Rabies

[AJE]

http://www.cdc.gov/ncidod/dvrd/rabies/


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Texas teen fights for life after rabid bat bite

Thursday, May 11, 2006; Posted: 12:17 a.m. EDT CNN.com

HOUSTON, Texas (Reuters) -- A Texas teenager bitten by a bat while he slept in his Houston-area home was in critical condition with rabies in a local hospital Wednesday, health officials said.

The high school sophomore awoke from a nap four weeks ago to find a bat had apparently flown in an open window in his home, said Harris County Health Department doctor Herminia Palacio.

"What we have is a history of the child waking up from a nap in his room and seeing a bat in the room and having felt the bat brush against him," she said.

The boy did not know he had been bitten, which Harris County veterinarian Dawn Blackmar said was not unusual because bats have "very, very tiny" teeth.

The bat was captured and thrown out the window, news reports said.

The boy began feeling ill last week, was taken to the hospital and diagnosed with rabies. He is being treated, but Palacio said the chance of survival is low. Ten people in the United States have died of rabies since 1998, according to the Centers for Disease Control and Prevention, or CDC.

"Once a person becomes ill, there's really no effective treatment. Clinical illness with rabies is almost universally fatal," Palacio said.

Symptoms can range from flu-like fever and headaches to anxiety, delirium and hallucinations, the CDC said.

Bats, which wildlife experts say are beneficial animals because they consume large quantities of insects, are prevalent at this time of year in Texas because they are migrating north after spending the winter in Mexico, Palacio said.

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May 12, 2006, 12:38PM
Diagnosis rabies — and she lived to tell
Wisconsin teen's ordeal gives a local family some hope


By LEIGH HOPPER
Copyright 2006 Houston Chronicle

Ann Giese's daughter, Jeanna, was in the hospital, her condition worsening rapidly — she couldn't keep food or water down, she couldn't walk, and her arm was jerking uncontrollably. Doctors couldn't figure out why.

The answer came unexpectedly: Ann Giese told the pediatrician her daughter had been bitten on the finger by a bat weeks earlier.

"I can still picture his face. It turned (completely) white. 'Tell me that again? When did it happen?,' " Giese recalled. "He just said, 'I'll be right back.' "

The diagnosis was rabies. But Jeanna, who lives in Fond du Lac, Wis., survived, the only known case of an unvaccinated victim to recover from the fatal disease.

Her recovery offers a sliver of hope for an Humble family, whose teenage son is fighting for his life at Texas Children's Hospital.

It also offers the only glimpse into what the boy's family is going through since his parents have asked the hospital, family and friends not to talk about their son's care or condition.

Zach Jones, an Humble High School sophomore who was bitten on the head four weeks ago by a rabid bat while sleeping, is in critical condition as doctors try to control swelling of his brain stem. Doctors are using the same experimental combination of drugs credited with saving Jeanna's life.

However, a Texas Children's spokeswoman on Thursday painted a less-than-hopeful picture for the local teen. Jeanna Giese was seen "significantly earlier in the progression of her disease," the spokeswoman said. Because she was bitten on the hand, the virus — which travels through nerves — took longer to reach her brain.

"There is no protocol for treating rabies. We are treating the symptoms of a fatal disease ... ," said the spokeswoman, who asked not to be named because of the family's sensitivity about publicity. "We are trying everything we possibly can."


No followup treatment
Eighteen months after she first fell ill, Jeanna Giese is back in school full time in Fond du Lac. The 16-year-old has been given a clean bill of health and requires no followup medical treatment or tests.

She still has physical therapy twice a week, and her speech sounds slightly thickened and deliberate. Curiously, her voice is deeper than before, her mother said. But her grades are back to normal and she's starting to run again. She hangs out with her old group of friends. Tonight, she's going to dinner and a movie with her family.

"If you survive, the virus is gone. It doesn't go into dormancy," said Skip Oertli, a veterinarian with the Texas Department of State Health Services.

In September 2004, Jeanna was attending a church service when she picked up a bat that fell to the floor. She let the bat go outside the building. On her left finger was a tiny bite. It was cleaned with hydrogen peroxide, but no medical attention was sought.

"We didn't know to get the shots. We didn't think of it," Ann Giese said. "We thought you get them if you have rabies, not to prevent rabies. Rabies never crossed our minds, really."

