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Treatment after rodent exposure necessary to avoid death from rabies
Public Health (2001) 115, 243 ß R.I.P.H.H. 2001 www.nature.com/ph
Letter to the Editor Treatment after rodent exposure necessary to avoid death from rabies I have gone through, with interest, the article `Rabies in Israel: decades of prevention and a human case' published in Public Health 2000: issue 6.1 It was noted that prophylaxis against rabies was not considered necessary because the bite was by a rat or mouse. It is true that prophylaxis is not usually recommended after rodent exposure because in the opinion of the WHO Expert Committee, these animals do not serve as a reservoir of infection in nature.2 However, there are some reports of transmission by rodents in Thailand and other countries. A rat bite caused rabies in a pet, caged white rabbit in Thailand, which gave a positive result with ¯uorescent antibody test (FAT). Three more FAT positive rats were also found in the same country (Wilde H, personal communication). The rabies virus was found in 7.9% of ®eld and domestic rats in Thailand (Bandicota indicus, Suncus murinus, Rattus rajah, Rattus Norwegicus, Rattus rattus, Rattus exulans and Bandicota bengalensis).3 In Sri Lanka, three bandicoots that were examined were also found to be positive for the rabies antigen by ¯uorescent antibody test.4 Therefore, post-exposure treatment for rabies is advised following bandicoot bites in that country. Hence, bites from rodents such as rats and bandicoots should not always be considered free from risk. The
situation becomes dif®cult when the biting animal has not been properly recognised and identi®ed as reported in the case noted above. Further, when the patient developed rabies, he was treated with the human rabies immunoglobulin, acyclovir and interferon-alpha. These drugs have no proven value in a case with clinical manifestation of rabies.5 References 1 Gdalevich M, Mimouni D, Ashkenazi I, Shemer J. Rabies in Israel: decades of prevention and a human case. Public Health, 2000; 114: 484 ± 487. 2 WHO Expert Committee Report on rabies. Control of rabies in wild animals. WHO Tech Rep Ser. 1992; 824: 36. 3 Smith PC, Lawhaswasdi K, Vick WE, Stanton JS. Enzootic rabies in rodents in Thailand. Nature 1968; 954 ± 955. 4 Wimalaratne O. Is it necessary to give rabies post-exposure treatment after rodent (rats, mice, squirrels and bandicoots) bites? (Letter). Ceylon Med J 1997; 42: 144. 5 WHO expert Committee Report of Rabies. Treatment of con®rmed rabies in humans. WHO Tech Rep Ser 1992; 824: 26.
Dr JK Dutta Anar Nath Poly Clinic, Bhaskar Ganj (B), Balasore ± 756001, India
Letter to the Editor Treatment after rodent exposure necessary to avoid death from rabies I have gone through, with interest, the article `Rabies in Israel: decades of prevention and a human case' published in Public Health 2000: issue 6.1 It was noted that prophylaxis against rabies was not considered necessary because the bite was by a rat or mouse. It is true that prophylaxis is not usually recommended after rodent exposure because in the opinion of the WHO Expert Committee, these animals do not serve as a reservoir of infection in nature.2 However, there are some reports of transmission by rodents in Thailand and other countries. A rat bite caused rabies in a pet, caged white rabbit in Thailand, which gave a positive result with ¯uorescent antibody test (FAT). Three more FAT positive rats were also found in the same country (Wilde H, personal communication). The rabies virus was found in 7.9% of ®eld and domestic rats in Thailand (Bandicota indicus, Suncus murinus, Rattus rajah, Rattus Norwegicus, Rattus rattus, Rattus exulans and Bandicota bengalensis).3 In Sri Lanka, three bandicoots that were examined were also found to be positive for the rabies antigen by ¯uorescent antibody test.4 Therefore, post-exposure treatment for rabies is advised following bandicoot bites in that country. Hence, bites from rodents such as rats and bandicoots should not always be considered free from risk. The
situation becomes dif®cult when the biting animal has not been properly recognised and identi®ed as reported in the case noted above. Further, when the patient developed rabies, he was treated with the human rabies immunoglobulin, acyclovir and interferon-alpha. These drugs have no proven value in a case with clinical manifestation of rabies.5 References 1 Gdalevich M, Mimouni D, Ashkenazi I, Shemer J. Rabies in Israel: decades of prevention and a human case. Public Health, 2000; 114: 484 ± 487. 2 WHO Expert Committee Report on rabies. Control of rabies in wild animals. WHO Tech Rep Ser. 1992; 824: 36. 3 Smith PC, Lawhaswasdi K, Vick WE, Stanton JS. Enzootic rabies in rodents in Thailand. Nature 1968; 954 ± 955. 4 Wimalaratne O. Is it necessary to give rabies post-exposure treatment after rodent (rats, mice, squirrels and bandicoots) bites? (Letter). Ceylon Med J 1997; 42: 144. 5 WHO expert Committee Report of Rabies. Treatment of con®rmed rabies in humans. WHO Tech Rep Ser 1992; 824: 26.
Dr JK Dutta Anar Nath Poly Clinic, Bhaskar Ganj (B), Balasore ± 756001, India