Outbreak of Human Rabies in Madre de Dios and...
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___________________________________________________________________________ 2008/SOM3/HWG/WKSP/005 Outbreak of Human Rabies in Madre de Dios and Puno, Peru Due to Contact with the Common Vampire Bat, Desmodus rotundus Submitted by: Peru Health Working Group Policy Dialogue and Risk Communications Workshop Lima, Peru 13-15 August 2008
Transcript of Outbreak of Human Rabies in Madre de Dios and...
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2008/SOM3/HWG/WKSP/005
Outbreak of Human Rabies in Madre de Dios and Puno, Peru Due to Contact with the Common
Vampire Bat, Desmodus rotundus
Submitted by: Peru
Health Working Group Policy Dialogue and Risk Communications Workshop
Lima, Peru13-15 August 2008
J. Gómez-Benavides MD1
C. Manrique1, F. Passara1, C. Huallpa1, V.A. Laguna2, H. Zamalloa2, S. Recuenco3, A. Diaz1, A. Velasco-Villa3, M. Niezgoda3, C. Rupprecht3, T. Kochel2 and J.M. Montgomery2,3
1 Ministry of Health of Peru.2 US Naval Medical Research Center, Lima – Peru.3 Center of Disease Control.
Human Rabies Cases Perú 1970 – 2007 (Epi week 42)
Source: DGE-DGSP-Ministry of Health.
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5
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35
40
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70 75 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06
Urban (Dog) Mass canine
vaccination campaigns
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20
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30
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70 75 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 06
Sylvatic (Bat)
Improvementof
surveillance and response capabilities
BackgroundHuman rabies infections in Peru are typically associated with vampire bat or dog bites.1975 - 2006: 234 vampire bat-transmitted human rabies associated deaths were reported from Peru (Epidemiology Office).1987 - 2002: Madre de Dios (MDD), a Department located in the jungle, reported 42 human rabies cases. 1989: A large outbreak (24 cases) occurred among gold miners and their family members.
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Outbreak investigation23 human deaths occurred between December 2006 and February 2007.Areas: MDD, Puno and Cusco.Acute febrile syndrome and neurologic manifestations (paralysis, agitation) followed by death.Whole brains sent for testing
Peruvian National Institutes of Health: detection of rabies antigen by DFA.CDC through NMRCD for sequencing.
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Location of the outbreak
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Human rabies cases due to vampire bat variant rabies, Madre de Dios and Puno,Epi week 51 – 2006 to week 10 – 2007
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ResultsCases:
Inambari District (MDD): 6 cases.Ayapata District (Puno): 17 cases.57% males; 35% under 15 y-old.
Laboratory confirmation:19 (83%) by direct fluorescent assay (DFA).○ 2 sequenced: Vampire bat variant rabies.
Incubation period: 8-87 days (average: 31 days)Rabies post-exposure vaccination with Suckling Mouse Brain Vaccine (SMBV) initiated in 7 cases:
4 started 10 days prior to disease onset.3 cases discontinued their vaccinations; all died.
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Observational risk factors
All cases were associated with vampire bat bites; < 8 days prior to symptom onset.Living in rural areas without protection from vampire bat bite (i.e., nonexistent or permeable household walls and roofs).No history of vaccination prior to vampire bite.Infrequent or no use of mosquito nets.6 cases were migrant gold miners/panners, who died after returning to their homes in Cusco.
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Human rabiesVuelta Grande
Bovine rabies Human rabiesRemanso
Risk area 1
TownRoadRisk area 2 10
1 0
3 2
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July August September October November December January
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Bitt
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Vampire bat bites among humansInambari, Madre de Dios --- July 2006 - January 2007
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Outbreak
n = 27
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2017158
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July August September October November December January
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Bitt
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n = 252
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Outbreak
Vampire bat bites among humansAyapata, Puno --- July 2006 - January 2007
Timeline of human rabies cases, Inambari - MDD and Ayapata -Puno, Epi week 51 – 2006 to week 10– 2007
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29 24
4 1
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4 1
24
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4 18 24
52 24Parents
Daughter
WifeBrother
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Case clustering in families
Survived
Died
Training, Mazuco Local Health Network , 12/01/07
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Active surveillance for vampire bat bites among people at gold mining sites, Inambari - MDD, 11/01/07
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Active surveillance for vampire bat bites among people at gold mining sites, Inambari - MDD, 11/01/07
Wound one day after vampire bat bite Ayapata - Puno, 29/01/07
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Rabies post-exposure vaccination for persons with history of vampire bat bite, Inambari - MDD, 11/01/07
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Typical housing at Ayapata, Puno permitting vampire bats incursion, 29/01/07
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Inadequate use of mosquito nets, MDD, 12/02/07
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Venezuela V3, V5
Colombia V3
Brazil 1 V3
Peru-Brazil V3
Brazil 2 V3
Argentina V3
Bolivia V3
Brazil 3 V3
Mexico 1 V3
Mexico-Colombia V3
Mexico V11
Colombia V8/V3 – Peru V3Mexico V8 atypical
Tadarida brasiliensis V9 North America
Tadarida brasiliensis V4 South AmericaColonial bats North AmericaOther bats South America
Solitary bats North America
Terrestrial carnivores North America
Sagui monkey Brazil
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Phylogenetic tree of rabies viruses
Recommendations
Education on vampire bat rabies transmission. Reinforce early reporting of vampire bat bites and to obtain proper care and post-exposure prophylaxis.Initiate ecological studies to elucidate transmission dynamics in vampire bat populations of the affected areas.Provide sufficient and timely cell culture based rabies vaccine doses for outbreak control.Necessary to vaccinate persons at-risk?
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Acknowledgments
Health personnel of MDD, Puno and CuscoUS Naval Medical Research Center, Lima –Peru (NMRCD).
Center of Disease Control (CDC)
