Yellow mongooseEvery few days, it seems, I get an email or call that goes something like “I was just bitten by [insert various mammals here]. Do I need to worry about rabies or do anything?”

The answer’s pretty similar every time. While the relative risk posed by different animal species in different geographic regions varies, you have to think about rabies anytime you’ve been bitten by a mammal. Knowing what to do can save a lot of hassles, and maybe your life. While the likelihood of rabies exposure from a bite in most countries is very low, ignoring or not being aware of this low risk leads to deaths.

CDC’s Morbidity and Mortality Weekly Report Recently published an article about a rabies death in Puerto Rico from 2015 (Styczynski et al 2016). The affected person was a 54-year-old man who initially presented to the ER with fever, difficulty swallowing, tingling in a hand, cough and chest tightness. He died the next day. Upon further investigation, his wife reported that he had been bitten by a mongoose approximately 2 months earlier. However, he did not seek care for the bite. Rabies was confirmed on autopsy. After an investigation of his contacts, seven family members and two healthcare personnel received rabies post-exposure prophylaxis (PEP).

Mongooses are a rabies reservoir species in certain areas, and rabies is very common in mongooses in Puerto Rico. An astounding 97% of mongooses that were tested after biting a person between 2005-2008 were positive for rabies. Not surprisingly, rabies PEP is recommended after mongoose bites, as it is for bites from other rabies reservoir species (e.g. raccoons, skunks, foxes, bats) in other regions.

If this bite had been reported, it’s virtually guaranteed that the man would have received PEP, and with that, it’s virtually guaranteed that he would not have developed rabies. There are a number of reasons why people don’t get appropriate care following a bite from a potentially rabid animal. In some regions, it’s because of poor access to medical care, or little to no supply of the rabies vaccine and rabies antibodies required. That’s not the case in Puerto Rico, where failure to obtain treatment is much more likely due to lack of the victim knowing it’s needed.

As the authors conclude, “Public health measures to reduce the risk for human rabies should include increased resources for primary prevention, including routine pet vaccination (canine rabies in Puerto Rico results from transmission from mongooses) and pre-exposure prophylaxis for persons at highest risk. Community education should highlight measures to avoid bites from pets and wildlife. Effective oral rabies vaccine baits targeting mongooses might also be considered as they become commercially available. Interventions should focus on areas with known human-mongoose contacts, as determined by overlaying bite surveillance data and population density. Secondary prevention measures should be aimed at increasing awareness of the need for medical evaluation and PEP after any mongoose bite.”