Toronto Public Health has confirmed the diagnosis of rabies in a person in the city of Toronto, the first such diagnosis since 1931. Details are limited at this point, but there appears to be strong suspicion that this is a travel-associated infection.
The affected person is a 41-year-old man who was working in the Dominican Republic as a bartender. He reportedly started to develop signs of illness last month - it's unusual for someone to be clinical ill due to rabies for so long, as typically once signs occur they progress very rapidly (and almost always end in death). Regardless, after he became sick in the Dominican, he returned home to Toronto, presumably for more medical care. He was taken to hospital by police after arrival since he was behaving erratically at customs. It's reported that he had fairly serious signs before leaving the Dominican Republic, including trouble swallowing and fear of food, water and air. Given that, I'm amazed that he was allowed onto a plane, even with the pretty lax approach that airlines typically take towards sick people boarding planes. While I know circumstances can be difficult and options may have been limited, this isn't really a good way to bring someone home from a foreign country with an unknown disease. Fortunately, rabies isn't spread by casual contact, but you have to consider the potential for more easily transmitted diseases when you go ahead and put someone on a plane with lots of other people. Thankfully his erratic behaviour started on the ground, not in the air, and he didn't have a more transmissible disease.
The man's current condition isn't clear. It appears that the diagnosis was made a few days ago and he's being treated in hospital. However, rabies is almost invariably fatal, especially when disease is advanced by the time it's diagnosed.
People who have had contact with the affected man are being evaluated to determine who requires post-exposure treatment. Further testing will be done on the virus to see what strain it is, to provide more information about the possible origin. Most likely, it was from a dog bite, but that's just a guess on my part.
While little information is available regarding this case, it's a chance to remind people again of a few key rabies prevention points:
- Pets should be vaccinated against rabies.
- People (especially kids) should be taught basic bite-prevention practices and to avoid strange animals.
- Any bite from an animal needs to be investigated to determine whether there might have been rabies exposure.
- Rabies is very common in many countries (especially less developed countries), particularly dog rabies. People need to pay extra attention to bite avoidance when traveling.
- Rabies is basically 100% preventable if proper post-exposure treatment is provided. The weak link is often people failing to seek medical care after a bite. That's particularly true for many travelers. If you are bitten while traveling, you need to make sure you get adequate care, or get home to get treated properly, and promptly.