Dangers of Untreated Rabies icon

Dangers of Untreated Rabies

Prevalence of Rabies

The most recent data from the US Centers for Disease Control (CDC) collected in 2013 found that a total of 5,398 wild animals and 467 domestic animals in the United States were infected with rabies.1

US data for animal bites range from 1 million to 4.5 million a year. Cat and dog bites result in 334,000 emergency room visits annually. Each year, 1 to 3 people in the United States report a rabies infection.1,2

Lessons From Lack of Treatment Icon

Lessons From Lack of Treatment1

In 2011, a Maryland man received a kidney transplant from a deceased donor who had lived in Florida and North Carolina. In 2013, the Maryland man began experiencing symptoms consistent with rabies, and eventually died from the disease a full year and a half after the kidney transplant. After a detailed medical investigation by the CDC, the source of the Maryland man's disease was determined to be the organ donor, a young man who died of unexplained encephalitis that had been attributed to complications from severe gastroenteritis. The CDC's investigation revealed that both the organ donor and the recipient in Maryland had died of a variant of the rabies virus carried by raccoons.

Had he known this threat and contacted his local health department or visited the emergency department, he might have been treated with rabies postexposure prophylaxis (PEP) and survived.

More recently, a 52-year-old Missouri man died in September 2014. It was reported that the victim had been infected with a rabies virus variant associated with the tricolored bat. The victim was said to have found bats in his home and at his workplace a month before his symptoms began, and he may have unknowingly sustained a bite.

In the case of the Maryland death in 2013 associated with the organ donor, better communication between the healthcare provider and the originally exposed patient and his family might have yielded a different outcome. In compliance with current organ donation policy, family members of the donor completed a questionnaire at the time of death, including the decedent's exposure to potentially rabid animals or receipt of rabies PEP. But when asked if the donor had been exposed to potentially rabid animals, the family answered "no," presumably unaware that the raccoons kept penned on the family property fell into the category of potentially rabid animals. The fact that the donor had sustained bites from these raccoons was never revealed in the patient's history until the CDC investigation of the Maryland organ recipient's death.

In the case of the Missouri man who died in 2014, he was presumably not aware of the rabies threat associated with bats, whether a bite is apparent or not. Had he known this threat and contacted his local health department or visited the emergency department, he might have been treated with rabies PEP and survived.

Providers in emergency departments, primary care offices, and pediatric offices need better education about rabies and PEP, as do consumers.

The prevention of human rabies deaths begins with increased awareness and better education among healthcare professionals, public health professionals, and the general public, along with improved screening of organ donors to recognize infectious encephalitis and closer monitoring of transplant recipients. That was the conclusion of researchers investigating the 2013 Maryland death.

While human rabies deaths have been significantly reduced over the last 100 years, the most desirable outcome is not a decline but the elimination of human rabies deaths.1

Myth or Fact?

Domestic animals are the most common rabid animal in the United States.

Rabies vaccine and HyperRAB® S/D (rabies immune globulin [human]) should be given to all persons suspected of exposure to rabies with one exception: persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. HyperRAB S/D should be administered as promptly as possible after exposure, but can be administered up to the eighth day after the first dose of vaccine is given.

HyperRAB S/D should be given with caution to patients with a history of prior systemic allergic reactions following the administration of human immunoglobulin preparations.

The attending physician who wishes to administer HyperRAB S/D to persons with isolated immunoglobulin A (IgA) deficiency must weigh the benefits of immunization against the potential risks of hypersensitivity reactions. Such persons have increased potential for developing antibodies to IgA and could have anaphylactic reactions to subsequent administration of blood products that contain IgA.

As with all preparations administered by the intramuscular route, bleeding complications may be encountered in patients with thrombocytopenia or other bleeding disorders.

Soreness at the site of injection and mild temperature elevations may be observed at times. Sensitization to repeated injections has occurred occasionally in immunoglobulin-deficient patients. Angioneurotic edema, skin rash, nephrotic syndrome, and anaphylactic shock have rarely been reported after intramuscular injection so that a causal relationship between immunoglobulin and these reactions is not clear.

Administration of live virus vaccines (e.g., MMR) should be deferred for approximately 3 months after rabies immune globulin (human) administration.

HyperRAB S/D is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent that can cause disease. There is also the possibility that unknown infectious agents may be present in such products.

Please see HyperRAB S/D full Prescribing Information for complete prescribing details.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

HyperTET® S/D (tetanus immune globulin [human]) is indicated for prophylaxis against tetanus following injury in patients whose immunization is incomplete or uncertain.

HyperTET S/D should be given with caution to patients with a history of prior systemic allergic reactions following the administration of human immunoglobulin preparations.

In patients who have severe thrombocytopenia or any coagulation disorder that would contraindicate intramuscular injections, HyperTET S/D should be given only if the expected benefits outweigh the risks.

Slight soreness at the site of injection and slight temperature elevation may be noted at times. Sensitization to repeated injections of human immunoglobulin is extremely rare. In the course of routine injections of large numbers of persons with immunoglobulin, there have been a few isolated occurrences of angioneurotic edema, nephrotic syndrome, and anaphylactic shock after injection. Administration of live virus vaccines (eg, MMR) should be deferred for approximately 3 months after tetanus immune globulin (human) administration.

HyperTET S/D is made from human plasma. Products made from human plasma may contain infectious agents, such as viruses and theoretically, the Creutzfeldt-Jakob disease (CJD) agent that can cause disease. There is also the possibility that unknown infectious agents may be present in such products.

Please see HyperTET S/D full Prescribing Information for complete prescribing details.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.


References:

  1. Dyer JL, Yager P, Orciari L, et al. Rabies surveillance in the United States during 2013. J Am Vet Med Assoc. 2014;245(10):1111-1123.
  2. Centers for Disease Control and Prevention. Human rabies. Centers for Disease Control and Prevention website. http://www.cdc.gov/rabies/location/usa/surveillance/human_rabies.html. Updated September 21, 2015. Accessed April 22, 2016.
  3. Encyclopedia of Children's Health. Animal bite infections. Encyclopedia of Children's Health website. http://www.healthofchildren.com/A/Animal-Bite-Infections.html. Accessed April 8, 2016.
  4. Centers for Disease Control and Prevention. How is rabies transmitted? Centers for Disease Control and Prevention website. http://www.cdc.gov/rabies/transmission/index.html. Updated April 22, 2011. Accessed April 11, 2016.
  5. Centers for Disease Control and Prevention. What are the signs and symptoms of rabies? Centers for Disease Control and Prevention website. http://www.cdc.gov/rabies/symptoms/index.html. Updated February 15, 2012. Accessed April 11, 2016.