William G. Winkler

Human Rabies in the United States, 1960 to 1979: Epidemiology, Diagnosis, and Prevention

Thirty-eight cases of human rabies occurred in the United States and its territories from 1960 to 1979. The major source of exposure to rabies has changed from indigenous dogs and cats in the 1940s and 1950s to wild carnivores and bats (11 of the 27 cases with known exposures); unusual exposures (3 cases) and exposures in a foreign country (7 cases) have also become more important. No exposure could be identified for 6 of the 38 cases. Two patients received optimal prophylaxis, 14 suboptimal, and 22 no prophylaxis after exposure. Some cases might have been prevented by an increased awareness of the risks and treatment for exposure to rabies, and use of the new rabies vaccines. The diagnosis was often made late in the clinical course including after death in 8 cases. This delay, in part, resulted from the diversity in the clinical presentation. Rabies should be considered in any case of encephalitis or myelitis. Laboratory confirmation of the diagnosis was often delayed. Testing for serum antibodies was the most reliable test in unvaccinated patients, and isolation of virus was the test most likely to be positive early in the illness.

Lassa Fever: Response to an Imported Case

In February, 1976, a Peace Corps worker returned to the United States from Sierra Leone with an undiagnosed illness later recognized as Lassa fever. To assess the risk of transmission and to contain a potential outbreak, we identified 552 contacts as having had exposure to the patient before the start of strict isolation procedures, and maintained intensive surveillance on these contacts for 21 days. At the end of the surveillance period, no illness had developed in contacts. One month later, a serologic survey among 29 of the contacts judged to be at high risk gave no evidence of infection. In response to the importation of this communicable and highly fatal disease, procedures for the isolation of the patient, the identification, surveillance and management of contacts and the handling of laboratory specimens were developed and implemented. These procedures could be adapted to future introductions of highly contagious diseases.

Rabies control in the Republic of the Philippines : benefits and costs of elimination

We compared the benefits and costs of eliminating animal and human rabies in the Philippines. If rabies had been eliminated in 1988, economic benefits would total P52.8 (US

Q Fever Control Measures: Recommendations for Research Facilities Using Sheep

2.5) million in 1989. These benefits would largely arise from the abolition of expenses associated with rabies prevention: P29.7 (US

A clinical study of Merieux human rabies immune globulin

1.4) million for animal vaccination, P21.6 (US

RABIES IN RODENTS AND LAGOMORPHS IN THE UNITED STATES, 1971–1984: INCREASED CASES IN THE WOODCHUCK (MARMOTA MONAX) IN MID-ATLANTIC STATES

1.0) million for human postexposure prophylaxis, and P0.3 (US

Respiratory Illness in Conference Participants Following Exposure to Rug Shampoo

0.02) million for animal rabies examinations. Benefits also included P1.2 (US

Welcome Address from the President of the Wildlife Disease Association

0.06) million in additional earnings of humans whose death due to rabies would be prevented. Nationwide elimination was estimated to cost between P88.1 (US

DESCRIPTIVE EPIDEMIOLOGY FROM AN EPIZOOTIC OF RACCOON RABIES IN THE MIDDLE ATLANTIC STATES, 1982-1983

4.2) million and P317.2 (US

Ecology and Epidemiology of Raccoon Rabies

15.0) million, assuming a canine-to-human ratio of 1:10, vaccine coverage of 60%, and a cost per vaccination of no less than P25 (US