News
14 March 2007
Rabies in China and Peru
China
According to media reports, a total of 61 people have died from rabies during January and February 2007 in Hunan province in central China [1]. Since 1996, there have been 2,719 deaths from rabies in the province, with 443 occurring during 2006. This high number of cases is thought to be due to increasing numbers of dogs and a low rabies vaccination rate.
Peru
The Peruvian Ministry of Health has confirmed a cluster of human rabies deaths following bites from hematophagous (Desmodus rotundas, or vampire) bats [2, 3]. The deaths occurred in rural areas of Madre de Dios and Puno regions and reports indicate that the outbreak began in July 2006. This follows a previous outbreak in December 2006 which occurred in the Amazonas region in northern Peru [4].
Vampire bats are endemic to Central and South America, and usually take blood meals from mammals such as cows, pigs and horses, or birds, but will occasionally bite humans if their usual food source is disrupted [5]. They are known to transmit the rabies virus.
Peru is considered to be a rabies endemic country with cases of both canine and bat rabies reported. Although programmes are in place to try to control canine rabies throughout Latin America, the control of rabies in wild animals, including bats, remains a challenge. In general, bat rabies in Peru occurs in remote, often jungle areas, where access to medical care is difficult [5-7].
Advice for travellers
These two reports highlight the risk of rabies during travel. Travellers to areas known to be endemic for rabies should be aware of this risk and take precautions:
- Avoid unnecessary contact with animals.
- Sleep in enclosed areas protected by an intact building structure or screening and netting.
- If bitten or scratched by a warm blooded animal, wash the wound with plenty of soap and water and seek immediate medical attention, even if previously vaccinated. Promptly administered post-exposure treatment is extremely effective in preventing rabies.
- Travellers returning to the UK with a possible exposure to rabies should seek prompt medical attention and discuss any treatment they may have received overseas.
- Pre-exposure rabies vaccine should be considered, particularly for longer trips and when access to prompt and safe post-exposure rabies treatment may be difficult.
Detailed information on the prevention of rabies and the management of exposures is available in the Department of Health Green Book chapter on rabies: http://www.dh.gov.uk/assetRoot/04/14/13/47/04141347.pdf
Health professionals can obtain advice on post-exposure rabies management from the Duty Doctor at their Health Protection Unit, or at the Health Protection Agency (HPA) Centre for Infections. Guidelines on post exposure management are available on the HPA website at: http://www.hpa.org.uk/webw/HPAweb&Page&HPAweb
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References
1. ProMED mail. Rabies, human, canine - China (Hunan). ProMED-mail 2007; 5 Mar: 20070305.0782. [accessed 14 March 2007] Available at http://www.promedmail.org/pls/promed/f?p=2400:1001:1110105
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2. Ministerio de Salud, Peru. Oficina de la Prensa. . Desde Julio hasta Febrero se han reportado 527 mordeduras de murciélagos. 26 February 2007. {accessed 14 March 2007]. Avialable at: http://www.minsa.gob.pe/portal/ogcminsa/Notasprensa/spv-notadeprensa.asp?np_codigo=4476&mes=2&anio=2007
3. ProMED mail. Rabies, human, vampire bat - Peru (03). ProMED-mail 2007; 6 Mar: 20070306.0786. [accessed 14 March 2007] Available at http://www.promedmail.org/pls/promed/f?p=2400:1001:1110105
9513867394995::NO::F2400_P1001_BACK_PAGE,F2400_P100
4. ProMED mail. Peru: vampire bat rabies kills 11 children. ProMED-mail 2007; 23 Jan: 20070123.0299. [accessed 14 March 2007] Available at http://www.promedmail.org/pls/promed/f?p=2400:1001:1401628
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5. Warner CK, Zaki SR, Shieh W et al. Laboratory investigation of human deaths from vampire bat rabies in Peru. Am. J. Trop. Med. Hyg. 1999; 60: 502-507.
6. Lopez A, Miranda P, Tejada E, Fishbein DB. Outbreak of human rabies in the Peruvian jungle. Lancet. 1992; 339: 408-411.
7. NaTHNaC News. Rabies in Brazil. 9 November 2005. [accessed 14 March 2007]. Available at http://www.NaTHNaC.org/travel/news/rabies_brazil_091105.htm
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