Rabies: Difference between revisions
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{{Taxobox | color=violet |
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| name = ''Rabies virus'' |
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| virus_group = v |
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| ordo = ''[[Mononegavirales]]'' |
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| familia = ''[[Rhabdoviridae]]'' |
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| genus = ''[[Lyssavirus]]'' |
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| type_species = '''''Rabies virus''''' |
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}} |
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{{Infobox_Disease | |
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Name = Rabies | |
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Image = Elec_micro_of_rahbdovirus_isolate.jpg| |
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Caption = ''EM of rabies virus.''| |
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DiseasesDB = 11148 | |
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ICD10 = {{ICD10|A|82||a|82}}- | |
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ICD9 = {{ICD9|071}} | |
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ICDO = | |
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OMIM = | |
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MedlinePlus = 001334 | |
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eMedicineSubj = med | |
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eMedicineTopic = 1374 | |
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eMedicine_mult = {{eMedicine2|emerg|493}} {{eMedicine2|ped|1974}} | |
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MeshID = D011818 |
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}} |
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'''Rabies''' ({{lang-la|rabies}}, "madness, rage, fury" also "'''hydrophobia'''") is a [[virus (biology)|viral]] [[zoonotic]] [[neurotropic virus|neuroinvasive]] disease that causes acute [[encephalitis]] (inflammation of the brain) in [[mammal]]s. |
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In non-vaccinated humans, rabies is almost invariably fatal after [[neurological]] symptoms have developed, but prompt post-exposure [[vaccination]] may prevent the virus from progressing. There are only six known cases of a person surviving symptomatic rabies, and only one known [[#Induced coma treatment|case]] of survival in which the patient received no rabies-specific treatment either before or after illness onset.<ref>[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5350a1.htm] Recovery of a Patient from Clinical Rabies --- Wisconsin, 2004</ref> |
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==Structure== |
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The virus is a ''[[Lyssavirus]]''. This [[genus]] of [[RNA virus]]es also includes the Aravan virus, [[Australian bat lyssavirus]], [[Duvenhage virus]], European bat lyssavirus 1, European bat lyssavirus 2, Irkut virus, Khujand virus, [[Lagos bat virus]], [[Mokola virus]] and West Caucasian bat virus. Lyssaviruses have [[helical]] symmetry, so their infectious particles are approximately cylindrical in shape. This is typical of plant-infecting viruses; human-infecting viruses more commonly have cubic symmetry and take shapes approximating [[regular polyhedron|regular polyhedra]]. ''[[Negri bodies]]'' in the infected neurons are [[pathognomonic]]. |
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The virus has a bullet-like shape with a length of about [[1 E-7 m|180 nm]] and a cross-sectional diameter of about [[1 E-8 m|75 nm]]. One end is rounded or conical and the other end is planar or concave. The [[lipoprotein]] envelope carries knob-like spikes composed of [[Glycoprotein]] G. Spikes do not cover the planar end of the virion (virus particle). Beneath the envelope is the membrane or matrix (M) protein layer which may be [[invaginated]] at the planar end. The core of the virion consists of helically arranged [[ribonucleoprotein]]. The [[genome]] is unsegmented linear [[antisense]] [[RNA]]. Also present in the [[nucleocapsid]] are RNA dependent RNA transcriptase and some structural proteins. |
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<center> |
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[[Image:Rabies virus longitudinal.jpg|250px|Longitudinal schematic view of rabies virus]] [[Image:Rabies virus crosssection.jpg|250px|Cross section of Rabies virus]]<br /> |
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''Longitudinal and cross-sectional schematic view of rabies virus'' |
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</center> |
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==Differential diagnosis== |
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The [[differential diagnosis]] in a case of suspected human rabies may initially include any cause of encephalitis, |
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particularly infection with viruses such as [[herpesviridae|herpesviruses]], [[enteroviruses]], and [[arboviruses]] (e.g., [[West Nile virus]]). The most important viruses to rule out are [[herpes simplex virus]] type 1, [[varicella-zoster virus]], and (less commonly) enteroviruses, including [[coxsackie virus|coxsackievirus]]es, [[echovirus]]es, [[poliovirus]]es, and human [[enterovirus]]es 68 to 71. A specific diagnosis may be made by a variety of diagnostic techniques, including [[polymerase chain reaction]] (PCR) testing of [[cerebrospinal fluid]], [[cell culture#Viral culture methods|viral culture]], and [[serology]]. In addition, consideration should be given to the local [[epidemiology]] of encephalitis caused by arboviruses belonging to several [[taxonomy|taxonomic]] groups, including eastern and western [[equine encephalitis|equine encephalitis virus]]es, [[St. Louis encephalitis]] virus, [[Powassan virus]], the [[California encephalitis virus]] serogroup, and [[La Crosse virus]]. |
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New causes of viral encephalitis are also possible, as was evidenced by the recent outbreak in Malaysia of some 300 cases of encephalitis (mortality rate, 40%) caused by [[Nipah virus]], a newly recognized [[paramyxovirus]].<ref>{{cite book |title=Diseases of Swine |last=Straw |first=Barbara E. |year=2006 |publisher=Blackwell Publishing |isbn=081381703X }}</ref> Similarly, well-known viruses may be introduced into new locations, as is illustrated by the recent outbreak of encephalitis due to West Nile virus in the eastern United States.<ref>{{cite book |title=Inflammatory Disorders Of The Nervous System: Pathogenesis, Immunology, and Clinical Management |last=Minagar |first=Alireza |coauthors=J. Steven Alexander |year=2005 |publisher=Humana Press |isbn=1588294242 }}</ref> Epidemiologic factors (e.g., season, geographic location, and the patient’s age, travel history, and possible exposure to animal bites, rodents, and ticks) may help direct the diagnostic workup. |
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Cheaper rabies diagnosis will be possible for low-income settings according to research reported on the Science and Development Network website in 2008. Accurate rabies diagnosis can be done ten times cheaper, according to researchers from the Farcha Veterinary and Livestock Research Laboratory and the Support International Health Centre in N'Djamena, Chad. The scientists evaluated a method using light microscopy, cheaper than the standard tests, and say this could provide better rabies control across Africa. [http://www.scidev.net/en/sub-suharan-africa/news/sub-saharan-africa-news-in-brief-13-25-march.html] |
