Rabies risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Typically, the route of transmission for rabies is from the bite of an infected animal. People that live in an area, or travel to an area that has a large incidence for rabies, are at a high risk for acquiring rabies from a rabid animal. Handling certain wild animals such as bats or raccoons will put a person at a higher risk.
Risk Factors
Transmission through organ transplants
Rabies is known to have been transmitted between humans by transplant surgery.
Infections by corneal transplant have been reported in Thailand (2 cases), India (2 cases), Iran (2 cases),[1] the United States (1 case), and France (1 case).[2] Details of two further cases of infection resulting from corneal transplants were described in 1996.
In June 2004, three organ recipients died in the United States from rabies transmitted in the transplanted kidneys and liver of an infected donor from Texarkana.[3] There were bats near the donor's home, and the donor had told others that he had been bitten.[4] The donor is now reported to have died of a cerebral hemorrhage, the culmination of an unidentified neurological disorder, although recipients are said to have been told the cause of death had been a car crash. Marijuana and cocaine were found in the donor's urine at the time of his death, according to a report in The New England Journal of Medicine.[5]
"[The surgeons] thought he had suffered a fatal crack-cocaine overdose, which can produce symptoms similar to those of rabies. 'We had an explanation for his condition,' says Dr. Goran Klintmalm, a surgeon who oversees transplantation at Baylor University Medical Center, where the transplants occurred. 'He'd recently smoked crack cocaine. He'd hemorrhaged around the brain. He'd died. That was all we needed to know'. Because of doctor-patient confidentiality rules, doctors involved with this case would not talk about it on the record, but a few did say that if no cocaine was found in the donor's blood, the E.R. doctors might have investigated his symptoms more aggressively instead of assuming he had overdosed. (Because no autopsy was done, doctors have not been able to establish whether the rabies or the drugs actually killed him.)"[6]
In February 2005, three German patients in Mainz and Heidelberg were diagnosed with rabies after receiving various organs and cornea transplants from a female donor. Two of the infected people died. Three other patients who received organs from the woman have not yet shown rabies symptoms. The 26 year old donor had died of heart failure in December 2004 after consuming cocaine and ecstasy. In October 2004, she had visited India, one of the countries worst affected by rabies worldwide. Dozens of medical staff were vaccinated against rabies in the two hospitals as a precautionary measure.
Associated Press reports that "Donated organs are never tested for rabies. The strain detected in the victims' bodies is one commonly found in bats, health officials said." According to CNN "Rabies tests are not routine donor screening tests, Virginia McBride, public health organ donation specialist with the Health Resources and Services Administration, said. The number of tests is limited because doctors have only about six hours from the time a patient is declared brain-dead until the transplantation must begin for the organs to maintain viability."
Risks for travelers
Rabies vaccination is not a requirement for entry into any country. However, travelers to rabies-endemic countries should be warned about the risk of acquiring rabies and educated in animal bite prevention strategies (12-16). Travelers with extensive unprotected outdoor exposure such as might be experienced while bicycling, camping, hiking, or engaging in certain occupational activities, might be at higher risk even if their trip is brief. Also, children are considered at higher risk because of their tendencies to play with animals and to not report bites. Casual exposure to cave air is not a concern, but cavers should be warned not to handle bats (3).
References
- ↑ Javadi MA, Fayaz A, Mirdehghan SA, Ainollahi B (1996). "Transmission of rabies by corneal graft". Cornea. 15 (4): 431–3. PMID 8776570.
- ↑ CDC (1980). "Human-to-human transmission of rabies via a corneal transplant -- France". MMWR. 29: 25&ndash, 6.
- ↑ "Investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004". MMWR Morb Mortal Wkly Rep. 53 (26): 586–9. 2004. PMID 15241303.
- ↑ "Update: investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004". MMWR Morb Mortal Wkly Rep. 53 (27): 615–6. 2004. PMID 15254455.
- ↑ Srinivasan A, Burton EC, Kuehnert MJ, Rupprecht C, Sutker WL, Ksiazek TG, Paddock CD, Guarner J, Shieh WJ, Goldsmith C, Hanlon CA, Zoretic J, Fischbach B, Niezgoda M, El-Feky WH, Orciari L, Sanchez EQ, Likos A, Klintmalm GB, Cardo D, LeDuc J, Chamberland ME, Jernigan DB, Zaki SR (2005). "Transmission of rabies virus from an organ donor to four transplant recipients". N Engl J Med. 352 (11): 1103–11. PMID 15784663.
- ↑ Reynolds G (2005). "Will Any Organ Do?". The New York Times Magazine (10 July): &ndash, .