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PRO/AH> Rabies – Italy (02): Mantova ex India, human, fatal, RFI

cao“UMA VEZ MAIS …ATENÇÃO À RAIVA ANIMAL”
Date: Mon 6 Feb 2012
From: Jim Pearson [edited] <Jim.Pearson@dgs.virginia.gov>

Comment
——-
It appears the incubation period from exposure to clinical symptoms sufficient for admission to hospital was 5 days, barring an unrecognised or unreported earlier exposure. This is considerably shorter than the incubation period typically stated for rabies, even
with a severe exposure to the head (rather than arm and leg as was reported in this case).

I have not been able to find references documenting a very short incubation period, and expect other readers have similar questions. Are there examples in the literature or in your experience of a similar short duration between exposure to a rabid animal and onset of
symptoms?


Dr. Jim Pearson, Director
Virginia Division of Consolidated Laboratory Services
(Virginia Public Health Laboratory)
600 North 5th Street
Richmond, Virginia, USA 23219Jim.Pearson@dgs.virginia.gov  <Jim.Pearson@dgs.virginia.gov>

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[2]
Date: Mon 6 Feb 2012
From: Steven Van Gucht [edited] <Steven.VanGucht@wiv-isp.be>

Comment
————
Apparently, there is a 5-day incubation period despite the fact that the patient was bitten in the left arm and leg, sites which are relatively distant from the brain. It makes one wonder whether brain invasion of the virus may have occurred through the blood instead of
the nerves. Such a route was recently described by Preuss et al. (PLoS Pathog. 2009 5(6):e1000485) for bat-associated rabies virus in mice by invasion of the neurosecretory hypothalamic fibers. Indeed, axonal transport of rabies is generally considered a relatively slow process: 0.9 cm/day according to Klingen et al., 2008 (J. Virol. 82(1): 237-245) or 5-10 cm/day according to Tsiang et al., 1991 (J. Gen. Virol. 72:1191-4).


Dr. Steven Van Gucht
Head of scientific service
Viral Diseases | Communicable and Infectious Diseases
Rue Engelandstraat 642 | 1180 Brussels
Wetenschappelijk Instituut Volksgezondheid – Institut Scientifique de Santo Publique
Scientific Institute of Public Health <Steven.VanGucht@wiv-isp.be>

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[3]
Date: Tue 7 Feb 2012
From: Steven Schofield <steven.schofield@forces.gc.ca>

Comment
——-
We read with interest the post provided by Drs Gaetti and De Benedictis [see: R> Rabies – Italy: Mantova ex India, human, fatal, Archive Number: 20120206.1034574] regarding the travel-related rabies case in Mantova, Italy. In particular, it is instructive as regards
the importance of, and challenges related to the acquisition of RIG [rabies immunoglobulin] when travelling. Based on the case description, we presume that the patient did not receive pre-exposure vaccination? We would also be interested to know if Drs Gaetti and De
Benedictis can comment on the type of vaccine administered in India.

We note that the timeline presented, all occurring in 2011, and starting with an exposure on 28 Sep 2011, is very compressed for rabies. Moreover, based on the exposure and admission dates (28 Sep and 3 Oct 2011 respectively), it would seem that RIG could have been
administered in Italy if the patient presented while asymptomatic, and further that additional doses of vaccine would have been reasonable if the patient presented in Italy while asymptomatic. Given that such was not described, we suspect a “typo” somewhere in the timeline (e.g., date of exposure). We would appreciate if ProMED and/or Drs Gaetti and
De Benedictis could clarify.


Steve Schofield, PhD and Martin Tepper, MD
Directorate of Force Health Protection – Department of National Defence
Ottawa, Canada <steven.schofield@forces.gc.ca>

[It is frequently stated for example that: the incubation period for rabies is typically 1 to 3 months, but may vary from <1 week to >1 year (<http://www.who.int/mediacentre/factsheets/fs099/en/>), but precise information is hard to find. The moderator is passing these comments on to Drs Gaetti and De Benedictis, and their response will be awaited with interest. – Mod.CP]

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