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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 2019 found that a total of 4305 wild animals and 385 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

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Lessons From Lack of Treatment Icon

Lessons From Lack of Treatment

Even with highly effective rabies prevention and control programs in place, death from rabies still occurs.3-5

In mid-August of 2021, an 80-year-old man in Illinois woke to find a bat on his neck. The bat was captured and found to be positive for rabies. The man was advised to start postexposure treatment for rabies immediately, but he denied the recommended treatment. Early in September, the man reported neurological symptoms, including neck pain, headache, difficulty controlling his arms, finger numbness, and difficulty speaking. He died before the month was over, with the Centers for Disease Control and Prevention confirming the diagnosis of rabies.3 

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.4

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.

Only a short time later, 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.5

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 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. 

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.6

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Myth or Fact?

All rabies exposures are caused by a bite.

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Indication and Usage

HYPERRAB® (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.

Limitations of Use 

Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine.

For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis.

Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

Important Safety Information

For infiltration and intramuscular use only.

Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reactions in >5% of subjects during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.

Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.

Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio, or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.  

Please see full Prescribing Information for HyperRAB.

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

HyperTET 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 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 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 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.


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References:

  1. Ma X, Monroe BP, Wallace RM, et al. Rabies surveillance in the United States during 2019. JAVMA. 2021;258(11):1205-1220.
  2. Animal bite infections. Encyclopedia of Children’s Health. Accessed October 5, 2021. http://www.healthofchildren.com/A/Animal-Bite-Infections.html.
  3. Heching D. Illinois man who denied treatment dies of rabies after bat colony was found in his home. People.com/Health website. September 28, 2021. Accessed October 7, 2021. https://people.com/health/illinois-man-dies-of-rabies-after-denying-treatment/.
  4. Dyer JL, Yager P, Orciari L, et al. Rabies surveillance in the United States during 2013. J Am Vet Med Assoc. 2014;245(10):111-1123.
  5. Pratt PD, Henschel K, Turabelidze G, et al. Human rabies—Missouri, 2014. MMWR Weekly / March 18, 2016;65(10):253-256.
  6. Rabies in the U.S. Centers for Disease Control and Prevention (CDC). Updated April 6, 2020. Accessed November 16, 2021. https://www.cdc.gov/rabies/location/usa/index.html.

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Myth/Fact References:

  1. How is rabies transmitted? Centers for Disease Control and Prevention (CDC). Updated June 11, 2019. Accessed October 1, 2021. https://www.cdc.gov/rabies/transmission/index.html.
  2. Ma X, Monroe BP, Wallace RM, et al. Rabies surveillance in the United States during 2019. JAVMA. 2021;258(11):1205-1220.
  3. What are the signs and symptoms of rabies? Centers for Disease Control and Prevention (CDC). Updated June 11, 2019. Accessed October 1, 2021. https://www.cdc.gov/rabies/symptoms/index.html.