NZ’s first rabies case treated at Whangārei Hospital

The man was believed to have been infected by rabies from a dog in the Philippines, where the virus is endemic, seven months before dying in New Zealand. Photo / Emmanuelle Bonsami 123RF

A study of New Zealand’s first recorded rabies case shows the nightmare of the fatal disease, which can be prevented by vaccine.

The 48-year-old Filipino man died from rabies at Auckland City Hospital in March this year, 20 days after seeking medical attention in Whangārei for difficulty swallowing.

He is believed to have been infected from a dog in the Philippines - where rabies is rampant - more than seven months earlier, according to a case study published in the New Zealand Medical Journal on Friday.

There was no risk to members of the public from the case as person-to-person transmission of rabies almost never happens. Personal protective equipment used by healthcare workers treating the man also helped to protect them from infection.

The case was the first in Aotearoa and, because the disease is not present in New Zealand’s animals or people, it does not change our rabies-free status.

The case study outlines how the man was working on a commercial cargo ship and had not been ashore since boarding in the Philippines more than seven months earlier. There were reportedly no animals aboard the ship.

The man’s first symptoms were fever and vomiting, followed by difficulty swallowing.

He sought medical attention at three days after first experiencing symptoms and was admitted to Whangārei Hospital.

By the next day, he was experiencing some of the psychological symptoms of rabies, including hydrophobia - an extreme fear of water - and paranoia.

His agitation was so extreme, he was intubated and transferred to ICU. He was also treated with a range of antibiotics.

By day five, the man was transferred to Auckland Hospital’s ICU. His symptoms included abnormal breathing, with a heart rate speeding up and slowing down.

The man’s symptoms continued to worsen, including abnormal gagging motions, eye rolling and neck bending, plus instability of vitals like blood-oxygen levels.

He required deep sedation and an anticonvulsant was added to his treatment on day six, while a steroid for possible autoimmune disease was added on day seven.

With treatment not being successful, the antibiotics and steroid were stopped on day 12.

The 48-year-old man was initially treated at Whangārei Hospital, before being transferred to Auckland City Hospital where he died. Photo / Tania Whyte

By day 14, the man was producing more than a litre of extra saliva a day and was so lethargic the doctors gradually weaned his sedation.

The man eventually stopped breathing and had multi-organ failure, and he died on day 23 after his breathing tube was removed with approval from his family.

The case study shows doctors initially struggled to diagnose the man, with two different rabies tests being negative on days 8 and 10.

Meanwhile, the hospitals tested the man for a range of diseases including tuberculosis, HIV, Epstein–Barr virus, syphilis, Legionnaire’s disease, malaria and autoimmune diseases.

It was not until day 19 of the man’s symptoms that a rabies serology test came back positive, with samples having to be referred to Australia for testing.

Sequencing later showed rabies consistent with a virus of Philippines origin.

What is rabies?

• Rabies is a fatal brain inflammation caused by the virus Lyssavirus rabies.
• It is most commonly transmitted to humans from dog bites. Dogs, skunks, racoons, foxes and bats can infect people with a bite or scratch.
• The only cases of human-to-human transmission were during organ or tissue transplant.
• Incubation can take months, even several years in rare cases.
• Once symptoms develop, rabies is almost always fatal for patients.
• A vaccine can prevent rabies in both people and animals. Vaccines can also stop a person from developing the disease if given immediately after they are bitten or scratched by an infected animal.

New Zealand lucky rabies is not present, experts say

Experts say Aotearoa is lucky it does not have rabies in its animals or people, but Kiwis who travel abroad need to understand the risk.

Professor David Hayman, from Massey University’s School of Veterinary Science said at the time of the man’s death that it was tragic.

“Unfortunately, tens of thousands of people die of rabies each year, often children in poor countries.

“Rabies is an entirely vaccine-preventable disease in people and animals ... Unfortunately, the disease is also always fatal.”

Hayman encouraged Kiwis travelling abroad to get vaccinated if going to a high-risk area and to seek immediate medical attention if bitten by a dog.

Meanwhile, the case study highlights the importance of managing patients with standard infection prevention and control precautions.

Staff using personal protective equipment helped protect them from contact with infectious bodily fluids from the man as he was being cared for.

Denise Piper is a news reporter for the Northern Advocate, focusing on health and business. She has more than 20 years in journalism and is passionate about covering stories that make a difference.