9 November 2005

 

Rabies in Brazil

On 25 October 2005, the Brazilian Health Ministry reported a cluster of rabies deaths following bites from rabid Desmodus rotundus, or vampire bats [1,2].  The deaths occurred in rural areas of north-east Brazil in the state of Maranhão [3]. Media reports suggest that the outbreak began in July 2005.

The neighbouring state of Pará has also reported bat associated human rabies cases in 2005 . 

Vampire bats usually take blood meals from mammals such as cows, pigs and horses, or birds, but will occasionally bite humans, and are known to transmit the rabies virus. These bats are endemic to Central and South America. In the currently affected region, they may have been displaced from their usual habitat by deforestation.

Brazil is considered to be a rabies endemic country with cases of both canine and bat rabies reported. Although programs are in place to try to control canine rabies throughout Latin America, the control of rabies in wild animals, including bats, remains a challenge [4]. In general, bat rabies in Brazil occurs in remote, often jungle areas, where access to medical care is difficult.  

Recommendations for Travellers

The extent of the outbreak in Brazil is not fully understood. Travellers to this area of Brazil should be aware of the risk of rabies from both bats and dogs and exercise precautions:

             

• Avoid unnecessary contact with animals.
• Sleep in enclosed areas protected by an intact building structure or screening and netting.
• If bitten or scratched by a warm blooded animal, wash the wound with plenty of soap and water and seek medical attention immediately, even if previously vaccinated. Promptly administered post-exposure treatment is extremely effective in preventing rabies.
• Anyone returning to the UK with a possible exposure to rabies should seek prompt medical attention. They should discuss any treatment they may have received overseas.
• Pre-travel rabies vaccine can be considered, particularly for longer trips and when access to prompt and safe post-exposure rabies treatment may be difficult.

Detailed information on the prevention of rabies and the management of exposures is available in the Department of Health Green Book chapter on rabies http://www.dh.gov.uk/assetRoot/04/11/09/70/04110970.pdf.

 

UK clinicians responding to the medical urgency of a patient with a potential rabies exposure can obtain advice, vaccine and immunoglobulin from the Health Protection Agency Centre for Infections (020 8200 6868); Health Protection Scotland (0141 300 1100); and the Public Health Laboratory, Belfast City Hospital (028 9032 9241) in Northern Ireland.

Further information about rabies can be found on the NaTHNaC rabies information sheet.

References

1. ProMED-mail. Rabies, human, vampire bats - Brazil (Maranhao) (03). ProMED-mail 2005; 2 Nov: 20051102.3202. http://www.promedmail.org/pls/askus/f?p=2400:1001:

448415::NO::F2400_P1001_BACK_PAGE,F2400_P1001_

PUB_MAIL_ID:1010,30907 Accessed 8 Nov 2005.

2. Ministry of Health, Brazil. Raiva humana transmitida por morcegos no estado do Pará e Marahão. http://portal.saude.gov.br/portal/arquivos/pdf/nota_raiva.pdf. Accessed 9 November 2005.

3. Gupta R. Recent outbreak of rabies infections in Brazil transmitted by vampire bats. Euro Surveill 2005; 10(11): 051110. http://www.eurosurveillance.org/ew/2005/051110.asp#3

4. Schneider MC, Belotto A, Adé MP et al. Epidemiologic situation of human rabies in Latin America in 2004. Epidemiologic Bulletin/PAHO 26: 2-4, 2005. Available at: www.paho.org/English/DD/AIS/be_v26n1-cover.htm.