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== Transmission and symptoms == |
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[[Image:Rabies Virus EM PHIL 1876.JPG|thumb|250px|Micrograph with numerous rabies [[virion]]s (small dark-grey rod-like particles) and Negri bodies, larger pathognomonic cellular inclusions of rabies infection]] Any mammal may become infected with the rabies virus and develop symptoms, including humans. Most animals can be infected by the virus and can transmit the disease to humans. Infected bats, monkeys, raccoons, foxes, skunks, cattle, wolves, dogs or cats provide the greatest risk to humans. Rabies may also spread through exposure to infected domestic farm animals, groundhogs, weasels and other wild carnivores. Rodents (mice, squirrels etc) are seldom infected. |
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The virus is usually present in the nerves and [[saliva]] of a symptomatic rabid animal.<ref>The ''Merck Manual'', Eleventh Edition (1983), p. 183</ref><ref>''The Merck manual of Medical Information. Second Home Edition'', (2003), p. 484.</ref> The route of [[infection]] is usually, but not necessarily, by a bite. In many cases the infected animal is exceptionally aggressive, may attack without provocation, and exhibits otherwise uncharacteristic behaviour[http://www.nda.agric.za/docs/rabies/rabies.htm]. Transmission may also occur via an [[particulate|aerosol]] through [[mucous membrane]]s; transmission in this form may have happened in people exploring caves populated by rabid bats. The single case of aerosol transmission to people exploring a bat cave has essentially been disproven.{{Fact|date=April 2008}} As most bats have such small teeth that their bites can barely be felt (may feel like a small prick or bug bite); it is more likely that these people were bitten by a bat unbeknownst to them and contracted rabies in that manner {{Fact|date=February 2008}}. |
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Transmission between humans is extremely rare, although it can happen through [[organ transplant|transplant surgery]] (see below for recent cases), or, even more rarely, through bites, kisses or sexual relations. |
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After a typical human infection by bite, the virus enters the [[peripheral nervous system]]. It then travels along the [[nerve]]s towards the [[central nervous system]]. During this phase, the virus cannot be easily detected within the host, and vaccination may still confer cell-mediated immunity to prevent symptomatic rabies. Once the virus reaches the [[brain]], it rapidly causes encephalitis. This is called the "prodromal" phase. At this time, treatment is useless. Then symptoms appear. Rabies may also inflame the [[spinal cord]] producing [[myelitis]]. |
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The period between infection and the first [[flu]]-like symptoms is normally two to twelve weeks, but can be as long as two years. Soon after, the symptoms expand to slight or partial [[paralysis]], [[cerebral dysfunction]], [[anxiety]], [[insomnia]], [[confusion]], [[agitation (emotion)|agitation]], abnormal behavior, [[paranoia]], terror, [[hallucination]]s, progressing to [[delirium]].{{Fact|date=February 2008}} The production of large quantities of saliva and tears coupled with an inability to speak or swallow are typical during the later stages of the disease; this can result in "hydrophobia", where the victim has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst. The disease itself was also once commonly known as ''[[wiktionary:hydrophobia|hydrophobia]]'', from this characteristic symptom. The patient "foams at the mouth" because they cannot swallow their own saliva for days and it gathers in the mouth until it overflows. |
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Death almost invariably results two to ten days after the first symptoms; the few humans who are known to have survived the disease were all left with severe [[brain damage]], with the recent exception of [[Jeanna Giese]] (see below). It is neurotrophic in nature. |
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=== Example of symptoms === |
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In ''Rabies: The Facts''<ref>Kaplan, Turner, and Warrell 1986. pp. 43-44 ''Rabies: The Facts'', Oxford University Press. ISBN 0-19-261441-X</ref>, Kaplan et. al. describe several typical cases, including one of a 23 year-old Englishwoman: |
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<blockquote>"On June 17, 1981 she was bitten on the ankle by a dog in New Delhi. On August 18, about two months later, she experienced the first prodromal symptoms. She became anxious and depressed, and it became impossible for her to drink more than small sips of liquid. While sleeping, she frequently sat up in bed suddenly, terrified. On August 19, she became confused, hallucinated, and was incontinent of urine. On August 20, she was unable to eat or drink and was taken to the hospital where she hallucinated and screamed in terror. Misdiagnosed as a psychiatric case, she was injected with a tranquilizer and sent home, however she repeatedly woke up screaming in fear and became so wild and agitated that her husband felt he could not deal with her by himself and took her to her mother's house. She remained terrified, hallucinating and screaming in horror throughout the night. She had no water for almost three days. She fell into a coma the next morning, and died on August 23."</blockquote> |
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== Prevention == |
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Rabies can be prevented by vaccination, both in humans and other animals. Virtually every infection with rabies resulted in death, until [[Louis Pasteur]] and [[Emile Roux]] developed the first rabies vaccination in 1885. This vaccine was first used on a human on [[July 6]], [[1885]] – nine-year old boy [[Joseph Meister]] (1876–1940) had been mauled by a rabid dog.[http://links.jstor.org/sici?sici=0093-0334(197804)8%3A2%3C26%3APWORRT%3E2.0.CO%3B2-J] [http://www.zephyrus.co.uk/louispasteur.html] |
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Their vaccine consisted of a sample of the virus harvested from infected (and necessarily dead) rabbits, which was weakened by allowing it to dry for 5 to 10 days. Similar nerve tissue-derived vaccines are still used now in some countries, and while they are much cheaper than modern cell culture vaccines, they are not as effective and carry a certain risk of neurological complications. |
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The human [[diploid]] cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are made using the attenuated Pitman-Moore L503 strain of the virus. Human diploid cell rabies vaccines have been given to more than 1.5 million humans [[as of 2006]]. Newer and less expensive purified chicken embryo cell vaccine, and purified [[Vero cell]] rabies vaccine are now available. The purified Vero cell rabies vaccine uses the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host. |
