Imported Human Rabies - California, 2008 by ProQuest


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									                               Morbidity and Mortality Weekly Report

  Weekly                                                                              July 10, 2009 / Vol. 58 / No. 26

                            Imported Human Rabies — California, 2008
   Compared with rabies in developing countries, human rabies         Results were normal except an elevated blood urea nitrogen
is rare in the United States, but animal rabies is common (1,2).      value of 20 mg/dL (normal range: 7–18 mg/dL). The patient
In the United States, most human rabies cases are associated with     was given intravenous fluids and discharged with the diagnosis
rabid bats, whereas in developing countries, dogs are the most        of pharyngitis and abdominal pain.
common reservoir and vector species. In March 2008, a case of            Several hours later, the patient was brought by his family
imported human rabies in a recently arrived, undocumented             to the same ED with nausea, vomiting, fever, and sore throat.
Mexican immigrant was laboratory confirmed by public health           He was mildly febrile (99.1°F [37.3°C]) with tachycardia (164
officials in California. The rabies virus isolated from the patient   beats per minute) and was noted to be agitated and uncoop-
was a previously uncharacterized variant most closely related to      erative. He refused to take fluids and was observed to spit
viruses found in Mexican free-tailed bats (Tadarida brasiliensis).    frequently. Because of the patient’s agitated behavior and his
The molecular and phylogenetic characterizations of this rabies       refusal to take oral fluids, the ED physician suggested that psy-
virus variant have been described previously (3). This report         chiatric consultation might be needed. The patient was again
summarizes the epidemiologic investigation and the ensuing            given intravenous fluids for dehydration. He was discharged
public health response. A total of 20 persons, mostly household       to his aunt’s home with the diagnosis of viral pharyngitis,
contacts, received postexposure prophylaxis (PEP) because of          depression, and anorexia.
potential exposure to rabies virus from the patient. The findings        The next day, on March 18, the patient experienced vomit-
underscore the difficulties encountered in the diagnosis and          ing and shaking and then collapsed at his aunt’s home. When
epidemiologic investigations of imported human rabies cases           paramedics arrived, the patient was not breathing and was
and the importance of a coordinated public health response            unresponsive. Resuscitation efforts were not successful.
across multiple international jurisdictions.                             After the patient’s death, the possibility of rabies as a cause
                                                                      of his illness was considered by the ED physician because
Case Report                                                           1) the patient exhibited hydrophobia and aggressive behav-
  On March 17, 2008, a male aged 16 years who had recently            ior, and 2) the patient had come to the United States from a
entered the United States from Oaxaca, Mexico, was brought by         canine rabies enzootic region in Mexico only the day before
his family to an emergency department (ED) in Santa Barbara           his presentation at the ED.
County, California, with sore throat and a recent history of
not eating or drinking. The ED physician obtained a history             INSIDE
with assistance from a translator. The patient’s vital signs were       716 Clinic-Based Testing for Rectal and Pharyngeal Neisseria
remarkable for a mild temperature elevation (100.6°F [38.1°C])              gonorrhoeae and Chlamydia trachomatis Infections by
and tachycardia (140 beats per minute). He was awake and alert              Community-Based Organizations — Five Cities, United
                                                                            States, 2007
but agitated and crying. His examination was notable for mild
                                                                        719 Progress Toward Poliomyelitis Eradication — India,
abdominal tenderness. Laboratory studies included a complete                January 2007–May 2009
blood count, electrolytes, liver function tests, and urinalysis.

                         department of health and human services
                          Centers for disease Control and Prevention
714                                                                      MMWR                                                July 10, 2009

 The MMWR series of publications is published by the Coordinating           Public Health Investigation
 Center for Health Information and Service, Centers for Disease                The Santa Barbara County Public Health Department and
 Control and Prevention (CDC), U.S. Department of Health and
 Human Services, Atlanta, GA 30333.
                                                                            health officials in Mexico interviewed family members and
 Suggested Citation: Centers for Disease Control and Prevention.            friends of the patient regarding potential rabies exposures.
 [Article title]. MMWR 2009;58:[inclusive page numbers].                    Through these interviews, two potential 
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