Hospital inquiry into rabies case
Thursday 24 May 2012
An investigation has been launched into how a woman suffering from rabies was reportedly turned away from a hospital emergency department.
The Health Protection Agency (HPA) has confirmed a case of the potentially fatal disease in a patient who had been bitten by a dog in South Asia.
The woman, believed to be a grandmother in her 50s, was reportedly turned away twice by doctors at Darent Valley Hospital in Dartford before she was finally diagnosed.
She is now being treated at London's Hospital for Tropical Diseases, which has reassured patients, visitors and staff there is no risk to them as a result of the case.
The HPA has also stressed there is no risk to the public, and said all family members and healthcare staff who have had contact with the patient have been assessed and offered a vaccination.
A spokesman for Darent Valley Hospital said an investigation was under way into the lady's attendance at its emergency department.
He said: "The UK is rabies free.
"If a patient does present at hospital with vague symptoms, a doctor is unlikely to consider rabies as a diagnosis unless the patient highlights wild animal contact in an at risk country.
"The hospital responded to the information supplied by the patient at the time.
"Although there are no cases of rabies being passed through human-to-human contact, the five members of staff that came into close contact with the patient are being vaccinated as a precautionary measure.
"We have launched an investigation into the circumstances around this lady's attendance at the emergency department and we are working closely with the Health Protection Agency."
Rabies is usually transferred through saliva from the bite of an infected animal, with dogs being the most common transmitter of rabies to humans.
More than 55,000 people are estimated to die from the disease every year, with most cases occurring in developing countries, particularly South and South-East Asia.
Dr Ron Behrens, travel medicine expert at the London School of Hygiene & Tropical Medicine, said the prognosis was "bleak" for people infected with rabies, with only one or two cases known to have survived rabies encephalitis - the disease once it reaches the brain.
But he urged anyone who had been bitten by an animal they thought might have rabies to seek medical advice.
Dr Behrens said symptoms resulted from inflammation of the brain from the virus.
"In the early stages, the symptoms are mild headaches, some anaesthetic feeling around the site of a bite and fever.
"There is often confusion and delirium - disorientation often associated with abnormal and sometimes violent behaviour."
He said a unique symptom is a fear of water, which means patients cannot drink or swallow.
He said they ultimately become comatose during the terminal stages.
"The prognosis is bleak as most patients with rabies encephalitis die," Dr Behrens said.
"Only one or two cases are known to have survived the disease.
"Once the patient has developed encephalitis, the management involves making the patient comfortable by sedation and paralysing them and placing them in an anaesthetic coma.
"At this stage, none of the vaccines or immunoglobulin has any benefit."
Dr Behrens said rabid dogs in their early stages do not behave unusually and the disease can incubate from weeks to years after infection with no signs.
If bitten by a rabid dog, there is roughly 24 hours where treatment with an antibody can prevent the virus entering the nervous system, he said.
"Unfortunately once the virus is in the nervous system the vaccine and immunoglobulin have minimal effect," he said.
He added that a "pre-exposure" course of three rabies vaccines would provide life-long protection, but was often expensive, and urged people to steer clear of animals in developing countries.
"If you are scratched, bitten or licked on an open wound and haven't received a pre-exposure course, you need to find a clinic that has rabies immunoglobulin immediately," he said.
"This is a very expensive and rare product and most centres outside capital cities and even in capital cities in many countries won't have it available.
"Immediate assessment at a tropical hospital or similar specialist centre is important if you are exposed to any animal bite.
"I suggest the course of pre-exposure vaccine be likened to an insurance vaccine against a rare problem.
"In countries such as India, 50,000 or more people every year die from rabies despite there being a very good preventative vaccine for both humans and animals."
Dr Brian McCloskey, director of the HPA for London, said: "It is important to stress that there is no risk to the general public as a result of this case or to patients and visitors at the hospital where the patient is receiving treatment.
"Despite there being tens of thousands of rabies cases each year worldwide, there have been no documented laboratory confirmed cases of human-to-human spread.
"Therefore, the risk to other humans or animals from a patient with rabies is considered negligible.
"However, to take every possible precaution, family members and healthcare staff who had close contact with the patient since they became unwell - which is when they are infectious - have been assessed and offered vaccination if appropriate."
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