Rabies Exposure—Implications for Wilderness Travelers

Rabies is a preventable, fatal infectious disease. Successful vaccination programs for domestic animals in developed countries have drastically decreased the risk of exposure to rabies. Yet awareness of rabies needs to remain high as important reservoirs still exist in our backyards, the wilderness, and abroad. Recognizing the risk before and after a potential exposure, so that appropriate medical care can be sought, is critical to preventing a fatal complication. This case report involves an exposure of a medical student to an ill-appearing and likely rabid gray fox in the Gila Wilderness Area of New Mexico. The student was a member of a 28-day wilderness medicine course taught by the National Outdoor Leadership School/Wilderness Medicine Institute in collaboration with the Harvard Affiliated Emergency Medicine Residency. On the first night in the field, the student awoke to a gray fox biting his foot through his sleeping bag in the early morning hours. Subsequently the student was evacuated for medical evaluation. Further care consisted of rabies postexposure prophylaxis, including thorough wound cleansing, injection of human rabies immunoglobulin, and initiation of a rabies vaccination schedule. Immediate wound care with soap and water and a viricidal agent is of utmost importance for any animal bite, but especially so in the prevention of rabies. Indications for rabies prophylaxis are complex and require prompt evaluation by a medical professional and consultation with local epidemiology to guide treatment.