Human Rabies — Puerto Rico, 2015

Weekly / January 6, 2017 / 65(52);1474–1476

Ashley Styczynski, MD1,2; Cuc Tran, PhD1,2; Emilio Dirlikov, PhD1,3; María Ramos Zapata, MPH3; Kyle Ryff, MPH3; Brett Petersen, MD2; Anibal Cruz Sanchez, MPH3; Marrielle Mayshack3,4; Laura Castro Martinez, MPH3; Rene Condori, MS2; James Ellison, PhD2; Lillian Orciari, MS2; Pamela Yager2; Rafael González Peña3; Dario Sanabria, MD5; Julio Cádiz Velázquez, MD3; Dana Thomas, MD3,6; Brenda Rivera García, DVM3 (View author affiliations)

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Summary

What is already known about this topic?

Human rabies associated with a mongoose encounter has never been reported in the United States or U.S. territories; however, studies by the U.S. Department of Agriculture indicate rabies seropositivity of approximately 40% among the Puerto Rican mongoose population. Because of the public health risk, Puerto Rico provides rabies postexposure prophylaxis (PEP) to any patient who experiences a mongoose bite.

What is added by this report?

A man aged 54 years who was bitten by a mongoose in October 2016 was the first person to acquire rabies from a mongoose in the United States or U.S. territories, confirming mongoose rabies as a public health threat. Limited awareness of rabies prevention and symptoms of the disease by the general public and health care personnel was likely a contributing factor in the exposures to the patient that required PEP.

What are the implications for public health practice?

This case highlights the importance of public and health care provider awareness of rabies to prevent adverse outcomes after exposures and reduce unnecessary exposures. This awareness includes maintaining a higher suspicion for zoonotic diseases by including animal exposures in the medical history. Universal use and monitoring of standard precautions in health care settings are necessary to minimize risk for occupational exposure to infectious diseases such as rabies when the nature of the illness is unknown.