Human cases of rabies have been associated with all major reservoirs and vectors of the disease in the United States, including dogs, cats, bats, foxes, skunks, coyotes, bobcats-and now raccoons. Genetic-sequence analysis is used to determine the rabies variant. A previously healthy 25-year-old man from northern Virginia presented with head and body aches, nausea, abdominal pain, chills, fever, dry cough, and listlessness. Six days later he awoke disoriented and had an unsteady gait and slurred speech. He was admitted to the hospital where further testing was conducted. His mental status declined, and he died on the 14th day of hospitalization despite aggressive critical management. Rabies was diagnosed when brain tissue was sent to the Centers for Disease Control and Prevention. The patient was an office worker who lived in a rabies endemic area. After extensive interviews with family and friends, it was determined that he had no specific exposure to any animals likely to be infected with the raccoon rabies virus variant and did not spend much time outdoors. Of the 30 human rabies cases reported and presumed to have been acquired in the United States since 1990, only 2 have a history of suspicious animal bite exposure. In this case, 5 family members and 3 hospital workers received postexposure prophylaxis for potential exposure to the patient's secretions.

COMMENTARY: Although the risk may be small, rabies is 100% fatal and this case is a reminder that veterinarians and staff should be vaccinated. The Advisory Committee on Immunization Practices publishes guidelines for human rabies prevention and recommendations have been published for managing suspected cases. These can be found at http://www.cdc.gov/mmwr/preview/mmwrhtml/00056176.htm

First human death associated with raccoon rabies-Virginia, 2003. MMWR 52:1102-1103, 2003.