Three weeks after the bite, Jeanna felt tingling in her arm. Because she played volleyball, the discomfort was attributed to a pinched nerve. The symptoms worsened, with double vision and vomiting. Soon, she developed twitching in her left arm, and had trouble standing or speaking.

When she was taken for a brain scan, she was salivating so much doctors feared she would choke and put a tube in to help her breathe. After her mother told doctors about the bat bite, she was tested for the disease, a viral infection of the central nervous system that is nearly always fatal once symptoms begin.


How she was treated
Lab tests confirmed the rabies diagnosis, beginning an 11-week medical roller coaster.

Dr. Rodney Willoughby, a pediatric infectious disease specialist at Children's Hospital of Wisconsin, met with Jeanna's parents, Ann and John, and told them there was no cure for rabies — but there was one treatment they could try.

Willoughby explained he would put their daughter into a medically induced coma for several days, while she received intravenous antiviral medication.

"We both kind of looked at each other and said, 'Do it,' " Ann Giese recalled. "They said, 'We'll give you a couple of minutes to think about it.' We looked at each other again and said, 'Try whatever you can.' "

And so they did. Jeanna looked "so peaceful" in her unconscious state, Ann Giese said. But inside, her body was at war. It was unclear whether the drugs would work. On her 12th hospital day, she developed a high fever and remained paralyzed.

"We just hoped and prayed and put the negative part out of our mind as best as possible," John Giese said. "Keep hoping and praying for the positive stuff. That's what you have to feed off and live off of."


Recovery begins
By the 14th day, things began to change. Jeanna blinked. On day 16, she raised her eyebrows in response to speech. On day 19, she wiggled her toes and squeezed hands in response to commands. Willoughby told her to look over at her mother.

"He said, 'Look at your mom,' and I was talking to her," Ann Giese said. "I don't know how to explain it. You get excited. It was like a baby doing a new thing."

Jeanna went home after 11 weeks in the hospital. She said she doesn't remember anything but the last three weeks, when she was in physical therapy.

"I'm feeling fine," Jeanna said. "I'm pretty much back to normal."

Ann Giese's message to Zach Jones' parents: "He's on prayer chains around here. Just keep to your faith and pray often. Just believe if Jeanna can make it, there's no reason why he can't."

leigh.hopper@chron.com

[AJE]

Although rabies infections in people are rare, they can cause serious health problems. So it's good to know how to recognize the signs of a bite by a rabid animal and what to do about it.

Rabies is a virus that is usually transmitted by a bite from a wild infected animal, such as a bat, raccoon, skunk, or fox. If a rabid animal bite goes untreated, an infection can develop and lead to brain damage or even death.

But if you recognize the warning signs of a rabies infection early and get medical help, your child can make a full recovery. After a bite by a rabid animal, a child may develop a fever, headache, and general malaise. A twitching around the animal bite, a trademark symptom of rabies, may appear in addition to a fever above 105 degrees Fahrenheit (40.5 degrees Celsius), agitation, and hallucinations.

If you suspect that your child has been bitten by a rabid animal, even if there are no rabies symptoms, take your child to the emergency department immediately. Any animal bites - even those that don't involve rabies - can lead to infections and other medical problems. As a precaution, you may want to call your child's doctor any time your child has been bitten.




Transmission
Approximately 7,000 cases of rabies in animals are reported each year to the Centers for Disease Control and Prevention (CDC). Raccoons are the most common carrier of rabies in the United States, but bats are most likely to infect people. Almost three quarters of rabies cases between 1990 and 2001 came from contact with bats.

Skunks and foxes also tend to carry rabies, and a few cases have been reported in wolves, coyotes, bobcats, and ferrets. Small rodents, such as hamsters, squirrels, chipmunks, mice, and rabbits, do not typically carry rabies.

Because of widespread vaccination programs in the United States, transmission from dogs to people is very rare. Outside the United States, exposure to rabid dogs is the most common cause of transmission to humans.

An infected animal carries the rabies virus in its saliva and can transmit it to a person through biting. In rarer cases, an animal can spread the virus when its saliva comes in contact with a person's mucous membranes (moist skin surfaces, like the mouth or inner eyelids) or broken skin such as a cut, scratch, bruise, or open wound.

After a bite, the rabies virus can spread into the person's surrounding muscle, then travel up a nearby nerve to the brain. Once the virus infects the brain, it can cause severe, possibly permanent injury.




Signs and Symptoms
The symptoms of rabies typically appear about 4 days after the bite occurs. But in rare cases, symptoms don't show up for more than a year.

