and people are at greater risk. When a person travels or immigrates from an area of higher risk (like Mexico) to an area of lower risk (like the United States), they may encounter obstacles in getting diagnosed correctly if they have rabies. A recent human rabies case from California demonstrates the challenges that can arise when attempting to administer care to a person from another country.

On March 17, 2008, a 16 year old male who had recently immigrated to the U.S. from Oaxaca, Mexico was brought to an emergency department (ED) in Santa Barbara County, California, with a sore throat and difficulty swallowing. Lab tests were performed and results indicated that he was dehydrated. The patient was given fluids and discharged as having pharyngitis (an inflammation of the throat or pharynx). However, the patient returned to the same ED several hours later, this time with nausea, vomiting, fever, and sore throat. He was also noted to be agitated, uncooperative, and hysterical; refused to take fluids; demonstrated a depressive state; was spitting frequently; and refused to take fluids or ice chips. He was again given intravenous fluids for dehydration and discharged.

The patient returned to the home of an aunt. The next day, he collapsed, and when paramedics arrived, the patient was not breathing, unresponsive, and could not be resuscitated. After the boy’s death, the ED physician began to consider rabies as the cause of his illness for two primary reasons: he presented several rabies symptoms (hydrophobia, aggressive behavior, and depression) and came from a region of Mexico where dog rabies is very common. An investigation was initiated to confirm the physician’s suspicion. After interviewing family members, talking with Mexican health authorities, and conducting lab tests, much was learned:

  • There were several stories about how he was exposed to rabies — one that implicated a dog bite and another a fox bite the patient had received approximately 3-4 months prior to leaving Mexico.
  • The rabies virus variant responsible for the patient’s infection was characterized as a bat rabies virus variant which had not been previously identified in the U.S. or in Mexico.
  • This case represented the first case of imported rabies in the United States not attributable to a dog rabies virus variant

What might this mean for rabies prevention and control between lower and higher risk countries? Well, a few things pop to mind as being critically important:

  • Sharing information between countries about persons affected as well as variants of the virus can be helpful in identifying new variants of a disease and implementing control measures and prevention education in both countries
  • Establishing collaborative efforts, especially along border regions, among entities that have a stake in human and animal health is key too. Having procedures for sharing cases of disease among people and animals can lead to faster identification of cases and outbreaks as well as to prevention and control measures.

For more information, please see the MMWR article from July 10, 2009

Posted on by JD Blanton
Categories Vectorborne

7 comments on “Imported Human Rabies Cases”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    I was so sorry that why governments neglect this disease.It has killed so many developing countries people.But now I read death from a US. I was so sorry by the incidence happened in the US. Oh,it is a horrible disease let us not ignore it. Let us teach people to handle animal bite seriously. Thank u

    I was bitten on my right hand by a coon two weeks ago today – I washed the wound for 5 min. _ then showered – soaked my hand in 100% vodka – put Neosporin on it – soaked it several times in full-strength Lysol (in brown bottle) for a couple of days – the wound healed within days.

    I strained my neck this week and then while riding in our truck my husband hit holes in driveways twice in one afternoon, making my neck really hurt – I’ve been in pain since – I had chills and shakes last night – I checked on line yeaterday for symptoms of rabies in humans and discovered that muscle and neck pain is a sign, as well as chills and shakes – my hand isn’t itching or in any kind of pain other than a little tenderness – I have headaches with the change of the weather, so a dull headache is common – I will probably go to the health dept tomorrow – I called emergency and spoke with a doctor early yesterday, letting him know what was going on with me and the circumstances of the bite – he told me it sounded like all was okay (before the chills,etc.) – he told me to contact the health dept as I’m allergic to so many medicines.

    Am I ok? My neck injury was a separate injury, but I’m not sure that it could me a symptom – I’ve been off balance since the neck injury.

    Judith

    Judith, thank you for reading and for your comment. We are not at liberty to give medical advise and strongly encourage you to see your doctor so that he/she can give you a proper assesment.

    Thanks

    I know the incubation period can take up to 8 years, but is there a time when one can stop worrying about an exposure? If 8, why not 30 right?

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