Page 8 - DMN2Q21

Detroit Health Department Update
MICHIGAN'S FIRST RABIES CASE SINCE 2011
Dear Medical Colleagues,
The City of Detroit Health Department (DHD) was notified in late May 2021 of the State’s first canine rabies case since 2011 (Oakland County). A 6-month old puppy, adopted as a stray months earlier, presented with lethargy, withdrawal and an inability to ambulate following an animal fight the week prior. Upon further interview, the owners disclosed ownership of a 4-5 year old cat that disappeared around the same time. The puppy was euthanized in order to provide brain/nervous tissue for variant typing at State laboratories. Neither of the animals were vaccinated. Interventions included PEP for the owners and staff that cared for the puppy (human rabies Ig + 4 doses of vaccine at 0, 3, 7 and 14 days) and canvassing in the affected neighborhood to alert residents of the case. Sequencing revealed the skunk variant, which predominates in Michigan alongside the bat variant. Previously, Detroit had identified just 4 bat cases from 2011- 2014
Rabies virus can be transmitted through open wounds or mucous membranes from saliva or brain/nervous tissue from an infected animal. The virus travels from nerves to the CNS, with an incubation period that can last weeks to months. In humans, symptoms are generally flu-like with discomfort at the site of injury/exposure, rapidly progressing into anxiety, confusion, delirium, hallucinations and hydrophobia. It is suspected that the Detroit animal case progressed quickly due to the puppy’s age and potential site of exposure in close proximity to the CNS.
If you suspect rabies exposure in one of your patients, please follow the attached algorithm and report the case to your local health department. Our Communicable Disease team is ready to help answer any questions: https://www. michigan.gov/documents/Rabflowcht3people_7361_7.pdf
Remember to get your pets vaccinated for rabies (and other vaccine preventable diseases)! Best,
Najibah K. Rehman, MD, MPH Detroit Health Department Medical Director
8 Detroit Medical News
Second Quarter 2021