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Published Date: 2012-05-24 17:08:54
Subject: PRO/AH/EDR> Rabies - UK (02): (London, England) ex India, human, canine
Archive Number: 20120524.1143694

RABIES - UK (02): (LONDON, ENGLAND) ex INDIA, HUMAN, CANINE
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In this update:
[1] Patient details
[2] Delayed diagnosis
[3] Background information

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[1] Patient details
Date: Thu 24 May 2012
Source: Irish Examiner [abbreviated & edited]
http://www.irishexaminer.com/breakingnews/world/uk-grandmother-catches-rabies-from-dog-552672.html

A case of rabies has been confirmed in the UK, the Health Protection Agency (HPA) said. The potentially fatal disease was confirmed in a patient from London who had been bitten by a dog in south Asia. It was reported last night that the patient was a grandmother in her 50s. The patient is receiving hospital treatment, and all relevant contacts have been followed up on, the HPA said, stressing there was no risk to the public.

The patient is being treated at London's Hospital for Tropical Diseases. A spokeswoman said: "We would like to reassure our patients, visitors and staff there is no risk to them as a result of this case." The Sun reported that the woman was of Indian origin and was in India with her husband when she was bitten by a puppy. As a matter of routine, if the woman had any pets at home, tests would have been carried out on them to check that the virus had not been passed on, a spokesman from the Department for Environment, Food and Rural Affairs said.

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[2] Delayed diagnosis
Date: Thu 24 may 2012
Source: Fox News [edited]
http://www.foxnews.com/health/2012/05/24/woman-life-at-risk-after-doctors-fail-to-spot-has-rabies/

A British woman's life is at risk after she contracted rabies from a puppy overseas and was misdiagnosed by doctors at home 3 times. Rabies was eradicated from the UK over a century ago, but the patient is fighting for life in hospital isolation almost 2 months after being bitten in India.

Understood to be in her 50s, the woman is said to have visited her doctor once and a hospital's accident and emergency department twice over 4 days feeling ill but was sent home each time, The Sun [newspaper] reported. Sources said she returned to her doctor once more, when she was forwarded to the hospital with a suspected case of rabies and then properly diagnosed.

The Hospital for Tropical Diseases based at University College Hospital in London confirmed the case, affirming patients, staff and visitors were not at risk, although it is understood that relatives and hospital staff have been offered precautionary vaccines, The (London) Daily Telegraph reported.

Possibly life-threatening, rabies is an acute virus disease of the nervous system. Symptoms include abnormal behavior plus increased salivation, then paralysis and death if it goes untreated. It is prevalent in south and southeast Asian countries and is transmitted by saliva, usually through the bite of an animal.

The British Health Protection Authority (HPA) says only 4 people in the UK have contracted the disease since 2009, compared to the 55 000 who die from it globally each year. The HPA has attempted to quell panic by pointing out that there have been no documented laboratory confirmed cases of rabies spreading from human-to-human. "Therefore, the risk to other humans or animals from a patient with rabies is considered negligible," Brian McCloskey, director of the HPA for London, said.

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[3] Background information
Date: Thu 24 May 2012
From: Steve Berger <mberger@post.tau.ac.il> [edited]

Background information on rabies virus infection imported into the UK and exported from India
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Regarding the recent report of human rabies imported into the United Kingdom from India, the following will summarize relevant cases reported during the past 25 years: [1,2] 62 cases of travel-related rabies were reported during 1987 to 2012, of which 7 were imported into the United Kingdom, and 10 followed animal contact in India. [3] (The Primary references are available on request).

Cases imported into the United Kingdom:
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Year / Origin
1987 / India
1996 / Nigeria (20)
2001 / Philippines
2001 / Nigeria (20)
2005 / India (20)
2008 / South Africa
2012 / India

Cases exported from India:
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Year / Country
1987 / United Kingdom
1997 / France*
2004 / Germany
2004 / Germany
2005 / United Kingdom
2007 / Lithuania
2009 / United Arab Emirates
2009 / United States
2012 / Italy
2012 / United Kingdom

*Infection was acquired in either India or Nepal

References:
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1. Berger SA. Infectious Diseases of India, 2012. 503 pp, 67 graphs, 4248 references. Gideon e-books, http://www.gideononline.com/ebooks/country/infectious-diseases-of-india/.

2. Berger SA. Infectious Diseases of the United Kingdom, 2012. 1029 pp, 797 graphs, 3290 references. Gideon e-books,
http://www.gideononline.com/ebooks/country/infectious-diseases-of-the-united-kingdom/.

3. Berger SA. Rabies: Global Status, 2012. 376 pp, 546 graphs, 1375 references. Gideon e-books,
http://www.gideononline.com/ebooks/disease/rabies-global-status/.

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Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<mberger@post.tau.ac.il>

[These new reports identify the patient and her nationality but do not indicate whether or when she received any form of anti-rabies prophylactic treatment after being bitten by a puppy in India some 9 weeks ago. The initially delayed diagnosis in the UK is hardly relevant if the victim had received no treatment in India immediately following her exposure. Her prospects for survival are not good.

ProMED-mail thanks Steve Berger for extracting relevant background information from the Gideon Database. Interested readers can obtain the primary references from him on request. - Mod.CP

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

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