He received some rabies vaccine after the bite, but could not obtain immunoglobulin. Just five days after the dog attack, he was admitted to hospital in Italy with fever, aches and breathing difficulties. His condition deteriorated and he died on 14th November. Tests performed both before and after his death confirm he had rabies.
This case is tragic for this gentleman and his family. There are some important things to note though. Firstly, his symptoms appeared after just five days. It is usual to think that the earliest we expect symptoms is 10 days to three months post exposure. Occasionally much longer intervals have been noted, but this is the earliest interval recorded to date. Once symptoms have commenced, there is little medics can do.
Secondly, this gentleman had immediate post bite care, with vaccine administered. However, the immunoglobulin was not given in the 24-48 hour time frame, as it was not obtainable. The most frequent cause of post bite exposure failure is inadequate administration of emergency post bite treatment.
This is a sobering reminder of the importance of considering pre-travel rabies vaccine. People who have completed a pre-travel rabies schedule will have antibodies already in their body ready to fight the rabies virus should an exposure occur. They will not require the immunoglobulin, but will be given two extra booster doses to increase their antibodies to a safe level.
The WHO estimates 55,000 deaths worldwide from rabies, roughly 36% or 20,000 deaths in India alone.
If you would like more information or to book an appointment to talk to a nurse or receive vaccine, please contact The Travel Clinic Ltd on 01223 367362, or enquiries@travelclinic.ltd.uk