Communicable Disease Center report here

Excerpt:
" Bat exposure in the home was the likely source of infection in this case. Over 90% of domestically acquired human rabies cases reported in United States since 1995 have been linked epidemiologically to bats (5). Cryptogenic human rabies (i.e., cases where a definitive history of animal exposure is lacking) constitutes an increasing proportion of these bat-associated cases (6). Rabies virus transmission can occur from seemingly minor or unrecognized bites. A complete rabies virus exposure risk assessment is recommended for any person reporting potential exposure to a bat, even in the absence of a documented bite (1)."

Hard to diagnose, impossible to cure. A particular danger to EMS and ER personnel, because of the body fluid transmission issues. I helped care for a farmer exposed to a rabid cow, once upon a time: Holsteins do not bite, having mandibular dentition only, but they drool a lot, and the saliva can transmit the virus via a skin break.

I don't have a case report to list,but an Internist in Macon, Ga. gave a talk on HIV/AIDS to some hospital employees; of which I was one. In the course of the talk he described the unfortunate case of an E.R. nurse of his acquaintance who applied direct pressure to a bleeding wound with her bare hand emergently. The skin of her hand was unbroken, yet she became infected with HIV and died of complications of AIDS some 10 or 15 years later. The Internist had grown up with the nurse and knew her personal history quite well. She had no history of risky behaviour other than work in a large city E.R.

IMO, rabid animals are the wild card in our planning. The real nightmare is rabid bears. I live in Maryland, and a number of years ago, a Maryland family (in their home) was attacked by a rabid black bear, normally a relatively well behaved bread of bear. Here is a link to the story:

http://www.washingtonpost.com/wp-dyn/content/article/2007/09/05/AR2007090501472.html

I've mentioned this incident in previous posts, but I keep bringing it up because I worry that I think there is a tendency to assume that wildlife we meet with will act "normally" for their kind. Rabies changes all that---do we prepare for it or not? If so, how?

Given the probabilities, I am not too concerned about rabid animals, but it is a condition about which one should be aware. Years ago I encountered a skunk standing his ground on a mountain trail in Arizona - completely unique behavior in my experience. I didn't contest the trail right of way with him, but gave Mr. Skunk a wide berth - I thought at the time that there was a possibility that the animal was rabid.

There are lots of good reasons for keeping your distance from critters - another two are hanta virus and bubonic plague - both endemic in western US populations

"Those shots sound horrible."
You're right. Had 'em when I was 11.

http://www.outsideonline.com/news-from-t...mpaign=08192013
Wear DEET, Wear Permethrin!

West Nile Virus Evolves

Texas has also been the focus of another medical story: last year's sudden resurgence of West Nile virus infections after nearly a decade of decline. Researchers there reported last week in Emerging Infectious Diseases that the genetic profile of West Nile virus isolates in the state had changed significantly from 2002 to 2012.

Study authors emphasized that the genetic alterations did not appear to have affected the pathogen's virulence. Other researchers had attributed last year's upswing of infections -- featuring a sharp spike in the Dallas area that drove national case and death counts to near-record highs -- to unusually warm weather and more active mosquito populations.

But according to Brian Mann, of the University of Texas Medical Branch in Galveston, and colleagues, the genetic changes seen in Texas show that viral populations in an area do not remain static over time. In particular, their analysis suggested that a West Nile virus strain was introduced into Texas from the northeastern U.S. sometime after 2010.

The researchers called for continued West Nile virus surveillance to track its transmission dynamics over time.

Mostly rabies is transmitted by bite, and not too many things bite bears. But rabid apex predators ar
e a worry, since the weapons that achieve one-shot kills on critters this large are on wheeled carriers, and complicate hiking considerably.

And yet the medical community continues to claim one cannot get it from mosquito bites.