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Virginia woman dies from rabies after dog bite in India

A Virginia woman died of rabies after being bitten by a dog infected with the virus in India, the Centers for Disease Control and Prevention has confirmed. It happened last spring, after the 65-year-old returned home from an extended stay in India for a yoga retreat. 

She's the ninth U.S. resident to die of rabies after being exposed to the disease while traveling abroad since 2008, according to the CDC.

In a case study published in the CDC's Morbidity and Mortality Weekly Report (MMWR), doctors said the woman first began experiencing symptoms on May 3, 2017. She reported pain and a tingling sensation in her right arm while gardening. Three days later she went to an urgent care facility where she was misdiagnosed with carpal tunnel syndrome.

The next day, her symptoms worsened and she was hospitalized with shortness of breath, anxiety, insomnia, and difficulty swallowing water. Her test results appeared normal and doctors treated her for a presumed panic attack. She was hospitalized twice more.

That's when "the patient became progressively agitated and combative and was noted to be gasping for air when attempting to drink water," according to the report.

Doctors questioned her family about animal exposures and her husband told them that she had been bitten on the right hand by a puppy outside her hotel in Rishikesh, India, about 6 weeks before her symptoms began. He said his wife cleaned the wound with the help of the tour operator but did not seek further medical treatment. She did not receive a rabies pre-exposure vaccination before the trip, and had never been vaccinated against rabies.

The woman's condition continued to worsen, requiring intubation and mechanical ventilation. On May 11, eight days after the woman's first symptoms appeared, rabies was confirmed. Experimental treatments failed to work, and the woman died 10 days later.

Rabies: A rare but serious threat

Rabies is a viral disease in mammals that infects the central nervous system. It eventually attacks the brain and ultimately causes death.

Canine rabies was eliminated from the United States in 2004, but it remains endemic in 122 countries. Death from rabies is extremely rare in the U.S., with only one or two fatalities occurring each year — usually from contact with an infected wild animal like a bat, raccoon or fox. However, the statistics are different in less developed nations, where more than 55,000 people die each year from the disease, mostly in Africa and Asia.

If a person is infected, early symptoms include fever, headache, and general weakness or discomfort. There may be a prickling or itching sensation in the area of the bite. As the disease progresses, more specific symptoms will begin to appear, including insomnia, anxiety, confusion, and agitation. Partial paralysis may set in and the person may have hallucinations and delirium. They'll experience an increase in saliva, difficulty swallowing, and hydrophobia (fear of water) because of the difficulty swallowing. 

Death usually occurs within a few days after symptoms appear. 

"Once there's a single symptom of rabies, it is no longer treatable," Noreen Hynes, M.D., director of the Johns Hopkins Geographic Medicine Center of the Division of Infectious Diseases, told CBS News last year.

When to seek treatment

According to the CDC, rabies is "a medical urgency but not an emergency." Decisions on treatment should not be delayed.

The first thing to do if you've been bitten or scratched is wash the wound thoroughly with soap and water to reduce the risk of infection.

See your doctor if you have been bitten or scratched by a wild animal, or any animal if you don't know whether it's been vaccinated. Your doctor, possibly in consultation with state or local health authorities, will decide if you need the rabies vaccine. The vaccine is given in a series of injections spread out over several days. Once administered, the vaccine is extremely effective. 

"The bottom line is that rabies is deadly but 100 percent preventable," Hynes said. "No one who has gotten proper treatment in a timely fashion has ever died." However, if a person forgoes the vaccine and then develops symptoms, it's too late: at that point, rabies is virtually always fatal.

The CDC also recommends that travelers to certain countries consider getting pre-exposure rabies vaccinations before going abroad. Those who are planning to work with animals, stay for a month or more in areas were dog rabies is common, or visit remote areas where medical care is difficult to obtain, may want to get the vaccine as a precaution.

Check the CDC's travel website to see what vaccines are recommended for the country you are visiting, and talk to your doctor about your travel plans.

According to the latest CDC report, "given the extended length of the [woman's] tour and the rural and community activities involved, pretravel rabies vaccination should have been considered."

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