One of the most distinctive signs of a rabies infection is a tingling or twitching sensation around the area of the animal bite. It is often accompanied by a fever, headache, muscle aches, loss of appetite, nausea, and fatigue.

As the infection progresses, someone infected with rabies may develop any of the following symptoms:

irritability
excessive movements or agitation
confusion
hallucinations
aggressiveness
bizarre or abnormal thoughts
muscle spasms
abnormal postures
seizures (convulsions)
weakness or paralysis (when a person cannot move some part of the body)
extreme sensitivity to bright lights, sounds, or touch
increased production of saliva or tears
difficulty speaking

In the advanced stage of the infection, as it spreads to other parts of the nervous system, other symptoms may develop:
double vision
problems moving facial muscles
abnormal movements of the diaphragm and muscles that control breathing
difficulty swallowing and increased production of saliva, causing the "foaming at the mouth" usually associated with a rabies infection

If Your Child Is Bitten by a Rabid Animal
If your child has an animal bite and shows any symptoms of a rabies infection, see a doctor immediately.

If your child has been bitten by a rabid animal but shows no symptoms, take the following steps right away:

Wash the bite area with soap and water for 10 minutes and cover the bite with a clean bandage.

Immediately call your doctor and go to a nearby emergency department. Anyone with a rabies infection must be treated in a hospital.

Call local animal-control authorities to help find the animal that caused the bite. The animal may need to be detained and observed for signs of rabies.

If you know the owner of the rabid animal that has bitten your child, get all the information about the animal, including vaccination status and the owner's name and address. Notify your local health department, particularly if the animal hasn't been vaccinated.

If you suspect that your child has been bitten by an unknown dog, bat, rat, or other animal, contact your child's doctor immediately, or take your child to the emergency department.


Vaccinate your pets: Cats, dogs, and ferrets can be infected by rabies.
Treatment
At the hospital, it is likely that the doctor will first clean the wound thoroughly and make sure that your child's tetanus immunizations are current.

To keep any potential infection from spreading, the doctor may decide to start treating your child right away with shots of human rabies immune globulin to the wound site and vaccine shots in the arm. This decision is usually based on the circumstances of the bite (provoked or unprovoked), the type of animal (species, wild or domestic), the animal's health history (vaccinated or not), and the recommendations of local health authorities.

Prevention
There are steps you can take to reduce the chances that your child is exposed to rabies. Report any stray animals to your local health authorities or animal-control officer. Remind your child that animals can be "strangers," too. Your child should never touch or feed stray cats or dogs wandering in the neighborhood or elsewhere.



As a precaution against rabies or any other infections, call your child's doctor if:

your child has been exposed to an animal that might have rabies, but is too young to describe the contact with the animal
your child has been exposed to bats, even if there is no bite
you plan to travel abroad and may come into contact with rabid animals, particularly if you're traveling to an area where you might not have access to health care



Reviewed by: Barbara P. Homeier, MD
Date reviewed: March 2005

[AJE]

Rabies rare in United States

Bats pose biggest concern for humans
By Suzanne Weiss
Herald Times Reporter
January 10, 2005

MANITOWOC — When 15-year-old Jeanna Giese of Fond du Lac became the first known human to survive rabies without a vaccination, the disease and the girl’s miraculous recovery received national headlines.

She was released from the hospital Jan. 1.

Bats likeliest culprits

Jeanna contracted rabies, a viral infection that affects the neurological system, after being bitten by a bat on Sept. 12.

“People typically disregard bat bites,” said Dr. Henry Loomans, infectious disease specialist with Aurora Health Care. “Now I think that’s going to change.”

“Any exposure to a bat should be considered exposure to a potentially rabid animal,” said Amy Wergin, public health nurse manager with the Manitowoc County Health Department.

Immediate attention crucial

“The most important thing is to immediately scrub any bite wound with soap and water,” Loomans said.

“If you have the bat, it should be tested,” Wergin said. “If you don’t have the bat you should be treated right away. That’s the moral of the story of the young woman in Fond du Lac.”

Treatment involves an immediate injection of rabies immune globulin followed by a series of five rabies vaccines, which are not as painful as they used to be because they are now given in the arm and not the abdomen, she said.

“If you have access to treatment within a reasonable time, the prognosis is excellent,” Loomans said.

Jeanna, who did not receive the standard injections, was saved by an experimental treatment that involved inducing a coma.

She was treated after the onset of symptoms.

