RABIES
(Human)

Wisconsin Division of Public Health Disease Surveillance Manual (EpiNet,July 2005)

I. IDENTIFICATION

A. CLINICAL DESCRIPTION: An almost invariably fatal acute encephalomyelitis caused by the rabies virus.

B. REPORTING CRITERIA: Clinical diagnosis initially; laboratory confirmation required to meet case definition.

C. LABORATORY CRITERIA FOR CONFIRMATION:

• Detection by direct fluorescent antibody of viral antigens in a clinical specimen (preferably the brain or the nerves surrounding hair follicles in the nape of the neck), OR
• Isolation (in cell culture or in a laboratory animal) of rabies virus from saliva, cerebrospinal fluid (CSF) or central nervous system tissue, OR
• Identification of a rabies-neutralizing antibody titer ³ 5 (complete neutralization) in the serum or CSF of an unvaccinated person.

D. WISCONSIN CASE DEFINITION: A laboratory confirmed infection with rabies virus.

II. ACTIONS REQUIRED / PREVENTION MEASURES

A. WISCONSIN DISEASE SURVEILLANCE CATEGORY I: REPORT TO THE LOCAL HEALTH DEPARTMENT IMMEDIATELY upon recognition of a case or suspected case by telephone and mail the Acute and Communicable Diseases Case Report (DPH 4151) within 24 hours. Public health intervention expected.

B. EPIDEMIOLOGY REPORTS REQUESTED: Acute and Communicable Diseases Case Report (DPH 4151).

C. PUBLIC HEALTH INTERVENTIONS:

• Ensure that appropriate infection control precautions are being taken at the facility in which the patient is hospitalized. This includes the use of standard and contact precautions, including the use of face protection during any patient contact.
• Source investigation (performed in cooperation with the BCD) to be conducted upon laboratory confirmation of a human rabies case.
• Identification of case contacts who had been exposed to potentially infectious patient secretions (saliva, tears, CSF, neural tissue) in the community as in health care settings (performed in cooperation with the BCD).

III. CONTACTS FOR CONSULTATION

A. BCDP / COMMUNICABLE DISEASE EPIDEMIOLOGY SECTION: (608) 267-7321.

B. WSLH / RABIES UNIT: (608) 262-7323.

 IV. RELATED REFERENCES

1. “Rabies” DPH Disease Fact Sheet Series: View a list of all current Communicable Disease Fact Sheets

2. Heymann DL, ed. RABIES. Control of Communicable Diseases Manual. 18 th ed. Washington , DC : American Public Health Association, 2004:438-447.

3. “Diagnosis of Rabies”. Wisconsin State Laboratory of Hygiene. (Brochure, Rev. 7/96).

4. Wisconsin Rabies Prevention Flowchart. http://hanplus.wisc.edu/DISEASES/rabies/introduction.htm

5. Bat Rabies: Update on Management of Patients with History of Bat Exposure. Wisconsin Epidemiology Bulletin (WEB), 1996;17(2).

6. Rabies Prevention - United States , 1991: Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(No.RR-3):1-19.

V. DISEASE TRENDS

The last three cases of human rabies in Wisconsin occurred in 1959, 2000, and 2004.