Rabies: epidemiology, diagnosis, prevention, and prospects for worldwide control
1995; Elsevier BV; Volume: 6; Issue: 1 Linguagem: Inglês
10.1016/s1080-6032(13)80009-9
ISSN1545-1534
Autores Tópico(s)Poxvirus research and outbreaks
ResumoDecember 15, 19 days after the onset of illness, with a diagnosis of "encephalitis of unknown etiology."On December 18 rabies antigen was demonstrated by fluorescent rabies antibody staining of brain tissue obtained during autopsy.Subsequently, rabies virus was isolated from the tissue.After the diagnosis was established, 12 family members and 75 of 177 health-care workers received rabies postexposure immunoprophylaxis (immune globulin and vaccination) at a cost of $39000.The rabies virus isolate reacted with a panel of monoclonal antibodies against rabies nucleocapsid and glycoprotein antigens in a pattern similar to that of rabies virus enzootic in skunks in northern California and distinctly different from the rabies viruses found in insectivorous bats.However, the boy had no history of exposure to a rabid animal and had not traveled outside the United States since he arrived in 1981.During the year prior to his death he had only twice traveled outside of San Francisco County, which has no known rabies in terrestrial animals.In August, he had gone on a picnic to a beach in San Mateo County, just south of San Francisco, and in October he had gone on a 3-day camping trip to Sonoma County north of San Francisco with his classmates and teachers.Although the purpose of the camping trip was to identify wild animals, no animal contacts could be identified [1 ].In studies published 3 years later, cytoplasmic viral RNA from cell cultures of the rabies isolate was amplified by polymerase chain reaction, and the resulting complimentary DNA was digested by restriction enzymes and submitted to agarose gel electrophoresis.The cleavage fragments migrated in a pattern identical to the patterns from rabies viruses isolated from dogs in the Philippine Islands and unlike rabies viruses found in the United States [2).Two years subsequently, nucleotide analysis of a segment of the viral genome demonstrated that the virus isolated from this boy was virtually identical (differing by only three base pairs) to viruses isolated from Philippine dogs.The boy's infection is now thought to have originated in the Philippines, presumably from an unreported encounter with a rabid dog when the boy was 7 years old or less, but to have undergone incubation for 6 years-at least-before becoming clinically apparent [3). Wilkerson Incidence in domestic and wild animalsA vast reservoir of rabies persists in wild animals, a situation that has been identified only in the western hemisphere and Europe [3].In the 1980-1989 decade, 56889 nonhuman rabies infections were reported to the CDC, of which 11% were in domestic animals and 89% were in wildlife [28].Among domestic animals, the number of cats with rabies has outnumbered the number of dogs with rabies in every year of this decade but one.(A major problem in vaccinating cats is establishing ownership.Farmers value cats for rodent control but do not recognize them as property, and have great difficulty catching them so they can be vaccinated.Cats wander from farm to farm and contact wild animals with rabies [29].)Of the wildlife infections, 52% were in skunks (Table 2).Some states accept only animals responsible for a human or domestic animal incident for rabies testing; others test all submitted specimens.Furthermore, most rabid wild animals die without being detected, so these data provide only an approximate incidence of rabies in wildlife [28].Currently, several major rabies epizootics are recognized in the United States and adjacent areas of Canada.An epizootic of rabies started in arctic foxes in northern Canada in the late 1940s and early 1950s, swept southward in the middle and late 1950s to involve red foxes in Alberta, Saskatchewan, Manitoba, Ontario, and Quebec, crossed the frozen St. Lawrence River in 1961, and persists in foxes in upper New York State and the adjacent Canadian provinces [8,30].This epizootic may be the largest ever observed [8].Since 1959, Ontario has consistently reported more cases of animal rabies than any state or province north of the Rio Grande [31 ].The epizootic also moved westward to involve arctic foxes in Alaska and the Northwest Territories [32].An outbreak of raccoon rabies started in central Florida in the 1950s and spread at the rate of about 25 miles per year until the late 1970s, when a second outbreak appeared on the Virginia-West Virginia border.That epizootic has now spread north to New York, Connecticut, Massachusetts, and New Hampshire, and south to North Carolina [33,34].This second outbreak developed when raccoons were translocated from Florida for restocking.Although the animal suppliers held legal permits and health certificates, the inclusion of some rabid animals among the more than 3500 transhipped raccoons has been documented [35,36].The raccoon epizootic is particularly threatening because many raccoons live in densely populated urban and suburban areas.In cities in southern Canada that have a large raccoon population, such as Toronto, the epizootic's crossing the St Lawrence is being awaited with considerable trepidation.No human rabies has resulted from exposure to rabid raccoons, but five lesser pandas died of rabies after being exposed to rabid raccoons on the grounds of the National Zoological Park [36].Most terrestrial rabies in the United States is in skunks, a problem peculiar to North America, but human rabies resulting from exposure to a spotted skunk in California was reported as early as 1826 [37].Four epizootics are recognized, one of which is in Quebec and New York and is associated with the fox epizootic in that area.A larger epizootic started in Iowa in 1945, and has spread east to Ohio, west to Montana, north to the Canadian provinces of Manitoba (1959), Saskatchewan (1963), and Alberta (1971), and south to meet with a third epizootic that originated in Texas and has spread to surrounding south Central states, particularly Oklahoma and Arkansas.A fourth epizootic in skunks is located in northern California [37].Screening of rabies virus isolates from the various epizootics with a battery of monoclonal antibodies directed against the viral nucleoprotein (N protein) has revealed five distinctive reaction patterns.Red foxes and skunks in New York and adjacent Canada
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