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Woman with rabies infection, no PEP delivers healthy baby in China
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Investigators reported that a woman in rural China who was infected with rabies while pregnant and did not receive post-exposure prophylaxis, or PEP, later gave birth to a healthy boy before she died.
According to a case report published in the Journal of Venomous Animals and Toxins Including Tropical Diseases, rabies is common in China, but rarely seen in pregnant women. In rural China, rabies is a serious threat because of the many feral dogs and that patients ignore the dangers of the disease or cannot afford the vaccine, or because health facilities are not equipped to test them.
The woman, aged 25 years, was 4 months pregnant in May 2013 when she was bitten on the right foot by a dog in Henan Province, according to the report. Her wound was treated at a local clinic, but she was not tested or given PEP for rabies.
Six months later, the woman exhibited symptoms of rabies infection while in a hospital delivery room. Her son was delivered by cesarean section the next day and was healthy, possibly because of placental protection or the absence of systemic viremia, the report said.
On the day of her delivery, the woman’s symptoms grew to include thirst, headache, fear, chest distress, hidrosis and difficulty swallowing water, and she was prescribed sedatives, according to the investigators. She was clinically diagnosed with rabies 1 day later after showing further signs of infection, including hydrophobia, vomiting, madness, dysphagia and fear.
The next day, she was transferred to an infectious diseases hospital, isolated, and treated with diazepam for irritability. She died later that day at home of respiratory failure after being discharged against medical advice, according to the report. Her husband and infant received rabies vaccinations after being diagnosed with category III rabies exposure, based on WHO guidelines. They received four more doses of the vaccine during the next 4 weeks and remained uninfected as of Sept. 30, 2015.
The researchers recommended several ways officials in China may be able to manage rabies through better surveillance and animal control.
“Although laboratory diagnosis comprises an important role in the management of rabies infection, most cases of the disease occur in rural areas of China, where no health facilities have technical conditions for the detection of the virus,” the researchers wrote. “The government should set up monitoring centers for laboratory identification of rabies virus in areas of high incidence in order to prevent its transmission.
“Latin American countries were almost able to eradicate rabies by strengthening measures against its virus through mass vaccination of dogs, for example. These successful experiences suggest that it is possible to fight the disease by means of virus control and prevention.” – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.
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