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New Zealand’s first recorded case of rabies posed no risk to the public, with healthcare workers taking appropriate precautions, an expert says.
The ship worker is believed to have been infected in the Philippines - where rabies is rampant - more than seven months before arriving in New Zealand on a commercial cargo ship.
The case study features in the New Zealand Medical Journal on Friday, with the paper showing clinicians the possibility of rabies occurring in New Zealand, said one of the authors, Te Whatu Ora Auckland intensive care fellow Hamish Wright.
He recommended healthcare workers seek expert guidance if a patient has arrived from overseas, including sending tests to the Victorian Infectious Diseases Reference Laboratory in Melbourne.
The paper outlines the man’s symptoms including fever, vomiting, paranoia, abnormal breathing and heart rates, before he eventually stopped breathing and suffered multiple organ failure.
He died 23 days after first experiencing symptoms, in the presence of his family.
But the paper also showed the difficulty of diagnosing the man, with initial rabies tests being negative, before positive results were received 19 days into the man’s symptoms.
But Wright said rabies was considered early in the patient’s admission to hospital. He was first admitted to Whangārei Hospital, before being transferred to Auckland City Hospital.
Staff at Whangārei and Auckland City Hospitals used appropriate personal protective equipment, such as the equipment used for protection during the Covid-19 pandemic. Photo / Mark Mitchell
The patient was managed with full infection prevention and control measures, including appropriate personal protective equipment (PPE) for staff, he said.
These standard precautions for all potentially infectious patients in New Zealand hospitals are the same as the recommended precautions for patients with rabies.
Wright said human-to-human transmission of rabies is extremely rare and the patient posed no health risk to the public.
There are no tests available to diagnose rabies before symptoms develop, he said. This means there was nothing New Zealand authorities could do to stop the case entering the country.
“We want to reassure the public that rabies is a very rare infection to be diagnosed in countries that are rabies-free.”
There was also nothing more clinicians could have done to help the man, Wright said.
“Unfortunately, rabies has a mortality rate of close to 100 per cent, with no proven beneficial treatments once symptoms occur,” he said.
“In this case, the patient had already developed symptoms, and expert national and international guidance confirmed no specific treatments would benefit the patient.”
However, Kiwis travelling abroad can avoid getting rabies by reducing the chances of being exposed - such as avoiding dog bites or touching wild animals, getting vaccinated if travelling to a country where rabies is endemic and seeking immediate treatment if exposed, he said.
The case does not change New Zealand’s rabies-free status as Aotearoa does not have rabies in its animal or human population.
What is rabies?
Rabies is a fatal brain inflammation caused by the virus Lyssavirus rabies.
It is most commonly transmitted to humans from dog bites. Dogs, skunks, racoons, foxes and bats can infect people with a bite or scratch.
The only cases of human-to-human transmission were during organ or tissue transplant.
Incubation can take months, even several years in rare cases.
Once symptoms develop, rabies is almost always fatal for patients.
A vaccine can prevent rabies in both people and animals. Vaccines can also stop a person from developing the disease if given immediately after they are bitten or scratched by an infected animal.
Denise Piper is a news reporter for the Northern Advocate, focusing on health and business. She has more than 20 years in journalism and is passionate about covering stories that make a difference.
