Global & Disaster Medicine

Rabies Deaths Among Pregnant and Breastfeeding Women — Vietnam

CDC MMWR

Nguyen HT, Tran CH, Dang AD, et al. Rabies Vaccine Hesitancy and Deaths Among Pregnant and Breastfeeding Women — Vietnam, 2015–2016. MMWR Morb Mortal Wkly Rep 2018;67:250–252. DOI: http://dx.doi.org/10.15585/mmwr.mm6708a4.

“…..Despite widespread availability of PEP in Vietnam, in 2015 the Ministry of Health (MoH) received reports of pregnant and breastfeeding women with clinically diagnosed rabies. MoH investigated factors associated with these rabies cases. MoH found that, during 2015–2016, among 169 cases reported in Vietnam, two probable cases of rabies were reported in breastfeeding mothers and four in pregnant women, all of whom had been bitten by dogs. All six patients died. Three of the four pregnant women had cesarean deliveries. One of the three newborns died from complications believed to be unrelated to rabies; the fourth pregnant woman contracted rabies too early in pregnancy for the fetus to be viable. Two of the patients sought care from a medical provider or traditional healer; however, none sought PEP after being bitten. In each case, families reported the patient’s fear of risk to the fetus or breastfed child as the primary barrier to receiving PEP. These findings highlight the need for public health messaging about the safety and effectiveness of PEP in preventing rabies among all persons with exposures, including pregnant and breastfeeding women.……”

Selected characteristics, animal exposure, signs and symptoms, and treatment for six fatal rabies cases in pregnant and breastfeeding women — Vietnam 2015–2016Return to your place in the text
Characteristic No.
Education
Junior high school 5
Senior high school 1
Dog bite 6
Status of dog at time of patient exposure
Normal* 2
Stray 3
Ill 1
Dog rabies vaccination status
Yes 0
No 2
Unknown 4
Bite location
Foot or leg 5
Hand or arm 1
Rabies signs and symptoms
Aerophobia (sensitivity to movement of air) 6
Anorexia 3
Anxiety 2
Fever 4
Headache 5
Hydrophobia 4
Insomnia 3
Malaise or fatigue 5
Muscle pain or spams 3
Paresthesia or localized pain 2
Wound treatment
None 2
At home 2
Medical center 1
Traditional healer 1
Received any postexposure prophylaxis 0

* Family reported that the dog appeared normal at the time of exposure. No information was available regarding the status of the dog after 10 days.
Patients could have multiple symptoms.


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