Thread by @InfectiousDz

In August, an 80 year old man woke up to find a bat on his neck. Bat tested positive for rabies. The man reportedly refused the vaccine. He died of rabies. First death in Illinois from rabies since 1954.
dph.illinois.gov/news/illinois-…

So far this year, 30 bats have tested positive for rabies in Illinois. More than 1,000 bats are tested for rabies each year in Illinois due to a possible exposure. Approximately 3% of tested bats are positive for rabies.

So what is post-exposure prophylaxis for rabies?
- Clean wound with soap and water (or povidine-iodine)
- Immunoglobulin if never vaccinated for rabies
- 4 doses (immediately, then days 3, 7, 14)

You do not need to get rabies shots in the stomach. This hasn't been done since the 1980s. There's a lot of trepidation around rabies vaccines, but the fear should just be about rabies. The shots are just in your arm, except immunoglobulin around wound
health.nd.gov/diseases-condi…

Some folks because of potential risk (travel to higher risk areas, expected bat exposures, lab work) are vaccinated ahead of time. They still need to have vaccinations after exposure, but not as many (just immediate and day 3) and no immunoglobulin needed.
cdc.gov/rabies/medical…

Worldwide, 99% of rabies is from dogs, especially in Africa given different bat populations. Local US cases usually from bats (70%). Some areas see more exposures from other animals (raccoons in NYC) or cats (given dog vaccination, more US cats infected)
cdc.gov/rabies/locatio…

Hint: There used to be 5 doses required for a vaccine regimen. It is now 4 doses, except 5th for some immunocompromised. Many rabies vaccine kits still have 5 doses. Getting rabies vaccine is hard around the world, healthcare workers can save that last dose for next person.

We refer to rabies as having 100% mortality without vaccination
That's almost true
There are 2 protocols, Milwaukee (Wisconsin, US) and now Recife (Brazil), which have helped people survive rabies around the world. Most, however, who are treated still die ncbi.nlm.nih.gov/pmc/articles/P…

On Sept. 12, 2004, Jeanna Giese-Frassetto was bitten by a bat which led to a rabies infection and became the 1st to survive due to treatment There are now more survivors in Brazil, South Africa, India, US
Many are left with severe sequelae
Most have died regardless of treatment

It's also intriguing to consider that some people may be exposed and not develop rabies, though cases can be delayed.
Data from Peruvian Amazon:
science.org/news/2012/08/s… ajtmh.org/view/journals/…

That said, there have been cases diagnosed well beyond the expected incubation period. If the bite was quite distal (say the a dog bites the heal of a foot) it can take a longtime to cause illness. Up to 10 years in fact, without other exposure.

Overall, rabies is a disease of low resources. It's people who aren't ever diagnosed who die from rabies. It's people who would want but don't have access to vaccines who die.
It is thought 59,000 die a year from rabies
cdc.gov/rabies/locatio…
who.int/news-room/fact…

https://twitter.com/KindrachukJason/status/1443585192929628184?s=20

Rabies is a reminder that public health is never just about treatment. Here it's about animal control and vaccination, community sensitization to avoid contact and to wash wounds and seek care immediately.

Disasters, like COVID, can disrupt and undermine crucial public health programs
US CDC suspects after 2010 earthquake disruption in Haiti, 2 people died a week from rabies in Haiti.
Haiti has more deaths from rabies than any other country in the Americas
cdc.gov/worldrabiesday…

https://twitter.com/InfectiousDz/status/1443628184755449856?s=20