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Some recent works have shown that during lethal rabies infection the [[blood-brain barrier]] (BBB) does not allow anti-viral immune cells to enter the brain, the primary site of rabies virus replication.<ref name=Roy_2007a>{{cite journal |author=Roy A, Phares TW, Koprowski H, Hooper DC |title=Failure to open the blood-brain barrier and deliver immune effectors to central nervous system tissues leads to the lethal outcome of silver-haired bat rabies virus infection |journal=J. Virol. |volume=81 |issue=3 |pages=1110-8 |year=2007 |pmid=17108029}}</ref> This aspect contributes to the pathogenicity of the virus and artificially increasing BBB permeability promotes viral clearance.<ref name=Roy_2007b>{{cite journal |author=Roy A, Hooper DC |title=Lethal silver-haired bat rabies virus infection can be prevented by opening the blood-brain barrier|journal=J. Virol. |volume=81 |issue=15 |pages=7993-8 |year=2007 |pmid=17507463 | doi = 10.1128/JVI.00710-07}}</ref> Opening the BBB during rabies infection has been suggested as a possible novel approach to treat the disease. |
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===Post-exposure prophylaxis=== |
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Treatment after exposure, known as [[post-exposure prophylaxis]] or "P.E.P.", is highly successful in preventing the disease if administered promptly, within six days after infection. Thoroughly washing the wound as soon as possible with soap and water for approximately five minutes is very effective at reducing the number of viral particles. "If available, a virucidal antiseptic such as povidone-iodine, iodine tincture, aqueous iodine solution or alcohol (ethanol) should be applied after washing."<ref>Rabies & Australian bat lyssavirus information sheet http://www.health.vic.gov.au/ideas/bluebook/rabies_info</ref> Exposed mucous membranes such as eyes, nose or mouth should be flushed well with water. In the United States, patients receive one dose of [[immunoglobulin]] and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of immunoglobulin is injected in the region of the bite, if possible, with the remainder injected [[intramuscular injection|intramuscularly]] away from the bite. This is much less painful compared with administering immunoglobulin through the [[abdominal wall]] with a large needle, as was done in the past. The first dose of rabies vaccine is given as soon as possible after exposure, with additional doses on days three, seven, fourteen, and twenty-eight after the first. Patients that have previously received pre-exposure vaccination do not receive the immunoglobulin, only the post-exposure vaccinations. Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths in the U.S. from rabies has dropped from one hundred or more annually in the early twentieth century, to 1–2 per year, mostly caused by bat bites, which may go unnoticed by the victim and hence untreated. |
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P.E.P. is effective in treating rabies because the virus must travel from the site of infection through the peripheral nervous system (nerves in the body) before infecting the central nervous system (brain and spinal cord) and glands to cause lethal damage. This travel along the nerves is usually slow enough that vaccine and immunoglobulin can be administered to protect the brain and glands from infection. The amount of time this travel requires is dependent on how far the infected area is from the brain: if the victim is bitten in the face, for example, the time between initial infection and infection of the brain is very short and P.E.P. may not be successful. |
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===Pre-exposure prophylaxis=== |
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Currently pre-exposure [[immunization]] has been used on domesticated and normal non-human populations. In many jurisdictions, domestic dogs, cats, and ferrets are required to be vaccinated. A pre-exposure vaccination is also available for humans, most commonly given to veterinarians and those traveling to regions where the disease is common, such as India. Most tourists do not need such a vaccination, just those doing substantial non-urban activities. However, should a vaccinated human be bitten by a carrier, failure to receive subsequent post-exposure treatment could be fatal, although post-exposure treatment for a vaccinated human is far less extensive than that which would normally be required by one with no pre-exposure vaccination. |
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In 1984 researchers at the [[Wistar Institute]] developed a [[recombinant]] vaccine called V-RG by inserting the [[glycoprotein]] gene from rabies into a [[vaccinia]] virus.<ref name=Wiktor_1984>{{cite journal |author=Wiktor TJ, Macfarlan RI, Reagan KJ, Dietzschold B, Curtis PJ, Wunner WH, Kieny MP, Lathe R, Lecocq JP, Mackett M |title=Protection from rabies by a vaccinia virus recombinant containing the rabies virus glycoprotein gene |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=81 |issue=22 |pages=7194–8 |year=1984 |pmid=6095272 | doi = 10.1073/pnas.81.22.7194}}</ref> The V-RG vaccine has since been commercialised by [[Merial]] under the trademark [http://www.raboral.com/ Raboral]. It is harmless to humans and has been shown to be safe for various species of animals that might accidentally encounter it in the wild, including birds (gulls, hawks, and owls).<ref name=Artois_1990>{{cite journal |author=Artois M, Charlton KM, Tolson ND, Casey GA, Knowles MK, Campbell JB |title=Vaccinia recombinant virus expressing the rabies virus glycoprotein: safety and efficacy trials in Canadian wildlife |journal=Can. J. Vet. Res. |volume=54 |issue=4 |pages=504-7 |year=1990 |pmid=2249183}}</ref> |
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V-RG has been successfully used in the field in [[Belgium]], [[France]], and the [[United States]] to prevent outbreaks of rabies in [[wildlife]]. The virus is stable under relatively high temperatures and can be delivered orally, making mass vaccination of wildlife possible by putting it in tasty baits. The plan for immunization of normal populations involves dropping bait containing food wrapped around a small dose of the live virus. The bait would be dropped by helicopter concentrating on areas that have not been infected yet. Just such a strategy of oral immunization of foxes in Europe has already achieved substantial reductions in the incidence of human rabies. A strategy of vaccinating "neighborhood dogs" in [[Jaipur]], [[India]], (combined with a sterilization program) has also resulted in a large reduction in the number of human cases.<ref name=Reece_2006>{{cite journal | author=Reece JF, Chawla SK. | title=Control of rabies in Jaipur, India, by the sterilisation and vaccination of neighbourhood dogs. | journal=Vet Rec | year=2006 | volume=159 | pages=379–83 }}</ref> |
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==Induced coma treatment== |
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{{main|Jeanna Giese}} |
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In 2005, the case of Jeanna Giese, a girl of 15 who survived acute, unvaccinated rabies was reported, indicating the successful treatment of rabies through [[induced coma|induction of a coma]].<ref name=Willoughby_2005>{{cite journal |author=Willoughby RE, Tieves KS, Hoffman GM, Ghanayem NS, Amlie-Lefond CM, Schwabe MJ, Chusid MJ, Rupprecht CE |title=Survival after treatment of rabies with induction of coma |journal=N. Engl. J. Med. |volume=352 |issue=24 |pages=2508–14 |year=2005 |pmid=15958806 | doi = 10.1056/NEJMoa050382}}</ref> This treatment approach was based on the theory that rabies' detrimental effects were caused by temporary dysfunctions of the brain, and that the induction of a coma, by producing a temporary partial stop in brain function, would protect the brain from damage while the body built up an immune response to the virus. After thirty-one days of isolation and seventy-six days of hospitalisation, she was released from the hospital, having survived rabies. |
