Rabies is “almost always” transmitted by bites and “almost invariably” fatal once disease develops in a person or animal. We use a lot of these kinds of disclaimers with infectious diseases, which can be frustrating, but it’s necessary because exceptional (strange) things occasionally occur.

A report in an upcoming edition of Emerging Infectious Diseases (Zhao et al). describes an unusual case of rabies in a man from China.

The man was from a village in Jiangsu province, China, where canine rabies is endemic. His son was bitten by a stray dog, which is absolutely considered a potential rabies exposure unless the dog is caught for quarantine or testing. Family members provided wound care, which is important, but as part of this treatment the man in question tried to suck “toxic blood” from his son’s wounds.

Neighbours killed and buried the dog, so it couldn’t be tested for rabies, but the son got appropriate medical care and received post-exposure prophylaxis (PEP). The physician also recommended PEP to the father, because of the potential that he could have been exposed to rabies virus in saliva from the dog that had been deposited in the wound. However, he declined, in part because of cost and because of his belief that he had spat out all the blood.

Approximately a month later, the man developed signs of rabies, and died the day after he was hospitalized. His son was fine.

While control of rabies in areas where it is widespread in the dog population is challenging, preventing rabies in people is actually straightforward. Rabies PEP is “almost always” effective (another waffly term, but failure of properly administered PEP is incredibly rare, if it even occurs). But things fall apart when there is poor education (e.g. the bite victim or healthcare providers not understanding the need for treatment), lack of access to treatment or economic barriers. Here, two of these were involved in this man’s death: while healthcare providers recognized the risk and made the appropriate recommendation, the man declined because of a lack of understanding of the risk and because of cost concerns. These factors resulted in his death as much as the dog itself did.

Happy Easter from Finnegan and Merlin (well… maybe not so much Finnegan).