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OKAY BACK FROM THE VACCINE CLINIC 🩹

A Kidney Recipient Died Of Rabies In February 2013

He Had No Reported Exposures To Potentially Rabid Animals

His Kidney Had Come From A Deceased Donor

The Death Came 18 Months After The Transplant

State And Local Health Departments And The CDC Investigated

The Donor Was Declared Brain Dead 17 Days After Symptom Onset

Ciguatera Poisoning Was The Presumed Diagnosis At That Time

Screening Asked About Potentially Rabid Animals In The Last 6 Months

Family Interviews Later Revealed Significant Wildlife Exposure

Examples Were Hunting And Trapping Animals In North Carolina

Raccoon Activities Included Trapping And Keeping Them In Captivity

They Also Included Using Raccoons As Live Bait In Dog Training

Preparing Pelts For Display Was Also Listed

Through These Activities The Donor Sustained At Least 2 Raccoon Bites

The Bites Came 18 And 7 Months Before Symptom Onset

He Did Not Seek Medical Care For The Bites

Neither Raccoon Could Be Obtained For Testing

Donor And Recipient Viruses Were Consistent With The Raccoon Variant

They Were More Than 99.9% Identical Across The Entire N Gene

The 3 Other Recipients Had No Signs Of Rabies Or Encephalitis

All 3 Received Postexposure Prophylaxis Or PEP

Asymptomatic Recipients Could Have Been Within The Incubation Period

They Might Have Developed Clinical Infection Had They Not Received PEP

A CDC Report Describes PEP As Rabies Vaccine And Immune Globulin

The Report Says Prompt Administration Effectively Prevents Disease

Prompt Here Means Immediately After Exposure

A Separate Modelling Study Looked At PEP Across Many Countries

It Covered 67 Countries Where Rabies Is Endemic

Each Of Them Is Or Was Gavi Eligible

Its Authors Say PEP Can Prevent Deaths In People Who Were Bitten

They Add That Dog Vaccination Can Eliminate Rabies Spread By Dogs

Their Model Says Current PEP Use Prevents About 56,000 Deaths A Year

The Authors Say That Use Saves Many Lives

They Say Availability Remains Poor In Many Rabies Endemic Countries

Reasons Given Are High Costs Poor Access And Supply

Under The Status Quo Patients Mainly Pay For PEP In 48 Of 67 Countries

The Model Predicts More Than 1 Million Deaths From 2020 To 2035

That Projection Assumes The Status Quo In Those 67 Countries

Expanded Access And Free Provision Of PEP Is Another Scenario

In That Scenario PEP Would Prevent 489,000 More Deaths

Those Deaths Would Be Prevented Between 2020 And 2035

A Case Report Describes A Man Bitten By A Dog

He Received Only One Dose Of Rabies Postexposure Vaccine

It Says He Did Not Receive The Four Doses

Those Four Doses Were What The World Health Organization Recommended

He Died The Day Of His Admission

The Raccoon Variant Investigation Reports On 3 Recipients

Their Organs Were A Right Kidney A Heart And A Liver

They Had Not Received Rabies Vaccination Before The Transplant

Each Received PEP With Rabies Immune Globulin And 5 Doses

At The Time Of Writing They All Remained Asymptomatic

Rabies Antibodies Were Not Detected In Their Serum Before PEP

Neutralizing Antibodies Developed After PEP Was Initiated

Levels After PEP Completion Ranged From 0.3 To 40.8 IU/mL

A CDC Report Says Human Rabies Is 99 Percent Fatal

The Same Report Calls It 100 Percent Preventable

Its First Way Is Vaccinating Pets Against Rabies

Next Is Avoiding Contact With Wildlife And Unknown Animals

The Last Is Seeking Care As Soon As Possible After A Bite Or Scratch