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Later attempts to use the same treatment have failed, but recently (10/04/08) in [[Cali]], [[Colombia]], it was reported (by local newspapers) that an 11-year-old may have recovered succesfully after induction of coma <ref name=El Tiempo_10/04/08>{{El Tiempo Nación Cali, "Nuevos síntomas dan aliento sobre recuperación de niño caucano contagiado por rabia", April 10th 2008([http://www.eltiempo.com/nacion/cali/2008-04-08/ARTICULO-WEB-NOTA_INTERIOR-4081557.html])</ref>. This patient got infected on February 15 when several children were bitten by a cat in Santander de Quilichao, a small town near Cali. However, this claim has not been scientifically proven. |
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The primary care physician in this case published in the April 2007 issue of ''Scientific American''.<ref name="SciAmApr07">Rodney E. Willoughby, Jr., "A Cure for Rabies?" ''Scientific American'', V. 256, No. 4, April 2007, p. 95 ([http://sciam.com/article.cfm?chanID=sa006&colID=1&articleID=5BCA4D82-E7F2-99DF-33323DF6FF21871F online link])</ref> He notes that subsequent failures of what he calls the ''Milwaukee protocol'' did not use the cocktail of drugs used during the treatment. A point he makes for future research is the relationship of the virus to depletion of [[biopterin]] in the brain. |
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== Prevalence == |
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[[Image:Rabies Free Countries.svg|thumb|right|300px|Rabies-free jurisdictions, as of January 2006:<br>[[Australia]], [[New Zealand]], [[Singapore]], [[Fiji]], [[Guam]], [[Hawaii]], the [[United Kingdom]], [[Republic of Ireland]], [[Norway]], [[Sweden]], [[Finland]], [[Iceland]], [[Japan]] and [[Taiwan]]/ROC.]] |
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More than 99% of all human deaths from rabies occur in [[Africa]], [[Asia]] and [[South America]] which report thirty thousand deaths annually.<ref name=WHO_stats>{{cite web | title = Rabies vaccine | work = WHO - Immunization, Vaccines and Biologicals | url = http://www.who.int/vaccines/en/rabies.shtml | accessdate = 2006-04-20}}</ref> One of the sources of recent flourishing of rabies in [[East Asia]] is the pet boom. [[China]] introduced in the city of [[Beijing]] the "[[One Dog policy]]" in November 2006 to control the problem.<ref>[http://www.thestar.com/News/article/238729 The Toronto Star "China cracks down on rabid dog menace"]</ref> India has been reported as having the highest rate of human rabies in the world [http://www.independent.co.uk/news/science/dead-as-a-dodo-why-scientists-fear-for-the-future-of-of-the-asian-vulture-818059.html]. |
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The [[English Channel]], dog licensing, killing of stray dogs, muzzling and other measures contributed to the elimination of rabies from the [[United Kingdom]] in the early 20th century. More recently, large-scale vaccination of cats, dogs and ferrets has been successful in combatting rabies in some developed countries. |
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The rabies virus survives in wide-spread, varied, rural fauna reservoirs. However, in Asia, parts of America and large parts of Africa, dogs remain the principal host. Mandatory vaccination of animals is less effective in rural areas. Especially in developing countries, pets may not be privately kept and their destruction may be unacceptable. Oral vaccines can be safely distributed in baits, and this has successfully reduced rabies in rural areas of France, [[Ontario]], [[Texas]], [[Florida]] and elsewhere, like in the City of Montréal (Québec) where baits are successfully used among raccoons in the Mont-Royal park area. Vaccination campaigns may be expensive, and a cost-benefit analysis can lead those responsible to opt for policies of containment rather than elimination of the disease. |
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Many territories, such as the United Kingdom, [[Republic of Ireland|Ireland]], [[Taiwan]], [[Japan]], [[Hawaii]], [[Mauritius]], [[Barbados]] and [[Guam]], are free of rabies, although there may be a very low prevalence of rabies among bats in the UK; see below. |
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[[New Zealand]] and [[Australia]] have never had rabies.[http://epix.hazard.net/topics/animal/rabies.htm] However, in Australia, the Australian Bat [[Lyssavirus]] occurs normally in both insectivorous and fruit eating bats (flying foxes) from most mainland states. Scientists believe it is present in bat populations throughout the range of flying foxes in Australia. |
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The UK is not completely free of rabies, as a new form of the lyssavirus has been found in some bats which could possibly affect humans. There has been one case of a bite from an infected bat, but the victim showed no symptoms of the virus and was vaccinated quickly as a precaution. |
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=== Rabies in the United States === |
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Rabies was once rare in the United States outside the [[Southern states]], but [[raccoon]]s in the mid-Atlantic and northeast United States have been suffering from a rabies epidemic since the 1970s, which is now moving westwards into [[Ohio]].<ref name=MMWR_2006>{{cite journal | author= | title=Compendium of animal rabies prevention and control, 2006 | journal=MMWR Recomm Rep | year=2006 | pages=1–8 | volume=55 | issue=RR-5 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5505a1.htm}}</ref> |
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[[Image:Reported l.gif|thumb|right|300px|Cases of animal rabies in the United States in 2001]] The particular variant of the virus has been identified in the southeastern United States raccoon population since the 1950s, and is believed to have traveled to the northeast as the result of infected raccoons being among those caught and transported from the southeast to the northeast by human hunters attempting to replenish the declining northeast raccoon population.<ref name=Nettles_1979>{{cite journal | author=Nettles VF, Shaddock JH, Sikes RK, Reyes CR | title=Rabies in translocated raccoons | journal=Am J Public Health | year=1979 | pages=601-2 | volume=69 | issue=6 | pmid = 443502 }}</ref> As a result, urban residents of these areas have become more wary of the large but normally unseen urban raccoon population. It has become the common assumption that any raccoon seen [[diurnal animal|diurnally]] is infected; certainly the reported behavior of most such animals appears to show some sort of illness, and [[autopsy|necropsies]] can confirm rabies. Whether as a result of increased vigilance or only the common human avoidance reaction to any other animal not normally seen, such as a raccoon, there has only been one documented human rabies case as a result of this variant.