Few troops get rabies vaccine after bites
Few troops in Iraq and Afghanistan get rabies vaccine after animal bites
Contra Costa Times
WALNUT CREEK, Calif. — Less than 20 percent of U.S. soldiers bitten by animals in Iraq and Afghanistan since 2001 received rabies vaccinations and most of them did not receive the full regimen of drugs to fight the fatal disease, according to a military report released a month after the rare disease killed a soldier from Livermore, Calif.
The medical study — prompted by the Aug. 31 rabies death of Army Spc. Kevin Shumaker, the first U.S. soldier to die of the disease since the Vietnam War — recommends that the military better educates its soldiers on the dangers of animal bites, particularly rabies.
Shumaker, 24, became the first human rabies fatality in the United States this year when he died at a New York hospital Aug. 31. He told his parents that he received three of six rabies shots at his base after a stray dog bit him and that the final injection of vaccine, which he was not given, had expired.
Army Central Command in Afghanistan is investigating Shumaker's death. Army Medical Command has set up a rabies response team since Shumaker's death.
The Armed Forces Health Surveillance Center study looked at all reported non-insect animal bites for active and reserve members from January 2001 to December 2010 at home and abroad.
During that time, there were 20,522 animal bites,. Most were among U.S. military members serving on domestic bases.
Only 1,681 of those bitten were treated with the rabies vaccine, a low number but not unusual in the United States, where rabies is rare.
However, in Iraq or Afghanistan, where rabies is more common, animals bit 643 soldiers, but only 117 received rabies vaccines. Of those 117, only 25 received the rabies immune globulin, an infusion of antibodies near where they were bitten. It is the first step in a full rabies treatment regimen.
"I'm not surprised that a greater proportion in theater did not get the vaccine," said Dr. Frank O'Donnell, the military health center's senior adviser. "This could be bites by military working dogs ... that are all vaccinated against rabies."
His agency's study did not look at more specific data, such as the circumstances of the bites, he said. He could not explain only 25 soldiers received immune globulin.
"The documentation could be less than perfect ... they might not write down the code," O'Donnell said.
While most rabies treatments in Iraq and Afghanistan were started within seven days, 19 cases took 8 to 90 days for treatment to start for a disease that needs immediate treatment.
"The gold standard is to treat as soon as possible and I think that's why the business of timing is of some interest. If I'm bitten, I'd like to be treated sooner than later," O'Donnell said.
Jaime Cavazos, a spokesman for Army Medical Command, said with more than 1,200 bases in Afghanistan, not all can carry the rabies vaccine regimen.
Remote bases in forward zones and smaller bases lack immunization drugs that need refrigeration and controlled temperatures, he said.
"Those who need treatment for potential rabies exposure are evacuated to a higher level of medical care" where medications can be stored and monitored to protect their potency, he said.
The shelf life of the vaccine and globulin are about two years, Cavazos said.
The report acknowledges that animal bites are probably underreported, particularly in Iraq and Afghanistan, and that records before 2007 were incomplete.
"These are combat zones and they don't have computers everywhere they are providing health care," O'Donnell said.
In addition, an animal bite might not register as a reportable incident for a soldier in combat, he said.
Shumaker did report his bite but told his parents he never got the full treatment of globulin and four vaccine shots over two weeks.
Shumaker's mother, Elaine Taylor, said all soldiers should be immunized before deploying to Iraq and Afghanistan.
"The Army would still need to keep the vaccine on hand and treat appropriately when someone is bitten," she wrote in an email. "Having been vaccinated for rabies in advance of a bite, you stand a much higher chance of not dying as Kevin did."
O'Donnell said vaccinating all infantry soldiers before deployment would be expensive ($1,400 for each full regimen) and unnecessary since the post-exposure treatment is so effective.
"You deal with bites as they happen," he said.
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