Rabies case in SC illustrates bat-bite concerns

CDC report details death of Sumter woman, state’s first fatal rabies incident in 50 years

jholleman@thestate.comSeptember 2, 2013 

THE STATE

When a Sumter County woman in 2011 was the first South Carolinian in 50 years to die of rabies, some of the details of her case remained fuzzy in public reports.

Most of the gaps in the narrative were filled with a thorough examination of the case in the federal Centers for Disease Control and Prevention’s Aug. 16 Morbidity and Mortality Weekly Report. Entries in that report – aimed at health professionals – typically are clinical and antiseptic, with hints of an episode of the television show “House.”

Ivy Durant, 46, showed up at an emergency facility Dec. 3, 2011, sweating profusely, with shortness of breath, chills and tingling sensations in her hands. She had had heart bypass surgery 10 years earlier. She had no known history of an animal bite.

Blood tests and head and chest scans revealed nothing unusual. When her condition didn’t improve after five hours, she was taken to a nearby hospital. Within 12 hours, she stopped breathing on her own. Over the next several days, other organs began to fail.

Five days after her hospitalization, family members told doctors Durant had reported bats in her house the previous summer. She even had removed one from the house by shaking it out of curtains through an open window. But she had told them she had no bat bite or direct contact with a bat.

With that knowledge, doctors sent specimens from the woman to the CDC for lab tests. The results confirmed she had rabies. That knowledge was too late to save her. Durant died Dec. 19, 2011.

Human deaths from rabies are extremely rare, averaging fewer than three per year nationwide. The most recent cases in South Carolina were in the 1950s – an elderly Florence County man bitten by a dog in 1959 and an elderly Clarendon County woman bitten by a fox in 1958.

The rabies virus travels slowly through the body until it reaches the brain and central nervous system and produces serious initial symptoms, said Eric Brenner, a medical epidemiologist with the University of South Carolina who consults with the state Department of Health and Environmental Control. The symptoms include headaches, difficulty swallowing and seizures.

Most patients die within a few weeks after the onset of these symptoms, Brenner said.

Rabies deaths are rare because the vaccine used to prevent the onset after someone has been bitten by a rabid animal has been extremely successful. But Durant didn’t know she had contracted rabies, so she didn’t get the vaccine.

By the time she showed up at the emergency facility, her chances of survival were slim to none because she already had full-blown symptoms. A 15-year-old girl in Wisconsin was the first known survivor of rabies after she was put into a medically induced coma and treated with a cocktail of drugs in 2005. That procedure, called the Milwaukee Protocol, has worked in a few other cases since then, but it’s not always effective.

At the time in 2011, state health officials reported that all efforts were being made to save Durant’s life, but they refused to offer details on procedures. The CDC report also doesn’t provide those details.

Once Durant was diagnosed with rabies, state infectious-disease experts went into action to protect others. There is a slim possibility of transmission of rabies in bodily fluids, so four family members and 22 medical personnel who had contact with the victim went through the rabies vaccine procedure. Also, two dogs who lived in the house where bats had been seen were given rabies booster shots.

Neither the people nor the dogs showed any rabies symptoms before or after the vaccinations.

After all of the research in the case, one question remains: How exactly did Durant contract rabies? Almost certainly, she got it from bats that infested her house. But she never reported being bitten.

The CDC report was publicized in part to remind health professionals, and the public, that bat bites aren’t always obvious. A bite might not draw blood or even wake up someone bitten in their sleep.

Health officials recommend anyone coming into direct contact with a bat, or who has slept in a room where bats might have entered, should see a doctor and consider being vaccinated against rabies.

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