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Human rabies cases rare, but all should be careful

Published May 25, 2004

The United States is not free of human rabies, and Hawaii is the only state that has never reported an indigenous case. However, low case numbers should not make us complacent.

In Hernando, the alert area is bordered on the north by the Hernando-Citrus County line, on the south by the Hernando-Pasco County line, on the east by the Hernando-Sumter County line, and on the west by U.S. Hwy. 41 and U.S. Hwy 98.

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One of many great public health victories in the United States has been the prevention of human rabies to a few cases per year. Worldwide, 35,000 to 50,000 deaths are attributed to rabies annually. Asia leads the world in cases, followed by Africa and the Americas.

Outside of the United States most human rabies are caused by infected dogs. Dogs will contract the disease through contact with infected wild animals. Public health measures have reduced human cases worldwide, but many countries such as India, China and the Philippines still face significant numbers of cases each year.

Public health infrastructure and animal control may have little or no resources in poor countries accounting for high numbers of human cases. Proper care and vaccines may be difficult to come by after exposure, or people may frankly ignore scratches and minor bites from infected animals. Efforts directed at animal control and services through public health department efforts are keys to success in thwarting the threat of human rabies. Funds to those programs are critical for progress in minimizing this deadly disease.

The virus attacks certain wild and domestic animals in large numbers. In the United States we can anticipate 8,000 animal rabies cases a year. It is suggested that only one in 10 animals carrying the virus will be identified. It is clear the risk for human exposure is significant.

For the past 50 years, human cases in the United States have evolved from a pattern of dog-transmitted rabies to bat-transmitted rabies. From 1990 to 2002 there were 36 cases of human rabies in the United States. Bats caused 27 of the 36 cases and two were associated with canines.

Foxes and skunks are major carriers of the virus in the western United States, coyotes and skunks through the Midwest, and raccoons in the eastern states. Raccoons represented more than 37.2 percent of wild animal cases in 2001 and domestic animals represented only 7 percent.

In 2003 a human case in Virginia was the first death attributed to raccoon exposure. The 25-year-old man was an office worker who enjoyed the outdoors, where infected raccoons were present.

Rabies is significant among Florida wildlife. Thousands of people and pets are exposed to potentially rabid animals each year in the state. Human cases are rare. The most recent case of human rabies in the nation occurred in South Florida this year. A 41-year-old Haitian man went to an emergency room and was diagnosed initially with an upper respiratory infection. His symptoms became progressively worse and tests revealed rabies. The medical history noted a dog bite some eight months before while in Haiti. He died within five days of his hospitalization.

Regionally, there have been nine human cases diagnosed from 1912-1948. Pasco County's only case was in 1938; the other eight cases were in Hillsborough County. Citrus, Hernando and Pinellas counties have never reported a case. The first case recorded in Florida was in Monroe County in 1881.

Human rabies is a rare disease in the U.S. Much of the credit for control must go to federal, state and local efforts addressing animal control and educating residents to the importance of following up biting and scratching incidents. Although I would not suggest undue alarm relating to risk, it is important to understand what to do if you have an exposure concern.

All bites should be reported to the health department. Your own physician or local health department can answer any questions you may have concerning risk.

Please protect your dogs and cats with rabies vaccine. If they are outdoors, they will surely come in contact with infected wild animals. No one should keep wild animals as pets. Raccoons particularly are dangerous, as are bats and foxes. Talk to your local veterinarian so he can put your pets on a schedule for rabies vaccine. Simple measures will keep you safe.

- Dr. Marc J. Yacht is director of the Pasco County Health Department. Guest columnists write their own views on subjects they choose, which do not necessarily reflect the opinions of this newspaper.

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