486. Rapid and Coordinated Response to Human Rabies in a Maryland Transplant Recipient 2013
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Until 2013, Maryland’s last human rabies case was in 1976. Almost all human cases result from animal bites and can be prevented with postexposure prophylaxis (PEP). In February 2013, an area hospital consulted the Maryland Department of Health and Mental Hygiene (DHMH) about rabies in a Maryland resident with encephalitis who had had a kidney transplant 17 months earlier. Testing at the Centers for Disease Control and Prevention (CDC) confirmed rabies in antemortem and postmortem samples. Rabies is almost universally fatal after symptoms occur. Public concern was high, and rapid identification of the infection source and potentially exposed contacts were needed.

Methods: DHMH coordinated a response involving 2 clinical facilities and 5 local and state health departments to identify and assess risk of all persons who might have had contact with the patient’s cerebrospinal fluid, neural tissue, saliva, or tears during the 2 weeks before symptom onset to determine who needed PEP. Local acute-care facilities were polled to assess the rabies biologics inventory. Emergency departments (EDs) were monitored for increases in rabies-related visits. 

Results: Interviews with the patient’s family, friends, and colleagues revealed no clear animal exposure; infection through kidney transplantation was confirmed when identical rabies virus was identified in archived donor brain. After consultation with CDC, the transplanted kidney, which is innervated, but not urine, because virus was not detected in pre- or post-mortem specimens, was considered infectious. Overall, 257 health care workers, 19 family members, and 51 other contacts were identified as potentially exposed. Through an effort requiring 28 people and over 900 hours, all 327 underwent risk assessment, 244 (75%) within 5 days of initial diagnosis. Rabies PEP was recommended to 8 health care workers, 7 family members, and 2 friends; 2 other persons sought PEP on their own. EDs did not detect increased visits for persons potentially seeking PEP, and adequate supplies of rabies biologics were documented. 

Conclusion: A swift, comprehensive response to a lethal, but preventable, infection was essential and made possible through effective collaboration and communication among health agencies.

Maria Said, MD, MHS1, David Blythe, MD, MPH2, Kimberly Mitchell, MPH2, Fred Gordin, MD3, Virginia L. Kan, MD3, Timothy Burgess, MD, MPH4, Shawn Clausen, MD, MPH4, Richard Franka, DVM, PhD5 and Katherine Feldman, DVM, MPH2, (1)CDC Epidemic Intelligence Service Officer Assigned to the Maryland Department of Health and Mental Hygiene, Baltimore, MD, (2)Maryland Department of Health and Mental Hygiene, Baltimore, MD, (3)Washington DC VA Medical Center, Washington, DC, (4)Walter Reed National Military Medical Center, Bethesda, MD, (5)CDC, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA

Disclosures:

M. Said, None

D. Blythe, None

K. Mitchell, None

F. Gordin, None

V. L. Kan, None

T. Burgess, None

S. Clausen, None

R. Franka, None

K. Feldman, None

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