Surgeon General directs review of records for unreported rabies exposure
March 1, 2012
Army Surgeon General Lt. Gen. Patricia D. Horoho has directed the five regional Army medical commands to conduct a stand down of all Soldier Readiness Processing and conduct a 100-percent review of all Post Deployment Health Assessments and Post Deployment Health Reassessments forms processed since September 1, 2011. Army Medicine had conducted an earlier 100-percent review of PDHAs and PDHRAs, from 2003 to August 31, 2011, following the death of a Soldier who contracted rabies.
The second review was prompted by the recent self-reporting by a Soldier of a feral dog bite in October 2011, while he was deployed. The Soldier had read an Army Times article about rabies and immediately reported to his Army medical treatment facility to be evaluated. He was provided post-exposure prophylaxis. The Soldier had not sought medical treatment after being bitten.
Upon reviewing the Soldier's medical records, it was discovered that the Soldier had actually annotated the feral dog bite in his PDHA, but the entry was apparently overlooked by medical personnel during the medical review process when he redeployed.
The SRP stand downs were directed after consultation with U.S. Forces Command to ensure deployments to the theaters of operation were not impacted. Additionally, the Surgeon General directed RMC commanders to conduct training of medical personnel be completed by March 1.
"This Soldier did absolutely the right thing. Once he read the Army Times article and understood the potential deathly consequences of untreated feral mammal bites, he sought and received medical treatment before the onset of symptoms," noted Col. (Dr.) John J. Lammie, director of Health Policies & Services, Office of the Surgeon General. Had this Soldier waited for symptoms to manifest, he added, it would have been tragic because once symptoms appear, rabies is nearly always fatal.
The risk of rabies for deployed Service members has not changed. It is still a rare disease among Service members. Despite the fact that rabies is fortunately very rare, rabies exposures are not rare. The incidence of feral animal exposures in theater is high and these exposures constitute a very high risk for rabies transmission.
All Soldiers receive medical threat briefings and other health information on a variety of topics, including rabies, prior to and during deployments.
This potentially serious oversight of this Soldier's exposure to a rabid dog called attention to the Army Medical Department's need to ensure all medical personnel responsible for medical records review are trained and know exactly what to look for, including the free-text entries Soldiers often make in the PDHAs and PDHRAs.
Soldiers and Family members are reminded that if they or someone they know were scratched or bitten by a feral animal while they were deployed, they should seek immediate medical attention, get evaluated and treated, if necessary. They can also call the Wounded Warrior & Family HOTLINE at 1-800-984-8523 (Stateside DSN: 421-3700 or Overseas DSN: 312-421-3700)
Facts About Rabies
• Rabies is a viral disease that affects the central nervous system. It is transmitted from infected mammals to humans and, if untreated, is almost always fatal.
• Conversely, rabies is entirely preventable. Properly-administered post-exposure rabies prophylaxis (consisting of 4-5 doses of vaccine, as well as a dose of rabies immune globulin) has never failed to prevent rabies, at least in the U.S. By the time clinical rabies develops, however, it is too late to administer prophylaxis.
• Rabies exposure nearly always occurs through a bite, but can also be transmitted if a rabid animal's saliva comes into contact with a person's broken skin, eyes or mouth.
• Only mammals are capable of carrying and transmitting rabies. While exposure to birds, reptiles, amphibians, insects, and other animals carry risks of their own, none of these species pose a rabies threat.
• Early symptoms of rabies may include irritability, headache, fever and itching or pain at the exposure site. The disease eventually progresses to spasms of the throat and the muscles used for breathing, convulsions or seizures, confusion, paralysis and death.
• The time between exposure and the onset of symptoms -- the incubation period -- varies but averages two to twelve weeks in humans. In rare cases, symptoms may not appear for over one year.
• A human who is exposed to a rabid animal does not always contract rabies, but there's no way to know before symptoms occur (at which point, it's too late to prevent).
• There is no screening test for rabies.