Data indicated that oral rabies vaccination resulted in protective immunity in a sufficient percentage of the target wildlife population to preclude propagation of the disease and provided an effective means of controlling rabies in these species.

Information on the epidemiology of rabies in skunks may be useful in planning and implementing local, state, and national rabies control and prevention campaigns.

B urkholderia pseudomallei, which causes melioidosis, is a gram-negative saprophytic bacterium endemic to tropical and subtropical environments worldwide; to our knowledge, isolation from the continental United States has not been reported (1-3). The most overrepresented risk factor for melioidosis is diabetes mellitus (3,4). B. pseudomallei is resistant to many antimicrobial drugs (3). Laboratory exposures might occur without appropriate biosafety precautions (2,5). Surveillance is challenging because melioidosis is not nationally notifiable; however, B. pseudomallei is a Tier 1 overlap Select Agent (6), and the Centers for Disease Control and Prevention (CDC) receives voluntary reports (2,7). We report a case of melioidosis in a Texas resident who had no recent travel history. The Study On November 17, 2018, a 63-year-old man from Atascosa County, Texas, came to hospital A with fever, chest pain, and dyspnea of 3 days' duration. At admission, he reported congenital unilateral renal agenesis. Renal function measures were unremarkable. Increased hemoglobin A1c level and hyperglycemia (glucose >200 mg/dL) suggested undiagnosed type 2 diabetes. Computed tomography of chest and abdomen with intravenous contrast showed left lower lobe pneumonia with a small left pleural effusion. Empiric antimicrobial drug therapy with intravenous azithromycin and ceftriaxone was initiated. Blood culture yielded presumptive B. pseudomallei, which was sent for confirmation to the laboratory response network (LRN) site in Houston, Texas. On November 20, a localized, violaceous, cutaneous lesion developed on the central anterior chest wall of the patient and progressed to become purulent and ulcerated (Figure 1). The next day, he experienced respiratory failure, was emergently intubated, and was transferred to hospital B. Hospital B was not aware of the presumptive diagnosis and performed a blood and chest wound culture. Both cultures showed gram-negative rods; blood analysis showed acute kidney injury. On November 25, B. pseudomallei susceptible to trimethoprim/sulfamethoxazole and ceftazidime (Table) was identified, and treatment was switched to ceftazidime by using dosing for continuous renal replacement therapy (4). On November 26, the patient was extubated and began hemodialysis (3 ×/wk). He was discharged on December 9 and received 3 months of daily trimethoprim/sulfamethoxazole (4). Subsequent followup showed clinically recovery and resolution of z renal insufficiency.

The Texas PEP protocol was used during the 10-year period. Results indicated that an effective PEP protocol for unvaccinated domestic animals exposed to rabies was immediate vaccination against rabies, a strict isolation period of 90 days, and administration of booster vaccinations during the third and eighth weeks of the isolation period.

In October 2014, a health-care worker who had been part of the treatment team for the first laboratory-confirmed case of Ebola virus disease imported to the United States developed symptoms of Ebola virus disease. A presumptive positive reverse transcription PCR assay result for Ebola virus RNA in a blood sample from the worker was confirmed by the CDC, making this the first documented occurrence of domestic transmission of Ebola virus in the United States. The Texas Department of State Health Services commissioner issued a control order requiring disinfection and decontamination of the health-care worker's residence. This process was delayed until the patient's pet dog (which, having been exposed to a human with Ebola virus disease, potentially posed a public health risk) was removed from the residence. This report describes the movement, quarantine, care, testing, and release of the pet dog, highlighting the interdisciplinary, one-health approach and extensive collaboration and communication across local, county, state, and federal agencies involved in the response.