Girl’s death due to bat rabies

From ANIMAL PEOPLE, October 1993:

BLOOMINGBURG, New York––The New York State Health Department is running
a search of all computerized hospital records to find possible undiagnosed deaths from silver-
haired bat rabies. The review began following the August 26 discovery that silverhaired bat
rabies was responsible for the first human rabies fatality in New York state since 1954.
The mid-Atlantic raccoon rabies pandemic recently spread into mid-state New York.
Northeastern New York is meanwhile contending with sporadic invasions of fox rabies from
Quebec and northwestern Vermont. But the rabies strain that killed 11-year-old Kelly Ahrendt of
Bloomingburg on July 11 has apparently been in New York, little noticed, for many years.
The case served to warn animal care and control workers, rescuers, veterinary staff,

and other people who often handle unfamiliar
animals to take appropriate precautions, includ-
ing pre-exposure vaccination, which costs
about $375 for a set of three injections and must
be administered by a medical doctor or regis-
tered nurse under a medical doctor’s supervi-
sion. Ahrendt’s death was especially alarming
because she never knew she had been bitten by
any animal, much less a rabid animal. In fact,
no one even suspected she’d had rabies until
during a mandatory autopsy following what
doctors suspected was a case of encephalitis
brought on by a fall from a horse that no one
thought was serious at the time.
Investigators were mystified when
they could find no evidence of either a traumatic
injury or any familiar viral disease. Finally,
following up a casual suggestion by one of the
pediatricians who treated Ahrendt for steadily
worsening but inexplicable fever during her last
days of life, pathologist Dr. Christina Vellejo
discovered tell-tale proteins called Negri bodies
left by the rabies virus in nerve cells of
Ahrendt’s brain
Rabies hadn’t been considered before
because there were no bite marks on Ahrendt’s
body, she had never complained of being bitten,
and no one she knew could remember her ever
having been bitten. Early speculation had it that
she might have picked up and ingested froth from a rabid
animal while petting a cat or dog.
Silverhaired bats, however, leave bite marks
that are almost indistinguishable from ordinary bug
bites––and the bite probably came weeks before Aherndt
began complaining of arm pain on July 5. By that time,
the rabies was already so far advanced that even an
immediate course of post-exposure vaccinations could
not have saved her. Rabies is virtually 100% fatal after
symptoms appear; the handful of survivors have
remained semi-comatose, with severe brain injury.
Bat rabies is rarely discussed with the urgent
anxiety accompanying the spread of raccoon rabies, in
particular, but Aherndt’s death was not a fluke. Of the
20 most recent human deaths due to rabies, 10 cases
were contracted abroad; eight cases came from bat bites,
including three children who were bitten near the
Texas/Mexico border in 1979; and only two cases could
be attributed to raccoon rabies. One of the victims was a
trapper, while the other was a 12-year-old Pennsylvania
boy who was bitten by an unknown animal in 1984 and
didn’t tell anyone about it.
The spread of bat rabies is little documented,
largely due to the small size, shy nature, and nocturnal
habits of bats. Most people who share their homes with
bats never know the bats are present.
Raccoon rabies update
Raccoon rabies, by contrast, has been highly
visible since 1977, when a group of trappers and coon-
hunters relocated 700 raccoons from a rabies area in
Florida to the West Virginia/Virginia border. The dis-
ease has spread in all directions since, moving fastest
wherever heavy raccoon hunting and trapping creates a
refugee population, obliged to wander in search of
mates. As far back as 1973, Dr. William Winkler of the
Centers for Disease Control warned in a handbook pub-
lished by the National Academy of Science that
“Persistent trapping or poisoning campaigns as a means
to rabies control should be abolished,” as, “There is no
evidence that these costly and politically attractive pro-
grams reduce either wildlife reservoirs or rabies inci-
dence.” Raccoon rabies was then a problem only in con-
tiguous areas of Florida, Georgia, and South Carolina.
Winkler has reaffirmed his advice many times. Trappers
alone killed a combined average of 500,000 raccoons a
year in Pennsylvania, Delaware, Maryland, Virginia,
West Virginia, and New Jersey throughout the 1980s,
without having any visible impact upon either the rac-
coon population or the spread of the disease.
Repeating a now-old mistake, the Ohio
Division of Wildlife is introducing an open season on
raccoons with no bag limit on October 6. ANIMAL
PEOPLE correspondent Donna Robb, of Medina,
Ohio, has advised authorities that they could more
effectively reduce the risk of human contact with rac-
coons by arranging to have garbage collected from parks
and other public areas in the evening rather than the
morning, so that the animals don’t have all night to scav-
enge.
Raccoon rabies is also resurgent in the South.
The Georgia Department of Natural Resources recently
barred rehabilitation and relocation of injured or
orphaned raccoons, after rehabilitator Brad Hooks of
Nunez and six other people had potentially infectious
contact with an infant raccoon who proved to be rabid.
The USDA is reportedly likely to give an oral
raccoon rabies vaccine called Raboral final approval by
next spring, after seven years of testing and legal bat-
tles, 20 years after a related oral vaccine was deployed
against fox rabies in Switzerland. Oral vaccines are
most effectively used to create immunized barriers
against the spread of rabies. Such barriers have con-
tained fox rabies in Europe since the mid-1980s, and
have contained both fox rabies and a minor outbreak of
raccoon rabies (caused by accidental transport of a rabid
animal) in Ontario, Canada. Raboral field tests have
achieved a 60% success rate at immunizing wild rac-
coons in selected areas of Virginia, Pennsylvania, and
New Jersey. Massachusetts has already budgeted for an
experimental Raboral program to protect Cape Cod,
while New York and Texas, which has had a recent out-
break of rabies in coyotes, have also applied to use
Raboral in experimental applications.
––Merritt Clifton
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