Diagnosis, management and post-mortem findings of a human case of rabies imported into the United Kingdom from India: a case report

Pathak, Smriti; Horton, Daniel L.; Lucas, Sebastian; Brown, David G.; Quaderi, Shumonta; Polhill, Sara; Walker, D.; Nastouli, Eleni; Núñez, Alejandro; Wise, Emma L.; Fooks, Anthony R.; Brown, Michael J.

doi:10.1186/1743-422x-11-63

Cited by 15 publications

(8 citation statements)

References 46 publications

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“…After the incubation phase, humans first develop a flu-like illness and thereafter severe neurotropic symptoms caused by the ensuing progressive encephalomyelitis. While incubation phases vary, death commonly follows within an average survival time between 6 and 11 days after first symptomatic onset for furious or paralytic forms, respectively, thus leaving little time and extremely limited therapeutic options [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

An mRNA Vaccine Encoding Rabies Virus Glycoprotein Induces Protection against Lethal Infection in Mice and Correlates of Protection in Adult and Newborn Pigs

et al. 2016

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Rabies is a zoonotic infectious disease of the central nervous system (CNS). In unvaccinated or untreated subjects, rabies virus infection causes severe neurological symptoms and is invariably fatal. Despite the long-standing existence of effective vaccines, vaccine availability remains insufficient, with high numbers of fatal infections mostly in developing countries. Nucleic acid based vaccines have proven convincingly as a new technology for the fast development of vaccines against newly emerging pathogens, diseases where no vaccine exists or for replacing already existing vaccines. We used an optimized non-replicating rabies virus glycoprotein (RABV-G) encoding messenger RNA (mRNA) to induce potent neutralizing antibodies (VN titers) in mice and domestic pigs. Functional antibody titers were followed in mice for up to one year and titers remained stable for the entire observation period in all dose groups. T cell analysis revealed the induction of both, specific CD4+ as well as CD8+ T cells by RABV-G mRNA, with the induced CD4+ T cells being higher than those induced by a licensed vaccine. Notably, RABV-G mRNA vaccinated mice were protected against lethal intracerebral challenge infection. Inhibition of viral replication by vaccination was verified by qRT-PCR. Furthermore, we demonstrate that CD4+ T cells are crucial for the generation of neutralizing antibodies. In domestic pigs we were able to induce VN titers that correlate with protection in adult and newborn pigs. This study demonstrates the feasibility of a non-replicating mRNA rabies vaccine in small and large animals and highlights the promises of mRNA vaccines for the prevention of infectious diseases.

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Section: Introductionmentioning

confidence: 99%

An mRNA Vaccine Encoding Rabies Virus Glycoprotein Induces Protection against Lethal Infection in Mice and Correlates of Protection in Adult and Newborn Pigs

et al. 2016

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“…In As typically occurs in the natural history of human rabies, our patient in the early part of her admission was hydrophobic, became extremely agitated and had a violent episode prior to being anaesthetised, intubated and ventilated 4 . Caring for a patient during this stage poses a heightened risk and therefore strict precautions must be…”

Section: Public Health Managementmentioning

confidence: 69%

“…She progressed to profound autonomic disturbance and died 10 days after admission. Pathak et al have published the clinical features, ante-and post-mortem laboratory findings of this case 4 .…”

Section: Summary Of the Casementioning

confidence: 80%

“…Where this has failed to prevent disease, caring for patients with suspected and/or confirmed rabies, a Hazard Group 3 (HG3) pathogen, poses a major challenge. Following the survival of a patient 4 , the Milwaukee protocol has been suggested as a potential clinical algorithm. However, a co-ordinated approach both between and within relevant organisations is required with early laboratory confirmation in order to avoid exposure of others including health care workers.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Caring for a patient with rabies: implications of the Milwaukee protocol for infection control and public health measures

Lampejo

Bruce

Teall

et al. 2017

Journal of Hospital Infection

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This article discusses the infection control and public health measures taken whilst managing a case of laboratory-confirmed rabies, and the challenges faced in implementing these measures. Case management requires intensive multi-disciplinary co-ordination. The Milwaukee protocol, which to date has five reported human rabies survivors associated with its use, has been suggested as a potential management pathway for human rabies. Consensus among hospital and public health clinicians would aid future deployment of this approach in selected cases.

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“… a Based on the United Nations Statistics Division [ 45 ]. b Vaccination only, in the country of exposure.…”

Section: Human Rabies Casesmentioning

confidence: 99%

Prevention of human rabies: a challenge for the European Union and the European Economic Area

et al. 2020

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Rabies is enzootic in over one hundred countries worldwide. In the European Union/European Economic Area (EU/EEA), the vast majority of human rabies cases are travellers bitten by dogs in rabies-enzootic countries, mostly in Asia and Africa. Thus, EU/EEA travellers visiting rabies enzootic countries should be aware of the risk of being infected with the rabies virus when having physical contact with mammals. They should consider pre-exposure vaccination following criteria recommended by the World Health Organization and if unvaccinated, immediately seek medical attention in case of bites or scratches from mammals. As the majority of the EU/EEA countries are free from rabies in mammals, elimination of the disease (no enzootic circulation of the virus and low number of imported cases) has been achieved by 2020. However, illegal import of potentially infected animals, mainly dogs, poses a risk to public health and might threaten the elimination goal. Additionally, newly recognised bat lyssaviruses represent a potential emerging threat as the rabies vaccine may not confer protective immunity. To support preparedness activities in EU/EEA countries, guidance for the assessment and the management of the public health risk related to rabies but also other lyssaviruses, should be developed.

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Diagnosis, management and post-mortem findings of a human case of rabies imported into the United Kingdom from India: a case report

Cited by 15 publications

References 46 publications

An mRNA Vaccine Encoding Rabies Virus Glycoprotein Induces Protection against Lethal Infection in Mice and Correlates of Protection in Adult and Newborn Pigs

An mRNA Vaccine Encoding Rabies Virus Glycoprotein Induces Protection against Lethal Infection in Mice and Correlates of Protection in Adult and Newborn Pigs

Caring for a patient with rabies: implications of the Milwaukee protocol for infection control and public health measures

Prevention of human rabies: a challenge for the European Union and the European Economic Area

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