BACKGROUND: Since the 1980s, rare cases of rabies in humans in Canada and the United States have been almost exclusively caused by the bat-variant virus. METHODS: We reviewed indigenously acquired cases of bat-variant rabies in humans in Canada and the United States from 1950 through 2007. RESULTS: Of 61 cases identified, 5 occurred after organ transplantation and were excluded from further analysis. A bite was reported by 22 (39%) of the case patients, 9 (16%) had a direct contact (i.e., were touched by a bat) but no history of a bite, 6 (11%) found bats in their home (2 [4%] in the room where they slept) but reported no direct contact, and 19 (34%) reported no history of bat exposure whatsoever. With the exception of California (8 cases) and Texas (7 cases), no state or province had >3 cases. Of the case patients, 76% were men, and 40% were 10-29 years of age. The median incubation period was 7 weeks (<10 weeks in 72% of cases). The incidence of bat-variant rabies cases increased from 2.2 per billion person-years in 1950-1989 to 6.7 per billion person-years in 1990-2007. Of 36 case patients with bat rabies described since 1990, 16 had no history of direct bat contact; 2 (13%) of the 16 would have qualified for rabies postexposure prophylaxis on the basis of exposure criteria expanded in 1995 to include bats that were in the same room as a sleeping person. The incidence of rabies for this type of exposure was 0.6 cases per billion person-years. CONCLUSION: The true preventable proportion of cases and the number needed to treat with rabies postexposure prophylaxis to prevent 1 case would be useful information to inform the current guidelines.
BACKGROUND: Since the 1980s, rare cases of rabies in humans in Canada and the United States have been almost exclusively caused by the bat-variant virus. METHODS: We reviewed indigenously acquired cases of bat-variant rabies in humans in Canada and the United States from 1950 through 2007. RESULTS: Of 61 cases identified, 5 occurred after organ transplantation and were excluded from further analysis. A bite was reported by 22 (39%) of the case patients, 9 (16%) had a direct contact (i.e., were touched by a bat) but no history of a bite, 6 (11%) found bats in their home (2 [4%] in the room where they slept) but reported no direct contact, and 19 (34%) reported no history of bat exposure whatsoever. With the exception of California (8 cases) and Texas (7 cases), no state or province had >3 cases. Of the case patients, 76% were men, and 40% were 10-29 years of age. The median incubation period was 7 weeks (<10 weeks in 72% of cases). The incidence of bat-variant rabies cases increased from 2.2 per billion person-years in 1950-1989 to 6.7 per billion person-years in 1990-2007. Of 36 case patients with bat rabies described since 1990, 16 had no history of direct bat contact; 2 (13%) of the 16 would have qualified for rabies postexposure prophylaxis on the basis of exposure criteria expanded in 1995 to include bats that were in the same room as a sleeping person. The incidence of rabies for this type of exposure was 0.6 cases per billion person-years. CONCLUSION: The true preventable proportion of cases and the number needed to treat with rabies postexposure prophylaxis to prevent 1 case would be useful information to inform the current guidelines.
Authors: Brian Aw; Suni Boraston; David Botten; Darin Cherniwchan; Hyder Fazal; Timothy Kelton; Michael Libman; Colin Saldanha; Philip Scappatura; Brian Stowe Journal: Can Fam Physician Date: 2014-12 Impact factor: 3.275
Authors: Pieter-Paul A M van Thiel; Rob M A de Bie; Filip Eftimov; Robert Tepaske; Hans L Zaaijer; Gerard J J van Doornum; Martin Schutten; Albert D M E Osterhaus; Charles B L M Majoie; Eleonora Aronica; Christine Fehlner-Gardiner; Alex I Wandeler; Piet A Kager Journal: PLoS Negl Trop Dis Date: 2009-07-28
Authors: Ivan V Kuzmin; Brooke Bozick; Sarah A Guagliardo; Rebekah Kunkel; Joshua R Shak; Suxiang Tong; Charles E Rupprecht Journal: Emerg Health Threats J Date: 2011-06-20