Letter of Invitation - Puerto Rico

December 3, 2015

Dr. Beth P. Bell

Director

National Center for Zoonotic and Emerging Infectious Diseases (NCEZID)

Centers for Disease Control

Atlanta, GA

Dear Dr. Bell:

The Puerto Rico Department of Health (PRDH) would like to request assistance from the National Center for Zoonotic and Emerging Infectious Diseases (NCEZID), Pox and Rabies Branch, to conduct contract tracing and standardized risk assessments for post-exposure prophylaxis (PEP)for persons with possible exposures to a mongoose associated rabies case. Mongoose are the main rabies reservoir in island, acoounting for 5% of all reported bites and 12% of all PEP referrals. On December 1, 2015, PRDH was alerted of a possible case of human rabies in a >50 year old man. Relatives informed the patient had a history of a mongoose bite approximately one month prior for which he did not seek medical care. The patient presented to the ER on 11/30/15 with a history of fever, shortness of breath, confusion, anxiety, hydrophobia and dysphagia; however, the patient died within 24 hours. Direct fluorescent antibody testing of brain tissue collected at autopsy performed by the Puerto Rico Public Health Laboratory was positive indicating a diagnosis of rabies.

In Puerto Rico, the majority of post-exposure prophylaxis (PEP) for rabies is funded by the State or through workmen’s compensation fund. Given the limited supply of PEP and the community’s anxiety about possible exposures, we request assistance with conducting contract tracing and standardized risk assessments for persons with possible exposures to the patient to ensure only those individuals with actual exposures receive PEP. Assistance from the CDC would help the Puerto Rico Department of with the following objectives:

1. Identify community and healthcare contacts of the case patient during potential infectious period (11/9/15 – 12/1/15)

Epidemiology and Research Office

B lgd A, Office # 159

P.O. Box 70l84, San Juan, P.R. 00936-8184

Phone: 787-765-2929, ext 3551,3552, Fax: 787-751-6937

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2. Perform risk assessments for rabies virus exposure of contacts to determine need for PEP

3. Develeop healthcare community educational tools on occupational exposure to rabies

The Department of Health will be providing support to assist with the investigation.

Sincerely,

Brenda Rivera-García, DVM, MPH

Territorial Epidemiologist

Puerto Rico Department of Health

[email protected]