UK rabies update

A 50-year-old UK woman, the first of two recent travel-associated rabies cases in the UK, has unfortunately but not surprisingly succumbed to the infection.

The woman was bitten by a puppy while traveling in India. Given the widespread nature of rabies in dogs in India and the large number of human rabies deaths associated with canine rabies there, this was a high-risk exposure. I still haven't seen any information about whether she sought medical care in India or not. Too often, people don't bother to go to a doctor after being bitten, especially if the bite appears minor - but even a minor bite can transmit rabies. Furthermore, people don't always get the care they need, since rabies treatment is astoundingly not always offered after dog bites in India, and rabies vaccine and antibody may sometimes be in short supply.

Whatever happened in India, the woman was reportedly turned away twice by doctors back home at Darent Valley Hospital in Dartford, Kent. It's not clear why, and an investigation is underway, but it's not necessarily surprising since signs of rabies can be very vague at first. Initial signs could mimic a range of minor illnesses, and if the doctors didn't know that the woman was bitten by a dog in India, rabies presumably (and reasonably) wouldn't be considered, especially since it's not present in the UK.

In what is hopefully a case of misquoting or misinterpretation, Dr. Ron Behrens of the London School of Hygiene and Tropical Medicine is quoted as saying that there is a 24 hour window after a bite when antibody treatment can prevent the virus from entering the nervous system. In reality, it's not that quick and the incubation period can be very long in some cases. Post-exposure treatment can be highly effective even if it's given well after exposure, as long as it's before signs of rabies occur. Prompt treatment is always best.

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Maureen Anderson - May 29, 2012 8:32 AM

Dr. Behrens comment is in fact accurate - when rabies virus is inoculated into the tissues by a bite it takes approximately 24 hours for the virus to enter the nervous system at the local level, i.e. the local nerves. The virus then travels through the peripheral nerves to the central nervous system - this is the part that can take days, weeks or months depending on how peripheral the bite was. Once it reaches the central nervous system signs of illness start to develop and from there the disease usually cannot be stopped. However, Dr. Weese is also correct in that administration of post-exposure treatment (vaccine and antibody) can still be effective beyond the initial 24 hr window, as there are still opportunities for the virus to be "intercepted" on its way to the central nervous system as it passes between nerve cells.

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