Thread: Illegal alien's rabies death set off search for others

Immigrant's rabies death set off search for others

Posted: Jun 08, 2014 8:18 AM PDTUpdated: Jun 08, 2014 8:18 AM PDT

CORPUS CHRISTI, Texas (AP) - The death of a Guatemalan immigrant from rabies last year at a Corpus Christi hospital set off a transnational search for others who may have been exposed.

The Corpus Christi Caller-Times reports (http://bit.ly/1kIVAJt ) that more than 700 people were assessed for rabies exposure in what Ryan Wallace, a rabies expert for the U.S. Centers for Disease Control and Prevention, called a very rare scenario.

Federico Mendez-Hernandez began showing symptoms after Border Patrol captured him in South Texas following his illegal entry. The 28-year-old Mendez-Hernandez had traveled through four federal detention centers and two hospitals before dying in June 2013. Yet in the end, investigators determined only two dozen people required vaccinations.

The CDC was unable to determine how Mendez-Hernandez had contracted the incurable virus.

Information from: Corpus Christi Caller-Times, http://www.caller.com

http://www.myfoxdfw.com/story/257223...rch-for-others

More than 700 assessed for rabies exposure after Guatemalan national dies in Corpus Christi hospital last year

• By Rhiannon Meyers
• Posted June 8, 2014 at 6:25 a.m.

Photo by David Goldman
ASSOCIATED PRESS FILE More than 700 people had to be assessed for rabies exposure after a Guatemalan national apprehended by the U.S. Border Patrol died at a Corpus Christi hospital last year in the first reported case of a federal detainee diagnosed with rabies, according to a newly published U.S. Centers for Disease Control and Prevention.

CORPUS CHRISTI — More than 700 people had to be assessed for rabies exposure after a Guatemalan national apprehended by the U.S. Border Patrol died at a Corpus Christi hospital last year in the first reported case of a federal detainee diagnosed with rabies.

“This is a very rare scenario,” said Ryan Wallace, rabies expert for the U.S. Centers for Disease Control and Prevention.

The unusual case led to a multinational investigation spanning five countries to track down hundreds of people who may have been exposed to Federico Mendez-Hernandez, 28, as public health investigators worked to determine how many needed to be vaccinated.

While 55,000 people die each year of rabies, mostly in Africa and Asia, such deaths are rare in the United States, about one to six per year. There has never been a laboratory-confirmed case of rabies transmission between humans aside form organ transplants.

But detention facilities are among the worst settings for infectious disease transmission because of close contact during confinement, raising disease investigators’ concerns that Mendez-Hernandez had put large numbers of people at risk.

“At one point, he was in his cell and his throat hurt so bad, he was spitting on the floor and coughing quite a bit,” Wallace said. “Those are the stories we don’t often hear with the typical American who develops rabies at home and goes to the hospital.”

Yet, although Mendez-Hernandez was exposed to hundreds as he traveled through four federal detention centers and two hospitals, only two dozen people required vaccinations, according to the CDC.

“As far as rabies transmission and the dynamics of rabies, the protocols do seem fairly adequate at preventing rabies exposure within detainment facilities,” Wallace said.

In the aftermath of the case, the CDC made one recommendation, that U.S. Immigration and Customs Enforcement stop providing water from a central cooler with plastic cups passed around among detainees. The immigration agency instead installed water fountains, Wallace said.

The CDC was unable to pinpoint how Mendez-Hernandez contracted rabies, but his virus was a close match to a virus in dogs in Guatemala, his home country, Wallace said. He had no bite marks on his body nor could his family remember a time when he had been bit by a dog.

While canine rabies has been nearly eliminated in the United States, most human rabies deaths worldwide are caused by rabid dog bites, according to the CDC.

Mendez-Hernandez showed no signs of feeling sick when he was apprehended by U.S. Border Patrol on May 9, 2013 on the Rio Grande near Hidalgo, according to immigration agency reports. All detainees undergo a health screening when they arrive at detention centers, per agency protocol.

Several days into his detention, Mendez-Hernandez visited the facility’s medical clinic multiple times with an array of symptoms including excessive saliva, anxiety, insomnia, trouble swallowing and a rapid heart rate, according to CDC reports.

Nine days after he was picked up by border patrol agents, he was transported to Christus Spohn Hospital Kleberg, where a CT scan was performed and hospital staff discovered air in his chest between his lungs.

They transported him Christus Spohn Hospital Memorial, where his condition worsened. His blood pressure spiked and dipped, his mental status deteriorated and he needed a ventilator to breathe. His temperature jumped to nearly 104 degrees, but he became agitated when staff put a cooling fan on him. Fear of water is a well-known rabies symptom, but patients also experience irrational fears of drafts of air.

“On the surgery ICU side, they couldn’t figure out what was wrong with him,” said Dr. Andy Russell, an emergency medicine resident at Memorial. “He didn’t seem to have any surgical issue ... He was very unstable, teetering on multi-organ failure, but we couldn’t figure out why.”

To Russell, Mendez-Hernandez’s array of symptoms sounded like a medical board exam case study of rabies.

“I was just joking initially, but the more we thought about it, the more we thought maybe he does have rabies,” Russell said.

His serum was collected, labs were run and two days later, they came back positive for rabies antibodies.

“I couldn’t believe it,” Russell said. “It was really sad because you know it’s incurable.”

Hospital staff tended to Mendez-Hernandez round-the clock, with one nurse specifically assigned to him at all times, a rare and intense intervention, Russell said. He was kept in a sealed-off private room and staff treating him were required to wear disposable gowns, gloves and face masks that were discarded in a biohazard bin before leaving the room.

Once symptoms appear, rabies is nearly always fatal. An experimental rabies treatment pioneered by a Wisconsin pediatric infectious disease specialist successfully saved a Wisconsin teenager in 2004 by inducing a coma and administering anti-viral drugs.

But the so-called Milwaukee protocol didn’t work for Mendez-Hernandez. He developed an immune response but brain swelled dangerously, Russell said. On June 11, he was pronounced brain-dead and removed from life support, according to the CDC. His body was returned to Guatemala.

After Mendez-Hernandez died, state and federal health agencies launched a public health investigation to identify detainees, detention staff members and health care workers who had been exposed to the Guatemalan national. Of the 742 people identified, 432 were recommended for further assessment, including many detainees who returned to their home countries.

Using a risk scoring system to determine those at highest risk — people potentially exposed to Mendez-Hernandez’s tears and saliva — rabies vaccines were recommended for 23 people, including detainees, three officers who scuffled with Mendez-Hernandez during his arrest and five health care workers. Two others opted to receive the shots although they weren’t recommended.

However, only half of those identified for risk assessment received it, largely because one country chose not to conduct an investigation and another did not provide details on how it responded, according to CDC reports. The CDC did not identify those countries.

Still, the detainees most at risk were other Guatemalan nationals, with whom Mendez-Hernandez was primarily housed during his detention, Wallace said.

The Ministry of Health in Guatemala tracked down 17 of the 26 Guatemalan detainees exposed to Mendez-Hernandez and recommended 13 of them get the rabies shots.


http://www.caller.com/news/2014/jun/...xposure-after/