Imported human rabies in a U.S. Army soldier - New York, 2011

On August 19, 2011, a male U.S. Army soldier with progressive right arm and shoulder pain, nausea, vomiting, ataxia, anxiety, and dysphagia was admitted to an emergency department (ED) in New York for suspected rabies. Rabies virus antigens were detected in a nuchal skin biopsy, rabies virus antibodies in serum and cerebrospinal fluid (CSF), and rabies viral RNA in saliva and CSF specimens by state and CDC rabies laboratories. An Afghanistan canine rabies virus variant was identified. The patient underwent an experimental treatment protocol but died on August 31. The patient had described a dog bite while in Afghanistan. However, he had not received effective rabies postexposure prophylaxis (PEP). In total, 29 close contacts and health-care personnel (HCP) received PEP after contact with the patient. This case highlights the continued risks for rabies virus exposure during travel or deployment to rabies-enzootic countries, the need for global canine rabies elimination through vaccination, and the importance of following effective PEP protocols and ensuring global PEP availability.