A transplant patient in Maryland died of rabies contracted from a kidney transplant last year.
The donor had died of an undiagnosed neurologic disease. Because rabies is so rare in human medicine, it did not occur to the doctors involved to consider rabies as a differential. Rabies has infected organ recipients in at least 2 other cases, we have discovered.
This sad story gave me cause to think that rabies is on every veterinarian’s list when faced with an animal suffering from a poorly defined neurologic disease. Although extremely rare in our pet population, we must think about it because the zoonotic consequences of rabies are so devastating.
The Rabies Threat Is Serious — So Why Don’t We Act Like It?
As a veterinarian, it’s my job to talk about rabies with pet parents every day. If there’s any controversy with a client about a rabies vaccine, it’s usually because the pet parent doesn’t want to spend the money (rabies vaccines are CHEAP), or they are afraid of vaccines in general, or they are annoyed their pet has to receive another rabies vaccine because of a fight with another animal.
The problem with all of these arguments? These folks are giving me grief because they are not taking the threat of rabies seriously. If we, as a profession, were to become more lax about rabies, the deadly virus would infect and kill more animals and more humans.
I think this case should be an eye opener to all of us who think of rabies as an extremely rare disease or a third world disease only. Granted, rabies is rare in people in the U.S. because the animal and pet population is so highly controlled. But the distressing part of this transplant story is that the donor who died had no idea he had been infected by the horrific disease. The CDC has discovered it was a form of raccoon rabies, but the route of transmission is still unknown. The other recipients of transplanted organs from the same donor are healthy, and they are being carefully monitored.
Public Perception vs. the Truth About Rabies
Rabies!: I see a mad, frothing dog, viciously mauling a poor medieval peasant in a Breugel landscape, right?
Think again. Over 55,000 people still die from rabies every year, mainly in rural areas of Asia and Africa. Over 40% of these deaths are children who have been bitten by a rabid dog.
In the U.S., rabies is virtually eradicated in the dog population, but there are still 1 or 2 human deaths attributed to rabies every year. Most of these are traced to a bat bite that goes untreated. Many more people are exposed to the deadly rabies virus but receive immediate medical care and vaccination and do not succumb to the disease.
Take my idyllic New England town of Amherst, MA, for example. Last year, at a serene, Scandinavian-inspired co-housing community, a pastoral sheep cared for by the residents was looking a little funny. Circling a bit, drooling a bit more, the old girl was just getting a bit dotty, the animal lovers thought, and brought her water buckets and grain closer to her, wiping away her slobbers.
Weren’t they surprised to find out they had to undergo post-exposure rabies treatment when the sheep died and was diagnosed with rabies. Lucky for everyone a veterinarian thought this placid sheep may indeed have the deadly disease and had her tested. She must have been bitten by a rabid animal and the bite wound went undetected.
You Can Never Be Too Careful When It Comes to Rabies
Skip to this year. My practice. Last week. A lovely client had recently lost her beloved geriatric cat and adopted 2 adorable kittens from our local shelter. I saw the kitties for wellness exams, all 1.5 pounds of them, gave them a distemper booster, knew they were still too young for a rabies vaccine and sent them on their way.
Fast-forward 10 days, and the little longhaired black-and-white puffball began to act strange, salivate, go into a full seizure and recover. He would go back to playing with his sister, frolicking and tumbling like a normal kitten, and then go into an even more intense seizure. The client brought the kitten in. The kitten continued to seize, and the client decided to go to Tufts for a neurologic consult. Because the kitten continued to deteriorate and because the prognosis for the poor little thing was so dire, Tufts felt the best thing to do was humanely euthanize the kitty…and test for rabies.
A couple fretful days later, the caretakers of the kitten, who had begun to get vaccinations for possible exposure, got the news from the state lab that the kitten did not have rabies. They were able to stop their own treatment and were incredibly relieved for the remaining kitty at home, who remains healthy.
Another story comes to mind about a young puppy who wandered out of his yard and came home showing off a grand prize. The pup dropped a headless bat at his caretaker’s feet, wagging tail as if to say, “Let’s play throw the bat, Mom.” Although the bat looked as though it was decapitated long before the pup discovered it, local rabies protocols would be very harsh on this pup, who was still too young to be vaccinated for rabies.
Protecting Ourselves and Our Beloved Pets
How do we know what our furry friends are doing if not under nanny-cam surveillance 24/7? Could this pup have killed or been bitten by a rabid raccoon and the incident go undetected? The answer is yes.
Could your cat be bitten by a rabid skunk and make it home without you knowing what happened? The answer is yes.
Did I poke myself with the scalpel blade while decapitating a raccoon brought in by the police that turned out to be rabid? The answer is an embarrassingly sheepish yes!
Did I have to get re-vaccinated for rabies? You bet.
Local law enforcement, public health officials, doctors and veterinarians may seem rabid about protecting pets, livestock and people from the rabies virus, but I think this transplant story sadly proves that this extreme vigilance is warranted.
The specialists who make the transplant organ protocols are reconsidering what to do when a donor dies of an unknown neurologic disease. Time is of the essence when an organ is to be transplanted, so it is impossible to test for all diseases. The last thing anyone wants is for someone on the transplant list to lose a chance to receive a needed precious organ.
My Mother’s Day present from my son last year was so cool: A copy of RABID, A Cultural History of the World’s Most Diabolical Virus. Written by a senior editor from WIRED and a veterinarian with a double degree in public health, it makes for one incredibly great, geeky read. Tracing the history of the rabies virus through ancient times to the present, it’s no surprise that evil incarnate has often been expressed as a wild canid, whose bite can transform its victim into a delirious, inhuman creature. Ever wonder how vampire sagas and werewolf tales came into existence? I put my money on rabies.