Rabies Risk for OIF/OEF Veterans                  


Death of a Soldier After Contracting Rabies in Afghanistan                
On August 31, 2011, a U.S. Army soldier who had served in Afghanistan died of rabies at Fort Drum, New York. While deployed in Afghanistan, he was bitten by a dog, and developed symptoms of rabies several months later. This is the first fatal case of rabies in the Department of Defense (DoD) in more than 30 years. A public health investigation found that 11 other soldiers in the unit had sustained unreported and untreated rabies risk exposures, mostly from dog bites. Ten soldiers required post-exposure prophylaxis.                          
OEF/OIF/OND Veterans who were deployed in the previous 18 months, and were bitten or had contact with the saliva from a warm-blooded animal such as a dog, cat, bat, fox, skunk, raccoon, mongoose or jackal could be at risk for rabies.                         
VA and DoD are initiating programs to educate patients and providers about rabies risk, appropriate evaluation and post-exposure prophylaxis. The risk of being exposed to rabies is much higher in developing parts of the world including Iraq and Afghanistan where it is estimated that ten percent of dogs are infected with rabies. VHA Public Health is recommending that OEF/OIF/OND Veterans who have served in the previous 18 months be assessed for possible rabies exposure. Post-exposure prophylaxis is indicated in Veterans who have had a potential rabies exposure in the previous 18 months.
Clinical Description of Rabies                 
Rabies is a viral disease that is transmitted through the saliva of a rabid, warm-blooded animal such as a dog, cat, bat, fox, skunk, raccoon, mongoose, and jackal. (Mice, rats and other small animals are rarely infected with rabies.)                
Rabies infects the central nervous system and leads to a progressive encephalomyelitis, which is typically fatal once symptoms of the disease appear. The incubation period usually ranges from 1 to 3 months after exposure, but can range from days to years. Rabies seldom develops more than one year after exposure. The incubation period varies depending on the amount of virus in the body and the distance the virus has to travel from the site of exposure to the central nervous system.
Diagnosis and Treatment                    
Rabies is preventable if the infected person is vaccinated prior to developing symptoms. The first symptoms of rabies may include weakness or discomfort, fever, or headache. But as the disease progresses, the person may experience delirium, hallucinations, slight or partial paralysis, anxiety, confusion, increase in saliva, difficulty swallowing, fear of water, and insomnia. Death usually occurs within 2-10 days of the onset of these symptoms.                           


Post-exposure prophylaxis includes human rabies immune globulin (HRIG) and the rabies vaccine series. Specific guidance on post-exposure prophylaxis is provided in attachments.   

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