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Published Date: 2012-05-23 17:49:05
Subject: PRO/AH/EDR> Rabies - UK: (England) ex India, human, canine
Archive Number: 20120523.1142429

RABIES - UNITED KINGDOM: (LONDON,ENGLAND) ex INDIA, HUMAN, CANINE
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[1]
Date: Wed 23 May 2012
Source: BBC News [edited]
http://www.bbc.co.uk/news/uk-england-london-18182734

Rabies case confirmed in London
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A case of rabies has been confirmed in London, the Health Protection Agency (HPA) has said. The potentially fatal disease was confirmed in a patient after being bitten by a dog in South Asia. The patient, whose age and gender were not given, is receiving hospital treatment. All relevant contacts have been followed up, the HPA said. It added there was no risk to the public, including those at the hospital where the patient was being treated.

Rabies is usually transferred through saliva from the bite of an infected animal, with dogs being the most common transmitter of rabies to humans. Dr Brian McCloskey, director of the HPA for London, said: "Despite there being tens of thousands of rabies cases each year worldwide, there have been no documented laboratory confirmed cases of human-to-human spread. "Therefore the risk to other humans or animals from a patient with rabies is considered negligible."

More than 55 000 people are thought to die from rabies each year, with most cases occurring in South and South-East Asia. Professor David Brown, a rabies expert at the HPA, said only 4 cases of human rabies acquired from dogs, all from abroad, had been identified in the UK since 2000.

--
Communicated by;
Andrea Jones
<andrea.m.jones17@googlemail.com>

*****
[2]
Date: Wed 23 May 2012
Source: Daily Telegraph, Health News [edited]
http://www.telegraph.co.uk/health/healthnews/9285639/Rabies-case-confirmed-in-Britain-after-dog-bite-in-Asia.html

Rabies case confirmed in Britain after dog bite in Asia
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A British patient who contracted rabies after being bitten by a dog in South Asia is fighting for life in a London hospital, the Health Protection Agency said. The traveller from London, who has not been identified, was diagnosed with the potentially life-threatening disease and is having treatment in hospital after being bitten by a puppy in India 9 weeks ago. The age and gender of the patient was not disclosed. The patient is being cared for at the Hospital for Tropical Diseases, based at University College Hospital, London. Relatives and hospital staff were believed to have been offered vaccines as a precaution.

It is thought the patient only visited a doctor a week ago on Monday [14 May 2012], 7 weeks after being bitten, and was later transferred to the hospital where the patient is being kept in isolation. In a statement, the hospital said: "The Hospital for Tropical Diseases, based at University College Hospital, is currently looking after a British patient diagnosed with rabies following a trip abroad. The patient is in a serious condition. We would like to reassure our patients, visitors and staff that there is no risk to them as a result of this case."

The HPA said cases of rabies in the UK were "extremely rare" with only 4 people identified as contracting the disease from dogs since 2000. But there are more than 55 000 deaths from human rabies around the world each year. It is contracted through the saliva of an infected animal and is prevalent in most developing countries including south and south-east Asia. Dr Brian McCloskey, director of the HPA for London, said: "It is important to stress that there is no risk to the general public as a result of this case or to patients and visitors at the hospital where the patient is receiving treatment. Despite there being tens of thousands of rabies cases each year worldwide, there have been no documented laboratory confirmed cases of human-to-human spread. Therefore the risk to other humans or animals from a patient with rabies is considered negligible."

Rabies affects the central nervous system with symptoms including anxiety, headaches and fever. As the infection develops, patients also suffer spasms -- making it difficult to drink -- and respiratory failure. In 2003, it was recognised that bats [in Europe] could carry a similar illness to rabies after a bat handler died from a rabies-like infection a year earlier. [To date there have been only 9 confirmed cases of European bat lyssavirus type 2 (EBLV-2) infection in bats which have been identified by the UK Veterinary Laboratories Agency through routine testing. These include one in Newhaven in 1996, 2 in Lancashire in 2002 and 2003, one in Surrey in 2004, one in Oxfordshire in 2006, one in Shropshire in 2007, 2 in 2008 (Surrey and Shropshire), and one in Scotland in 2009. - Mod.CP].

Professor David Brown, a rabies expert at the HPA, said: "It is essential to get health advice if you are travelling to countries where rabies is common or if you know you will be working with animals. Talk to your doctor or nurse about whether or not a rabies vaccine is appropriate before you travel. All travellers to a rabies-endemic country should avoid contact with cats, dogs and other animals wherever possible as you cannot be certain that there is no risk. If you are bitten, scratched, or licked by a warm blooded animal you must take immediate action and wash the wound or site of exposure with plenty of soap and water. Seek medical advice without delay even if you have been previously vaccinated. Rabies vaccine is extremely effective at preventing rabies if you are bitten even when this is given some time after an exposure. If you do not seek medical treatment while abroad, you should still seek it when you come home."

[Byline: Dorothy Bowater]

--
Communicated by;
Andrea Jones
<andrea.m.jones17@googlemail.com>

[According to the World Health Organisation (WHO) approximately 36 percent of the world's rabies deaths occur in India each year, most of those when children come into contact with infected dogs. India has frequently been the source of travel-associated cases of rabies [see ProMED-posts listed below].

The WHO recommendations for post-exposure treatment divide rabies exposure into 3 categories: category I -- and least serious -- when the victim has been touching or feeding infected animals, but shows no skin lesions; category II, when the victim has received minor scratches without bleeding or has been licked by an infected animal on broken skin; and category III, when the victim has received one or more bites, scratches or licks on broken skin or has had other contact with infected mucus. Anti-rabies vaccine is recommended for category II and III, while anti-rabies immunoglobulin -- a liquid or freeze-dried preparation containing rabies antibodies extracted from plasma -- should be given for category III contact, or to people with weakened immune systems.

Not only is rabies exposure treatable if caught early enough: the virus carried by the dog population is also controllable. "The basic principles of dog rabies control are relatively simple. It is necessary to vaccinate 70 percent of the total dog population in a short period of time, maintain that immune coverage and protect the area from spillover through control of dog movement from affected adjacent areas," says Dr Francois-Xavier Meslin, a team leader in WHO's department of neglected tropical diseases. Things become a little more complicated when the dog population gets out of hand, as is certainly the case in many parts of rural India. Estimates vary, but some put the Indian dog population as high as 25 million. Rounding up and vaccinating that many dogs is not just a technical challenge, it is a test of community spirit and, ultimately, political will.

Says Meslin: "The most important success factors are high-level political commitment, dedicated and knowledgeable national staff championing the project inside and outside the country and good community involvement."

(For further information see: WHO Bulletin: "India's ongoing war against rabies" http://www.who.int/bulletin/volumes/87/12/09-021209/en/index.html".)

The patient currently being treated in University College Hospital, London was bitten some 9 weeks ago in India, and only very recently sought treatment in London. It is not stated what treatment, if any, was sought and received in India. Further information is awaited. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]

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