Incubation period varies

“The time between exposure and onset of symptoms is variable, but averages two to 12 weeks, although incubation periods of over one year have been reported,” Wergin said.

Initial symptoms appear flu-like and may include headache, achiness, irritability, sore throat, and vomiting, Loomans said.

These may be followed by fever, a feeling of anxiousness, hyperactivity, difficulty swallowing and excessive salivation, a change in mental status, paralysis, coma and eventually death, he said.

There have been no reports of human rabies in Manitowoc County since Wergin started working at the Health Department in 1987, although there have been some animal rabies cases reported, she said.

Some 40,000 to 50,000 people a year die from rabies worldwide, Loomans said.

Rabies rare in United States

“Between 1980 and 2000, there were only 36 cases of human rabies diagnosed in the U.S.,” he said. “Of those 36, 21 were from bats.”

While rabies is most commonly found in bats, it also can be present in raccoons, skunks, foxes, dogs, cats and even horses and cows, Wergin said.

Mice, squirrels, rabbits, rats and gerbils do not carry rabies, Loomans said.

Pets require immunization

The state of Wisconsin requires dogs to be immunized against rabies; some municipalities, including the city of Manitowoc, require cats to get rabies immunizations as well, Wergin said.

The first rabies vaccination is good for one year; following vaccinations are effective for three years, said Debbie Hibbard, office manager of Port Cities Animal Hospital.

“The campaigns by veterinarians and humane societies to vaccinate dogs and cats has dramatically reduced the amount of rabies we have seen in the U.S.,” Loomans said.

[AJE]

My sincere Sympathy goes out to the Jones family in Texas and to everyone whom has lost a loved one to such an ailment. I followed the Wisconsin teen’s ordeal as best as I could from my prayers. She truly is a miracle!

When I was in High School I had a family member and several close friends go through the peril of not knowing their fate as a result of rabies. :cry:

It happened one spring just outside of Rockwood, WI on a farm. A farm mutt had given birth to a gorgeous litter of puppies. Everything was going wonderful with the new litter until a rabid skunk entered the barn and attacked one of the puppies. The mother dog defending her family attacked and killed the intruder. But the fate of the dog was already loss, It now was too late since by the time the owners realized what had transpired and were forced to shoot their beloved pet she had already infected her pups.

My family member was one of 6 people whom needed to get immediate rabies shots after handling the puppies prior to test coming back from Madison tested positive. A god-awful ordeal which I’d never wish upon anyone. We held our breaths and prayers for a few weeks while we waited to see if the shots worked. Thank God our prayers were answered. :P Sadly the rest of the puppies had to be humanely euthanitze.

[AJE]

Ind. girl dies of rabies after bat bite
Yahho News Thursday Nov 2, 2006

:arrow: INDIANAPOLIS - A 10-year-old girl who was diagnosed with Indiana's first confirmed case of rabies in nearly half a century died Thursday, a hospital spokeswoman said.

Shannon Carroll had been bitten by a rabid bat in June and had been hospitalized since early October, said Riley Hospital for Children spokeswoman Jo Ann Klooz said.

http://news.yahoo.com/s/ap/20061102/...s/rabies_death

:arrow: Once again, I must say PLEASE DON'T EVER APPROUCH ANY SICK ANIMALS, LEAVE SOMEONE WHO IS EXPERIANCED HANDLE THE SITUATION. THIS IS A LIFE OR DEATH SITUATION. I have had two wild bats in my care and although they didn't show symptoms of sickness, I always was careful and used the proper attire. I also would like to remind everyone that RABIES is here in Wisconsin and that I almost lost a family member to the disease if they hadn't gotten the vaccination immediately after the encounter, which I spoke of above. God was watching over them.

Any further Information about Everything you would like to know about bats please follow to Bat Conservation International, Inc.

www.batcon.org

[AJE]

I really Hope a movie is made about our Wisconsin Miracle Jeanna Giese! The money would really help curtail the hefty health care expenses.


http://www.mymultiplesclerosis.co.uk...annagiese.html

When the confirmation came, Dr Willoughby knew Jeanna only had hours left to live and threw himself into one last effort to create the cure that had eluded science for centuries. He already suspected that the key was the way rabies killed, hijacking the brain. His breakthrough was to realise that if he could shut down the brain, he could stop the virus in it's tracks. Take Jeanna's brain offline and, perhaps, he could buy her immune system time to rid her body of the virus. He'd put her into the deepest of comas, denying rabies the chance to kill Jeanna by, effectively, killing her himself.

http://www.answers.com/topic/jeanna-giese

http://en.wikipedia.org/wiki/Jeanna_Giese

http://health.dailynewscentral.com/c...iew/000258/58/

[pk]

It's hard for me to read about Rabies. When I was a young girl an Irish Setter with Rabies came through the yard when I was playing outside.

