U.S-acquired human rabies with symptom onset and diagnosis abroad, 2012.

On July 8, 2012, a U.S. resident was admitted to a hospital in Dubai, United Arab Emirates, for evaluation of right arm spasticity, anxiety, and malaise. By the next day, the patient had become comatose following a period of agitation. On July 31, he died. Investigators from CDC, state, and local health departments determined that the patient acquired rabies from contact in March with a bat in California. Person-to-person transmission of rabies has been documented in cases of organ and tissue transplantation and is theoretically possible if infectious saliva or tears are introduced into fresh open wounds or onto mucous membranes. Once symptoms begin, rabies is almost always fatal. While he was potentially infectious, during June 11-July 31, the patient traveled on eight international flights through six countries. To date, 59 persons have been identified as contacts, and 23 persons have been administered postexposure prophylaxis (PEP); no secondary cases have been identified. Bites or scratches from bats or other animals suspected of having rabies should be regarded seriously; victims should promptly seek consultation with public health practitioners and medical-care providers. This report highlights the need for collaboration to 1) identify persons who potentially had contact with infectious materials from a person infected with rabies, 2) conduct a risk assessment, and 3) provide prophylaxis to all those with a reasonable risk for contact with infectious materials (e.g., tears, saliva, or neural tissue from a person with rabies contacting open wounds or mucous membranes of an uninfected person).