Rabies case in New South Wales, 1990: public health aspects

Rabies in Our Neighbourhood: Preparedness for an Emerging Infectious Disease

Emerging infectious disease (EID) events have the potential to cause devastating impacts on human, animal and environmental health. A range of tools exist which can be applied to address EID event detection, preparedness and response. Here we use a case study of rabies in Southeast Asia and Oceania to illustrate, via nearly a decade of research activities, how such tools can be systematically integrated into a framework for EID preparedness. During the past three decades, canine rabies has spread to previously free areas of Southeast Asia, threatening the rabies-free status of countries such as Timor Leste, Papua New Guinea and Australia. The program of research to address rabies preparedness in the Oceanic region has included scanning and surveillance to define the emerging nature of canine rabies within the Southeast Asia region; field studies to collect information on potential reservoir species, their distribution and behaviour; participatory and sociological studies to identify priorities for disease response; and targeted risk assessment and disease modelling studies. Lessons learnt include the need to develop methods to collect data in remote regions, and the need to continuously evaluate and update requirements for preparedness in response to evolving drivers of emerging infectious disease.

Canine rabies in Australia: a review of preparedness and research needs

Australia is unique as a populated continent in that canine rabies is exotic, with only one likely incursion in 1867. This is despite the presence of a widespread free-ranging dog population, which includes the naturalized dingo, feral domestic dogs and dingo-dog cross-breeds. To Australia's immediate north, rabies has recently spread within the Indonesian archipelago, with outbreaks occurring in historically free islands to the east including Bali, Flores, Ambon and the Tanimbar Islands. Australia depends on strict quarantine protocols to prevent importation of a rabid animal, but the risk of illegal animal movements by fishing and recreational vessels circumventing quarantine remains. Predicting where rabies will enter Australia is important, but understanding dog population dynamics and interactions, including contact rates in and around human populations, is essential for rabies preparedness. The interactions among and between Australia's large populations of wild, free-roaming and restrained domestic dogs require quantification for rabies incursions to be detected and controlled. The imminent risk of rabies breaching Australian borders makes the development of disease spread models that will assist in the deployment of cost-effective surveillance, improve preventive strategies and guide disease management protocols vitally important. Here, we critically review Australia's preparedness for rabies, discuss prevailing assumptions and models, identify knowledge deficits in free-roaming dog ecology relating to rabies maintenance and speculate on the likely consequences of endemic rabies for Australia.

Viral diseases of the ruminant nervous system

This article presents the etiology, epidemiology, clinical features,and diagnosis of the primary viral neurologic diseases observed in ruminants. In general, these viral neurologic diseases are uncommon but often fatal. Rabies virus is perhaps the most important cause of encephalitis in cattle because of the public health implications. Other viral encephalitis diseases in ruminants include bovine herpesvirus encephalomyelitis, pseudorabies, malignant catarrhal fever, ovine and caprine lentiviral encephalitis, West Nile virus encephalitis, Borna disease, paramyxoviral sporadic bovine encephalomyelitis,and ovine encephalomyelitis (louping-ill).

Imaging findings in rabies

A 10 year old Vietnamese girl presented with clinical features of an acute encephalitic process. A cerebral angiogram performed to rule out vasculitis showed narrowing at the supraclinoid internal carotid and terminal basilar arteries. A diagnosis of rabies was established at autopsy. Although the major blood vessels and basal meninges were normal it was possible that transient arterial spasm induced by the viral infection was responsible for the angiographic appearance. Other imaging findings in our patient are described with a brief review of the literature. This is only the second case of rabies reported in Australia. Rabies is a rare disease in the Australian community. Recently one patient with atypical clinical presentation was confirmed to have the disease only at autopsy. In the clinical work-up, various radiological examinations were performed and a range of interesting features were encountered including an abnormal cerebral angiogram. The purpose of this paper is to report on these unusual features and to review those documented in the literature.

Polymerase chain reaction and other laboratory techniques in the diagnosis of long incubation rabies in Australia

Blood and post-mortem tissues from a 10-years-old girl were submitted to the Australian Animal Health Laboratory. Clinical signs and histopathological lesions had suggested a diagnosis of rabies, but, an unusually long incubation period of at least 5 years did not encourage such a diagnosis. Serological examinations by the rapid fluorescent focus inhibition test revealed a dramatic increase in rabies virus-neutralising antibody during the 10-day period of hospitalisation. The results of a fluorescent antibody test on brain smears, and an immunoperoxidase test on formalin-fixed sections of brain were also consistent with a diagnosis of rabies. Attempts to isolate virus were unsuccessful. Polymerase chain reactions (PCRs) were conducted on a 10% suspension of a post-mortem sample from the patient's brain, using primers based on the published sequence of the Pasteur virus strain of rabies virus. 413 and 513 bp fragments from the nucleoprotein gene and a 403 bp fragment from the glycoprotein gene were amplified. Subsequent sequencing of these fragments, and comparison with equivalent regions of known rabies viruses, confirmed that the fragments originated from a virus belonging to the rabies virus serotype. This case demonstrated the advantage of using a range of laboratory techniques to obtain a definitive diagnosis. In particular, a PCR-based test may allow a diagnosis, even in the face of conditions that preclude virus isolation such as apparently occurred in this case. Finally, this case demonstrated that an unusually long incubation period should not discourage a tentative clinical diagnosis of rabies.

Rabies. A second Australian case, with a long incubation period

OBJECTIVE

The description of a second case of rabies in Australia, stressing the clinical features and that long incubation periods are possible.

CLINICAL FEATURES

A 10-year-old Vietnamese girl presented with fever, shoulder pain, subcutaneous emphysema, swallowing difficulty and agitation. After a period of maniacal behaviour all peripheral and central nervous system function was lost.

INTERVENTION AND OUTCOME

Despite maximal intensive care, the patient died. The diagnosis of rabies was made at autopsy.

CONCLUSIONS

Rabies occurs in Australia and needs to be considered in the differential diagnosis of acute encephalitis and/or the Guillain-Barré syndrome. Incubation periods of more than six years can occur.