<ref name=MMWR_2003>{{cite journal|author=Dietzschold, B, Proniak, M|title=First Human Death Associated with Raccoon Rabies --- Virginia, 2003|journal=Morbidity and Mortality Weekly Report|volume=52|issue=45|pages=1102–1103|publisher=Centers for Disease Control|date=2003|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5245a4.htm|accessdate=2006-06-30}}</ref><ref name=Humane Society_2006>{{cite web|year=2006|title=Rabies and Wildlife|work=The Humane Society of the United States| url=http://www.hsus.org/wildlife/urban_wildlife_our_wild_neighbors/rabies__wildlife.html|accessdate=2006-06-30}}</ref> This does not include, however, the greatly increasing rate of prophylactic rabies treatments in cases of possible exposure, which numbered fewer than one hundred humans annually in the state of [[New York]] before 1990, for instance, but rose to approximately ten thousand annually between 1990 and 1995. At approximately $1,500 per course of treatment, this represents a considerable public health expenditure. Raccoons do constitute approximately 50% of the approximately eight thousand documented non-human rabies cases in the United States.<ref name=Krebs_1996>{{cite journal | author=Krebs JW, Strine TW, Smith JS, Noah DL, Rupprecht CE, Childs JE | title=Rabies surveillance in the United States during 1995 | journal=J Am Vet Med Assoc | year=1996 | pages=2031–44 | volume=209 | issue=12 | pmid = 8960176 }}</ref> Domestic animals constitute only 8% of rabies cases, but are increasing at a rapid rate.<ref name=Krebs_1996 /> |
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[[Image:Rabid dog.jpg|thumb|right|250px|A rabid dog, with saliva dripping out of the mouth]] |
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In the midwestern United States, [[skunk]]s are the primary carriers of rabies, composing 134 of the 237 documented non-human cases in 1996. The most widely distributed reservoir of rabies in the United States, however, and the source of most human cases in the U.S., are [[bat]]s. Nineteen of the twenty-two human rabies cases documented in the United States between 1980 and 1997 have been identified genetically as bat rabies. In many cases, victims are not even aware of having been bitten by a bat, assuming that a small puncture wound found after the fact was the bite of an [[insect]] or [[spider]]; in some cases, no wound at all can be found, leading to the hypothesis that in some cases the virus can be contracted via inhaling airborne aerosols from the vicinity of bats. For instance, the [[Centers for Disease Control and Prevention]] warned on [[May 9]], [[1997]], that a woman who died in October, 1996 in [[Cumberland County, Kentucky]] and a man who died in December, 1996 in [[Missoula County, Montana]] were both infected with a rabies strain found in silver-haired bats; although bats were found living in the chimney of the woman's home and near the man's place of employment, neither victim could remember having had any contact with them.<ref name="cdc">[http://0-www.cdc.gov.mill1.sjlibrary.org/rabies/publications/mmwr_4618.html Human Rabies — Kentucky and Montana, 1996], [[May 9]], [[1997]]/Vol. 46/No. 18</ref> Similar reports among [[Caving|spelunker]]s led to experimental demonstration in animals.<ref name="cons"/> This inability to recognize a potential infection, in contrast to a bite from a dog or raccoon, leads to a lack of proper prophylactic treatment, and is the cause of the high mortality rate for bat bites. |
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On [[September 7]], [[2007]], rabies expert Dr. Charles Rupprecht of [[Atlanta]]-based U.S. Centers for Disease Control and Prevention said that [[Canidae|canine]] rabies had disappeared from the United States. Rupprecht emphasized that the disappearance of the canine-specific strain of rabies virus in the US does not eliminate the need for dog rabies vaccination as dogs can still become infected from exposure to wildlife<ref>[http://www.reuters.com/article/scienceNews/idUSN0741162020070907 Reuters, U.S. free of canine rabies virus]</ref>. |
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==Recently publicized cases== |
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===Transmission by bite=== |
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Several recently publicized cases have stemmed from bats, which are known to be a [[Vector (biology)|vector]] for rabies. See the [[#Rabies and bats|Rabies and bats]] section below. |
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In October 2004 a female brown [[bear]] killed one human and injured several others near the city of [[Braşov]] in Central [[Romania]]. The bear was killed by human hunters and diagnosed with rabies. More than one hundred humans were vaccinated afterwards. |
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===Transmission through organ transplants=== |
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Rabies is known to have been transmitted between humans by [[Organ transplant|transplant surgery]]. [[Image:Rabies patient.jpg|thumb|right|250px|A patient with rabies, 1959]] |
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Infections by [[cornea]]l transplant have been reported in Thailand (2 cases), India (2 cases), Iran (2 cases),<ref name=Javadi_1996>{{cite journal | author=Javadi MA, Fayaz A, Mirdehghan SA, Ainollahi B | title=Transmission of rabies by corneal graft | journal=Cornea | year=1996 | pages=431-3 | volume=15 | issue=4 | id={{PMID|8776570}} | doi = 10.1097/00003226-199607000-00014}}</ref> the United States (1 case), and France (1 case).<ref>{{cite journal | author = CDC | title = Human-to-human transmission of rabies via a corneal transplant -- France | journal = MMWR | year = 1980 | volume = 29 | issue = | pages = 25–6 | url= }}</ref> Details of two further cases of infection resulting from corneal transplants were described in 1996. |
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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]].<ref name=MMWR_2004a>{{cite journal | author= | title=Investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004 | journal=MMWR Morb Mortal Wkly Rep | year=2004 | pages=586-9 | vol=53 | issue=26 | id={{PMID|15241303}} }}</ref> There were bats near the donor's home, and the donor had told others that he had been bitten.<ref name=MMWR_2004b> {{cite journal | author= | title=Update: investigation of rabies infections in organ donor and transplant recipients--Alabama, Arkansas, Oklahoma, and Texas, 2004 | journal=MMWR Morb Mortal Wkly Rep | year=2004 | pages=615-6 | volume=53 | issue=27 | id={{PMID|15254455}} }}</ref> 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''.<ref name=Srinivasan_2005>{{cite journal | author=Srinivasan A, Burt 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 | title=Transmission of rabies virus from an organ donor to four transplant recipients | journal=N Engl J Med | year=2005 | pages=1103–11 | volume=352 | issue=11 | id=PMID 15784663 | doi = 10.1056/NEJMoa043018}}</ref><blockquote>"[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.)"On<ref> {{cite journal | author = Reynolds G | title = Will Any Organ Do? | journal = The New York Times Magazine | year = 2005 | volume = | issue = 10 July | pages = –}}</ref></blockquote> |
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In February 2005, three [[Germany|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 (drug)|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." This was the storyline for an episode of ''[[Scrubs (TV series)|Scrubs]]'' ("[[My Lunch]]") in which [[Perry Cox|Dr. Perry Cox]] was responsible for the death of three transplant patients. |
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==Transport of pet animals between countries== |
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{{main|Pet passport}} |
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[[Image:Arbroath Rabies Sign.JPG|thumb|250px|right|Sign at a UK port showing rabies prevention measures aimed at merchant seamen]] |
