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Description:Wednesday, October 12, 2005, 18:18 EDT (6:18 PM EDT)
CDCHAN-00239-2005-10-12-ADV-N
On October 5, 2005, the Centers for Disease Control and Prevention (CDC), working together with the Mississippi Department of Health, confirmed a diagnosis of rabies as the cause of death in a Mississippi child. This advisory provides information about this case, an update for states that may receive inquiries due to public concerns about rabies, and criteria for conducting risk assessments as part of these investigations to determine the need for post exposure prophylaxis (PEP).
The patient had been hospitalized with encephalitis of undetermined origin in September 2005. No history of foreign travel or definitive animal exposure was identified. A greater than fourfold rise in rabies virus antibodies was demonstrated in both paired serum and cerebrospinal fluid samples. No other clinical specimens were available to allow viral characterization and identification of a likely animal source of infection. Bats are the only known reservoirs of rabies in Mississippi, and the state has reported no human cases since 1956. Although the child stayed at a popular summer camp in Alabama and participated in an overnight caving event in Tennessee during the summer, there were no known exposure incidents at either venue. On additional investigation, it was reported that the child removed a live bat from his bedroom in the spring of this year. The Mississippi Department of Health, in conjunction with local medical staff and CDC, conducted an investigation to identify contacts of the patient among family, the local community, and health-care workers. CDC will continue to work with other state health departments and health-care providers as additional information becomes available.
Human rabies PEP is recommended only in situations in which potentially infectious material (e.g., saliva) from a rabid animal or human is introduced via a bite, or comes into direct contact with broken skin or mucous membranes. In addition, when a bat is physically present and rabies infection cannot be ruled out by testing the bat, human rabies PEP might be appropriate if there is a reasonable probability that an exposure might have occurred, such as when a bite cannot be excluded.
This is the first report of a human rabies case in the United States in 2005, and the 48th human case reported since 1990. Although human rabies is extremely rare in the United States, people are advised to exercise caution in settings where they might have contact with wildlife, especially bats, raccoons, skunks, and foxes.
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