Published Date: 2005-07-29 23:50:00
Subject: PRO/AH/EDR> Rabies, human, dog - UK (England) ex India (02)
Archive Number: 20050729.2208
RABIES, HUMAN, DOG - UK (ENGLAND) EX INDIA (02)
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Date: Fri 29 Jul 2005
From: ProMED-mail <promed@promedmail.org>
Source: Eurosurveillance Weekly, Surveillance Report, Vol. 10, Issue 7, Thu
28 Jul 2005 [edited]
<http://www.eurosurveillance.org/ew/2005/050728.asp>
UK: Death from Rabies in a Traveller Returning from India
-------------------------------------------------
A fatal case of imported human rabies has been reported in England. The
patient was bitten by a dog while on holiday in Goa, India. The diagnosis
of rabies was confirmed by the United Kingdom National Reference Laboratory
for Rabies in Weybridge, Surrey [1]. In February 2005, a German woman died
of rabies after spending four weeks in India in late 2004 [2], and in May
2004, a man in Bavaria, Germany died from a rabies infection that he
acquired during his 5-month stay in India [3]. India reports at least 30
000 human deaths from rabies per year [4].
There are risks associated with travel to rabies-endemic countries [5].
Travellers should avoid all unnecessary contact with animals. If bitten or
scratched by a warm-blooded animal they should wash the wound with plenty
of soap and water and seek medical attention immediately, even if
previously vaccinated. If they do not seek medical treatment while abroad,
they should seek it when they return to their home country, even if it is
some time after the event. Promptly administered post-exposure prophylaxis
is extremely effective in preventing rabies. For people who have not
received any rabies vaccine prior to a potential exposure, post-exposure
prophylaxis consists of a dose of vaccine as soon as possible after the
bite followed by 4 further doses 3, 7,14 and 30 days later. If the person
has been previously vaccinated, fewer doses of vaccine are required. Human
rabies immunoglobulin may also be given if the exposure is considered to be
high risk.
Travel agents need to stress the importance of obtaining travel health
advice well before holidays or trips overseas to ensure that the risks of
all travel associated illness, not just rabies, have been explained.
In the United Kingdom, while rabies vaccine is not routinely advised for
all travellers, pre-exposure immunisation is recommended for those living
in or travelling for more than one month to rabies enzootic areas, unless
there is reliable access to prompt, safe medical services; those travelling
for less than one month in rabies enzootic areas but who may be exposed to
rabies because of their travel activities; and those who have limited
access to post-exposure medical services.
References
----------
(1) HPA. Case of imported rabies in the UK. Commun Dis Rep CDR Weekly 2005;
15(30): news.
(<http://www.hpa.org.uk/cdr/index.html>)
(2) Robert Koch-Institut. Informationen zu den Tollwutuebertragungen durch
Spenderorgane. Epidemiologisches Bulletin 2005; (8): 69
(<http://www.rki.de/cln_006/nn_335538/DE/Content/Infekt/EpidBull/Archiv/2005/08__05,templateId=raw,property=publicationFile.pdf/08_05>)
(3) Summer R, Ross S, Kiehl W. Imported case of rabies in Germany from
India. Eurosurveillance Weekly 2004; 8(46): 11/11/2004
(<http://www.eurosurveillance.org/ew/2004/041111.asp#4>)
(4)World Health Organization. Immunization, Vaccines and Biologicals.
Rabies vaccine. [Updated April 2003, cited 28 July 2005]
(<http://www.who.int/vaccines/en/rabies.shtml>)
(5)Fooks AR, Johnson N, Brookes SM, Parsons G, McElhinney LM. Risk factors
associated with travel to rabies endemic countries. J Appl Microbiol 2003;
94 Suppl 1; 31-6.
[By: Alan Smith (<alan.smith@hpa.org.uk>)1, Marko Petrovic2, Tom Solomon3 and
Antony Fooks4
1Communicable Disease Surveillance Centre, Health Protection Agency Centre
for Infections, London, United Kingdom
2Greater Manchester Health Protection Unit, Manchester, United Kingdom
3Department of Neurological Science, University of Liverpool, Walton Centre
for Neurology and Neurosurgery, Liverpool, United Kingdom
4Rabies Research & Diagnostic Group, Veterinary Laboratory Agency,
Weybridge, United Kingdom)
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See Also
Rabies, human, dog - UK (England) ex India 20050723.21252004
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Rabies, human - Germany (ex India) 20041112.3054
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