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Rabies is [[endemic (epidemiology)|endemic]] to many parts of the world, and one of the reasons given for [[quarantine]] periods in international animal transport has been to try to keep the disease out of uninfected regions. However, most developed countries, pioneered by [[Sweden]], now allow unencumbered travel between their territories for pet animals that have demonstrated an adequate immune response to rabies vaccination. |
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Such countries may limit movement to animals from countries where rabies is considered to be under control in pet animals. There are various [[lists of countries where rabies in pet animals is under control|lists of such countries]]. The United Kingdom has developed a list, and France has a rather different list, said to be based on a list of the ''Office International des Epizooties'' (OIE). The European Union has a harmonised list. No list of rabies-free countries is readily available from OIE. |
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However, the recent spread of rabies in the northeastern United States and further may cause a restrengthening of precautions against movement of possibly rabid animals between countries. |
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==Rabies and dogs== |
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{{main|Dog health#Rabies}} |
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[[Image:Dog with rabies.jpg| thumb | 245px | right | Close-up of a dog's face during late-stage "dumb" paralytic rabies. Animals with "dumb" rabies appear depressed, lethargic, and uncoordinated. Gradually they become completely paralyzed. When their throat and jaw muscles are paralyzed, the animals will drool and have difficulty swallowing.]] |
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Rabies has a long history of association with dogs. The first written record of rabies is in the Codex of [[Eshnunna]] (ca. 1930 BC), which dictates that the owner of a dog showing symptoms of rabies should take preventative measure against bites. If a person is bitten by a rabid dog and later died, the owner was fined heavily.<ref>{{cite book | last = Dunlop | first = Robert H. | coauthors = Williams, David J. | title = Veterinary Medicine:An Illustrated History | publisher = Mosby | date= 1996 | id = ISBN 0-8016-3209-9 }}</ref> |
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Three stages of rabies are recognized in dogs. The first stage is a one to three day period characterized by behavioral changes and is known as the [[Prodrome|prodromal stage]]. The second stage is the excitative stage, which lasts three to four days. It is this stage that is often known as ''furious rabies'' due to the tendency of the affected dog to be hyperreactive to external stimuli and bite at anything near. The third stage is the paralytic stage and is caused by damage to [[motor neuron]]s. Incoordination is seen due to rear limb paralysis and drooling and difficulty swallowing is caused by paralysis of facial and throat muscles. Death is usually caused by [[respiratory arrest]].<ref name=Ettinger_1995>{{cite book|author=Ettinger, Stephen J.;Feldman, Edward C.|title=Textbook of Veterinary Internal Medicine|edition=4th ed.|publisher=W.B. Saunders Company|year=1995|id=ISBN 0-7216-6795-3}}</ref> |
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On [[April 25]], [[2008]] three people were bitten by a rabid puppy which was in quarantine after arriving into the UK on 18 April 2008 from Sri Lanka. The incident happened in the Chingford area of Essex at a licensed quarantine centre and the people involved received vaccinations. |
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==Rabies and opossums== |
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Experimental studies of rabies infection in the Virginia opossum have shown the importance of the mode of transmission. Opossums became infected when exposed to air-borne virus but were found to be fairly resistant to intramuscular inoculations. <ref>Constantine DG, Woodall DF. |
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Related Articles, Links |
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Transmission experiments with bat rabies isolates: reactions of certain Carnivora, opossum, rodents, and bats to rabies virus of red bat origin when exposed by bat bite or by intrasmuscular inoculation. |
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Am J Vet Res. 1966 Jan;27(116):24-32. No abstract available. |
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PMID: 5913032 [PubMed - indexed for MEDLINE] |
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</ref><ref>Constantine DG 1967 Rabies transmission by air in bat caves. US Pub Health Serv, Publ. 1617</ref><ref>1: Am J Vet Res. 1960 May;21:507-10.Links |
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Resistance of the opossum to rabies virus. BEAMER PD, MOHR CO, BARR TR. |
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PMID: 13797881 [PubMed - indexed for MEDLINE] |
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</ref>The aerosol transmission of rabies in opossum was investigated following the death from rabies of two men who had visited the Frio Caves, Texas, and did not remember any direct contact with bats. |
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===The spatial and temporal distribution of opossum rabies=== |
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Rabies cases in the Virginia opossum are spillover cases from other wildlife species such as bats, skunks and the raccoon epizootic in the eastern United States. |
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Cases have been reported across the United States from California to New York <ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.Rabies surveillance in the United States during 1996. |
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J Am Vet Med Assoc. (1997) 211(12):1525-39. Review. Erratum in: J Am Vet Med Assoc. (1998) 212(8):1280. |
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PMID: 9412679</ref><ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.(1999) Rabies surveillance in the United States during 1998. J Am Vet Med Assoc. (1999) 215(12):1786-98. Erratum in: J Am Vet Med Assoc 2000 216(8):1223</ref><ref>Krebs JW, Smith JS, Rupprecht CE, Childs JE.Rabies surveillance in the United States during 1996. |
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J Am Vet Med Assoc. (1997) 211(12):1525-39. Review. Erratum in: J Am Vet Med Assoc. (1998) 212(8):1280. |
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PMID: 9412679 </ref>. In New York state, the [[Wadsworth Center]] lists laboratory confirmed cases in opossums 5 years out of 10 from 1989 to 1998. |
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==Rabies and domestic skunks in the United States== |
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There is currently no [[United States Department of Agriculture|USDA]]-approved vaccine for the strain of rabies that afflicts skunks. When cases are reported of [[pet skunk]]s biting a human, the animals are frequently killed in order to be [[Rabies testing|tested for rabies]]. |
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Humans exposed to the rabies virus must begin post-exposure prophylaxis before the disease can progress to the central nervous system. For this reason, it is necessary to determine whether the animal, in fact, has rabies as quickly as possible. Without a definitive quarantine period in place for skunks, quarantining the animals is not advised as there is no way of knowing how long it may take the animal to show symptoms. Destruction of the skunk is recommended and the brain is then tested for presence of rabies virus. |