It tried to attack me but I was able to climb up on the top of our corral fence and scream. Our beagle came running and barked so much that it finally alerted my father.

All I remember was the fact that a group of men from the neighborhood includeing the police had to hunt the dog down that ran off. They finally found it and killed it.

We were lucky that day that I was able to stay away from it and that it did not attack our dog that was out there.

Years later I still had nightmares over that dog with the foaming mouth! I still have trouble going near wild animals/large dogs.

Yet another time I was bitten by a cat that was a stray and I was silly enough to pet it. It use to belong to someone in the area that moved away and left the cat to fend for itself and it quickly became wild.

I ended up at the hospital while my sister and neighbors spent hours looking the yards and field for this cat! We were told that they either had to find the cat right away or I would go through the series of shots. Finally my sister found the cat and it was determined to be ok and I was able to go without the shots.

Whew!

But my sister never let me forget how she had to spend hours stomping through a field to save my life! lol

pk

[CarolsCritterCare]

Originally Posted by pk

It's hard for me to read about Rabies. When I was a young girl an Irish Setter with Rabies came through the yard when I was playing outside.

It tried to attack me but I was able to climb up on the top of our corral fence and scream. Our beagle came running and barked so much that it finally alerted my father.

pk

That's really scarey...especially being so young. Lucky you were smart enough to get up high and away.

I have to have the Preexposure prophylaxis shots. I'm considered a high risk. I live with skunks and coons, work with them and other animals that are possible carriers. Besides being a state licensed rehabber, I'm also a state certifed humane officer (never placed thru the state to date), and I"m going to school for Vet Tech Certification.

{Preexposure vaccination is recommended for persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers. Other persons whose activities bring them into frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other species at risk of having rabies should also be considered for preexposure prophylaxis. In addition, international travelers likely to come in contact with animals in areas of enzootic dog rabies which lack immediate access to appropriate medical care, including biologics, should be considered for preexposure prophylaxis}

Carol

[pk]

I have to have the Preexposure prophylaxis shots.

I was just wondering what people do that work with wild animals to keep from getting exposed to rabies. So if you take these shots and you get a bite from an animal that has rabies will this prevent you from getting it? Or just a precaution that will help you but you still have to go through the regular series of shots?

How many shots do you have to take?

[CarolsCritterCare]

Preexposure vaccination does not eliminate the need for additional medical attention after a rabies exposure, it simplifies therapy by eliminating the need for human rabies immune globulin (HRIG) and decreasing the number of vaccine doses needed.
I had to have a series of shots given on days 0, 7, and 21.
Insurance does not cover this so I had to pay $600.00 out of pocket. Plus the doc and I had to look at the calendar and study the dates to make sure I got the vaccination on the proper days...which ment we had to make sure the clinic was open. I was told it would not hurt...not so true. It didn't hurt at the time, it was once home the arm started to throb and hurt. I also got a little nausiated with every shot. Now I just have to have titer tests yearly and when the titers drop to a certain # then I go in for a booster.

Post Exposure Prophylaxis consists of a regimen of one dose of immune globulin and five doses of rabies vaccine over a 28-day period. Rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure. Additional doses of rabies vaccine should be given on days 3, 7, 14, and 28 after the first vaccination. Current vaccines are relatively painless and are given in your arm, like a flu or tetanus vaccine.

Carol

[CarolsCritterCare]

Bobcat Hijacks Worker's Golf Cart
Feline Chases Rabbit Into Vehicle

POSTED: 12:22 pm CST March 9, 2007

CAPE GIRARDEAU, Mo. -- Rabbits don't always bring good luck.

Ask Missouri water plant worker Mitch Walter.

He was at work, inspecting treatment plant property in a golf cart when a rabbit leaped onto the passenger seat.

A 25-pound bobcat was in hot pursuit.

The rabbit leaped to freedom, leaving Walter riding along with the bobcat.

Walter got some scratches on his neck as he shoved the bobcat out.

And then he had to go get a painful round of rabies shots, but he said he figures it could have been worse.