Global & Disaster Medicine

Archive for the ‘Rabies’ Category

Rabies Deaths Among Pregnant and Breastfeeding Women — Vietnam


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:

“…..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.
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.

Stray dog situation in Thailand out of control & thus, the risk of rabies grows


“…..According to the last nationwide survey in 2014 there are around eight and a half million dogs in Thailand. Seven hundred thousand of those are considered to be strays with a round half of that number being females who produce up to ten puppies a year. This figure means that the stray canine population could increase by up to 3.4 million dogs a year.

Stray dogs as well as being unclean and causing noise pollution can also spread diseases such as rabies. 90% of the animals found with rabies in Thailand are dogs and 60% of rabid dogs are strays…..”

CDC:  This patient presented with early, though progressive symptoms due to what was confirmed as rabies virus.

Latest research: Rabies in bats and carnivores, and implications for spillover to humans

Comparative pathogenesis of rabies in bats and carnivores, and implications for spillover to humans

 Published online: October 31, 2017

 Lineke Begeman, Corine GeurtsvanKessel, Stefan Finke, Conrad M Freuling, Marion Koopmans, Thomas Müller, Tom J H Ruigrok, Thijs Kuiken

 The Lancet Infectious Diseases




CDC recommendations to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas during the period of September 2017 – March 2018.


Advice for Providers Treating Patients in or Recently Returned from Hurricane-Affected Areas, Including Puerto Rico and US Virgin Islands

Distributed via the CDC Health Alert Network
October 24, 2017, 1330 ET (1:30 PM ET)

The Centers for Disease Control and Prevention (CDC) is working with federal, state, territorial, and local agencies and global health partners in response to recent hurricanes. CDC is aware of media reports and anecdotal accounts of various infectious diseases in hurricane-affected areas, including Puerto Rico and the US Virgin Islands (USVI). Because of compromised drinking water and decreased access to safe water, food, and shelter, the conditions for outbreaks of infectious diseases exist.

The purpose of this HAN advisory is to remind clinicians assessing patients currently in or recently returned from hurricane-affected areas to be vigilant in looking for certain infectious diseases, including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. Additionally, this Advisory provides guidance to state and territorial health departments on enhanced disease reporting.


Hurricanes Irma and Maria made landfall in Puerto Rico and USVI in September 2017, causing widespread flooding and devastation. Natural hazards associated with the storms continue to affect many areas. Infectious disease outbreaks of diarrheal and respiratory illnesses can occur when access to safe water and sewage systems are disrupted and personal hygiene is difficult to maintain. Additionally, vector borne diseases can occur due to increased mosquito breeding in standing water; both Puerto Rico and USVI are at risk for outbreaks of dengue, Zika, and chikungunya.

Health care providers and public health practitioners should be aware that post-hurricane environmental conditions may pose an increased risk for the spread of infectious diseases among patients in or recently returned from hurricane-affected areas; including leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza. The period of heightened risk may last through March 2018, based on current predictions of full restoration of power and safe water systems in Puerto Rico and USVI.

In addition, providers in health care facilities that have experienced water damage or contaminated water systems should be aware of the potential for increased risk of infections in those facilities due to invasive fungi, nontuberculous Mycobacterium species, Legionella species, and other Gram-negative bacteria associated with water (e.g., Pseudomonas), especially among critically ill or immunocompromised patients.

Cholera has not occurred in Puerto Rico or USVI in many decades and is not expected to occur post-hurricane.



These recommendations apply to healthcare providers treating patients in Puerto Rico and USVI, as well as those treating patients in the continental US who recently traveled in hurricane-affected areas (e.g., within the past 4 weeks), during the period of September 2017 – March 2018.

  • Health care providers and public health practitioners in hurricane-affected areas should look for community and healthcare-associated infectious diseases.
  • Health care providers in the continental US are encouraged to ask patients about recent travel (e.g., within the past 4 weeks) to hurricane-affected areas.
  • All healthcare providers should consider less common infectious disease etiologies in patients presenting with evidence of acute respiratory illness, gastroenteritis, renal or hepatic failure, wound infection, or other febrile illness. Some particularly important infectious diseases to consider include leptospirosis, dengue, hepatitis A, typhoid fever, vibriosis, and influenza.
  • In the context of limited laboratory resources in hurricane-affected areas, health care providers should contact their territorial or state health department if they need assistance with ordering specific diagnostic tests.
  • For certain conditions, such as leptospirosis, empiric therapy should be considered pending results of diagnostic tests— treatment for leptospirosis is most effective when initiated early in the disease process. Providers can contact their territorial or state health department or CDC for consultation.
  • Local health care providers are strongly encouraged to report patients for whom there is a high level of suspicion for leptospirosis, dengue, hepatitis A, typhoid, and vibriosis to their local health authorities, while awaiting laboratory confirmation.
  • Confirmed cases of leptospirosis, dengue, hepatitis A, typhoid fever, and vibriosis should be immediately reported to the territorial or state health department to facilitate public health investigation and, as appropriate, mitigate the risk of local transmission. While some of these conditions are not listed as reportable conditions in all states, they are conditions of public health importance and should be reported.


For More Information

CDC video on Rabies

Annually, how many people die from rabies around the world?

Infographic of the Week: Rabies occur in more than 150 countries and territories. More than 55, 000 deaths a year- more than 95% in Asia & Africa. Almost 50% of rabies deaths are among children under the age of 15.

September 28 is World Rabies Day

September 28 is World Rabies Day, a global health observance started in 2007 to raise awareness about the burden of rabies and bring together partners to enhance prevention and control efforts worldwide. World Rabies Day is observed in many countries, including the United States.

While rabies is a 100% preventable disease, thousands of people die from the disease around the world each day. World Rabies Day is an opportunity to reflect on our efforts to control this deadly disease and remind ourselves that the fight is not yet over.

Diagram of the rabies virion                      Cross-sectional diagram of the rabies virion           Diagram displaying the cycle of infection and replication for the rabies virus


Malaysia: The death toll from rabies outbreak in the Serian district has increased to five people after a 52-year-old man succumbed to the virus at the Sarawak General Hospital

Malaysian Digest

  • Tinding Limbang was pronounced dead at 10.43pm.
  • Tinding was admitted to the hospital for weak limbs, numbness and backache on July 11.



Rabies Fears in Bangladesh: At least 66 people including, six children and five women, were bitten by stray dogs in different areas of Manikganj town in one day yesterday.

Daily Star

  • They were given treatment and anti-rabies vaccines at Manikganj Sadar Hospital.


Rabies in Borneo: 2 siblings, aged four and six – from Kampung Paun Rimu Bakong, passed away on Tuesday while a third child remains in critical condition.

Borneo Post

“…..The girl was confirmed positive for contracting the rabies virus following laboratory tests on June 30.
She started having fever on June 23 and was brought to Serian Hospital, but was treated as outpatient then.
However, her condition worsened as she started showing changes in behaviour, getting aggressive and exhibiting signs of hydrophobia.
On June 28, she had seizures at home and was rushed to SGH by her parents. It is reported that she was bitten by a dog about a month before the symptoms appeared……”

Map of the world



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