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Skunk owners have recently organized to campaign for USDA approval of both a vaccine and an officially recommended quarantine period for skunks in the United States.{{Fact|date=January 2008}} |
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==Rabies and bats== |
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The problem of bat-transmitted rabies is found over most of North and South America but was first closely studied in [[Trinidad]] in the [[West Indies]] which had a dreadful reputation for bat rabies, which took a significant toll of livestock and humans alike. In the 10 years from 1925 and 1935, 89 people and thousands of livestock had died from it - "the highest human mortality from rabies-infected bats thus far recorded anywhere.".<ref>Goodwin G. G., and A. M. Greenhall. 1961. "A review of the bats of [[Trinidad and Tobago]]." ''Bulletin of the American Museum of Natural History'', 122, p. 196</ref> |
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In early 1931, Dr. H. Metivier, a Veterinary surgeon, established the connection between the bites of bats and paralytic rabies. In September 1931, Dr. J. L. Pawan, a Government Bacteriologist found Negri bodies in the brain of a bat with unusual habits. In 1934 the Trinidad and Tobago Government began a program of vampire bat control, shooting, netting, trapping and poisoning, while encouraging the screening off of livestock buildings and free vaccination programs for exposed livestock. |
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After the opening of the [[Trinidad Regional Virus Laboratory]] in 1953, basic research on bats and rabies progressed rapidly under the able direction of Arthur Greenhall, who demonstrated that at least 8 species of bats in Trinidad had been infected with rabies - particularly the [[Common Vampire Bat]], ''Desmodus rotundus'' (which "will attack any warm blooded creature"), the rare [[White-winged Vampire Bat]], ''Diaemus youngi'', (which "appears to have a special preference for birds and goats"), as well as two abundant species of Fruit Bats: the [[Seba's Short-tailed Bat]] or Short-tailed Fruit Bat, ''Carollia perspicillata'', which commonly roosts with Vampires, and the [[Jamaican Fruit Bat]], ''Artibeus jamaicensis''.<ref>Greenhall, Arthur M. 1961. ''Bats in Agriculture''. Ministry of Agriculture, Trinidad and Tobago.</ref> |
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Non-bite transmission of rabies in people has been reported by the CDC<ref name="cdc"/>, and experimentally demonstrated with a high efficiency in susceptible animals placed in bat-proof and insect-proof cages in a cave with bat colonies by Constantine in Frio Cave, Texas, as early as 1960.<ref name="cons">[http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1914752&blobtype=pdf Constantine, D. G. 1962. "Rabies transmission by nonbite route."] ''Public Health Reports'' 77, pp. 287–289.</ref> In 1967, rabies virus was isolated from the air in the same cave,<ref>Winkler, W. G. 1968. "Airborne Rabies Virus Isolation." ''Bull. Wildlife Disease Assoc''. Vol. 4, April 1968, pp. 37-40. Available online at: http://www.jwildlifedis.org/cgi/reprint/4/2/37</ref> presumably passed by the bats urinating, potentially forming a source for infection of other susceptible animals, and presenting a hazard to researchers and spelunkers. While the risks may be low, they are deserving of further study and monitoring.<ref>Messenger, Sharon L., Jean S. Smith, and Charles E. Rupprecht. 2002. "Emerging Epidemiology of Bat-Associated Cryptic Cases of Rabies in Humans in the United States." ''Clinical Infectious Diseases''. 2002; 35, pp. 738–747. Available on line at: [http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/342387&erFrom=-2845139658306756774Guest journals.uchicago.edu]</ref> |
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The United Kingdom, which has stringent regulations on the importation of animals, had also been believed to be entirely free from rabies until 1996 when a single [[Daubenton's bat]] was found to be infected with a rabies-like virus usually found only in bats – European Bat Lyssavirus 2 (EBL2). There were no more known cases in the [[British Isles]] until September 2002 when another Daubenton's bat tested positive for EBL2 in [[Lancashire]]. A bat conservationist who was bitten by the infected bat received post-exposure treatment and did not develop rabies. |
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Then in November 2002 David McRae (1947-2002), a [[Scotland|Scottish]] bat conservationist from [[Guthrie, Angus|Guthrie]], [[Angus]] was bitten on the ring finger of his left hand by a bat, thereby becoming the first human to contract rabies in the United Kingdom since 1902. He subsequently died in hospital [http://news.bbc.co.uk/1/hi/scotland/2509375.stm] from EBL2 rabies on [[November 24]] [[2002]][http://news.scotsman.com/topics.cfm?tid=659&id=1391162003]. |
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{{wikinews|First unvaccinated survivor of rabies discharged from hospital}} |
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In November 2004, [[Jeanna Giese]], a fifteen-year old girl from [[Fond du Lac, Wisconsin|Fond du Lac]], [[Wisconsin]], became one of only six humans known to have survived rabies after the onset of symptoms, and the first known instance of a human surviving rabies without vaccine treatment. Giese's disease was already too far progressed for the vaccine to help, and she was considered too weak to tolerate it. Doctors at the Children's Hospital of Wisconsin in [[Wauwatosa, Wisconsin|Wauwatosa]], a suburb of [[Milwaukee, Wisconsin|Milwaukee]], achieved her survival with an experimental treatment that involved putting the girl into a drug-induced [[coma]], and administering a cocktail of [[antiviral drug]]s. Giese had symptoms of full-blown rabies when she sought medical help, thirty-seven days after being bitten by a bat. Her family did not seek treatment at the time because the bat seemed healthy. Jeanna regained her weight, strength, and coordination while in the hospital. She was released from the Children's Hospital of Wisconsin on [[January 1]], [[2005]]. |
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On [[May 12]], [[2006]] [[Harris County, Texas]] U.S.A. Health Department officials reported that a teenage boy, Zachary Jones of Humble, Texas, had died of rabies at Texas Children's Hospital in [[Houston, Texas]]. Zachary had contracted the disease after a bat flew in his bedroom and bit him in his sleep. He was unaware he had been bitten and was not hospitalized until he developed symptoms several weeks later. He died at Texas Children's Hospital after an attempt to cure the disease through a drug-induced coma, similar to that of Jeanna Giese. |
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On [[November 2]], [[2006]] a 10 year old girl in Bourbon, Indiana, U.S.A. died of rabies. The ''Indianapolis Star'' reports that she was bitten by a bat in June 2006. |
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In August of 2006, a 73 year old rural resident located east of Edmonton, Alberta, Canada was bitten by a bat while he slept. He ignored the bite and became symptomatic in January 2007. Diagnosed with rabies in March of 2007, he was treated with the Milwaukee protocol, but died [[April 26]], [[2007]]. |
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On [[August 6]], [[2006]], 950 Girl Scouts were urged to receive rabies shots by the Girl Scouts of America. The nine hundred and fifty girls had attended a camp in [[Virginia]], U.S.A. in July, and had reported seeing bats in their cabins. Even though infections were relatively unlikely, the G.S.A. offered to pay for the shots, at a cost of nearly two million dollars. The [[Centers for Disease Control]] reports 27 cases of human rabies caused by the bat variant rabies virus in the United States from 1990 to 2002.<ref name=CDC_2003>{{cite web|year=2003|title=Rabies Surveillance |work=Centers for Disease Control| url=http://www.cdc.gov/ncidod/dvrd/rabies/Professional/publications/Surveillance/Surveillance01/Table2-01.htm |
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|accessdate=2006-11-10}}</ref> |
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On [[December 8]], [[2007]], a 34 year old Dutch medical doctor died from rabies. According to Dutch media, the woman, who worked at the Amsterdam Academic Medical Center (AMC), had been attacked by a small bat while on holiday in Kenya last October. The attack, which occurred at a camping site somewhere between Nairobi and Mombasa, resulted in some bleeding scratches on her nose. She was infected with Duvenhage-virus and succumbed to severe brain infection. |
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==Rabies and Vampirism== |
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Dr Juan Gómez-Alonso, a neurologist at Xeral Hospital in Vigo, [[Spain]], examined the possibility of a link between [[vampire]] legends and rabies in the journal Neurology.<ref>[http://news.bbc.co.uk/2/hi/europe/178623.stm ''Rabies--the Vampire's Kiss'', BBC News]</ref> The supposed susceptibility of vampires to garlic and light could be due to rabies-induced hypersensitivity. The disease can also affect portions of the brain that could lead to disturbance of normal sleep patterns (thus leading to nocturnal behavior) and hypersexuality. Legend maintained that a man was not rabid if he could look at his own reflection (an allusion to the belief that vampires have no reflection).<ref>BBC News</ref> Wolves and bats, which are often associated with vampires, are rather common carriers of rabies. The disease can also lead to a drive to bite others, and to a bloody frothing at the mouth. |
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==See also== |
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* [[World Rabies Day]] |
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* [[Alliance for Rabies Control]] |
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* [[Neurotropic virus]] |
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==References== |
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=== Further reading === |
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<div class="references-small" style="-moz-column-count:2; column-count:2;"> |
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*Waterman, James A. 1965. "The History of the Outbreak of Paralytic Rabies in Trinidad Transmitted by Bats to Human Beings and the Lower Animals from 1925." The ''Caribbean Medical Journal''. 1954. Vol. XXVI, Nos. 1–4, pp. 164–169. |
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*Fleming, Theodore H. 2003. ''A Bat Man in the Tropics: Chasing El Duende''. University of California Press. ISBN 0-520-23606-8. |
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*Kaplan, Turner, and Warrell 1986. ''Rabies: The Facts'', Oxford University Press. ISBN 0-19-261441-X |
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</div> |
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==External links== |
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{{external links}} |
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* [http://www.lapublichealth.org/vet/reports/rabhist.htm History of Rabies in Los Angeles] |
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===Sources=== |
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* [http://www.manbir-online.com/rabies_m.htm#11 Manbir Online] |
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* [http://www.cnn.com/2004/HEALTH/07/01/rabies.organ.transplant/ CNN News report of CDC news release - July 1, 2004]. |
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* [http://www.chron.com/cs/CDA/printstory.mpl/metropolitan/2660998 Associated Press report: ''Families of rabies transplant victims react to deaths'' - July 3, 2004] |
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* [http://news.bbc.co.uk/2/hi/europe/3756078.stm BBC News Europe Report: Romanian killer bear had rabies - 19 October, 2004]. |
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* [http://health.dailynewscentral.com/content/view/000258/58/ First Unvaccinated Rabies Survivor Goes Home - January 3, 2005] |
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===Other links=== |
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{{wiktionary}} |
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{{wikinews}} |
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* [http://www.cdc.gov/ncidod/dvrd/rabies/ Centers for Disease Control and Prevention] |
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* [http://www.who.int/mediacentre/factsheets/fs099/en/ World Health Organization factsheet on Rabies] |
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* [http://www.who.int/vaccines/en/rabies.shtml World Health Organization factsheet on Rabies vaccine] |
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* [http://www.defra.gov.uk/animalh/quarantine/index.htm Rules for importing pets to the United Kingdom] |
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* [http://www.rabiesfreeworld.com/ A Rabies-Free World, Inc.] - NPO dedicated to fighting rabies worldwide |
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* [http://www.kids4rabiesfreeworld.com/ Kids4RabiesFreeWorld] - RFW's site for kids & students |
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* [http://europa.eu/eur-lex/pri/en/oj/dat/2003/l_146/l_14620030613en00010009.pdf Rules for importing pets to the European Union] |
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* [http://www.defra.gov.uk/animalh/quarantine/quarantine/regulation/eu_reg_qa.htm Rules for importing pets to the European Union Q&A] |
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* [http://www.aspenskunk.org/ Aspen Skunk Rabies Research] |
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* [http://fieldandstream.com/fieldstream/columnists/article/0,13199,724624,00.html "When Raccoons Attack" from Field & Stream Online] |
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* [http://www.usatoday.com/news/health/2005-12-24-rabiessurvivor_x.htm "Only Known Unvaccinated Rabies Survivor Thrives"] ''(USA Today)'' Progress report on the one known survivor of rabies |
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* [http://www.metacafe.com/watch/388523/poor_filipino_child_with_rabies/ "Filipino Child with Rabies"] ''(metacafe.com)'' Disturbing video of a small child, exhibiting the advanced stages of rabies mentioned above |
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* [http://www.scidev.net/en/sub-suharan-africa/news/sub-saharan-africa-news-in-brief-13-25-march.html Cheaper rabies diagnosis 'possible for low-income settings' ] |
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Revision as of 18:39, 1 May 2008
fuck u