News and Events

Case of the Month - June 2012

Lee Baker and Albie de Frey - SASTM

A health care worker on a remote mine site in Guinea, West Africa contacts the supervising medical officer for advice on 31 January, concerning the following case:

A 34-year old British female environmentalist was bitten on the finger by a bat whilst doing a survey in a mountain cave on 30 January 2012. She had been seen at the site clinic that day.

She had her “last vaccinations in October 2011 and all other vaccinations were updated”

On examination there was no puncture wound and no bleeding. The area was cleaned with a disinfectant, not scrubbed. A single dose of rabies vaccine was given. The patient was not unwell and will present for her next vaccine on 2 February 2012.

The health care worker was merely informing his supervising medical officer as a matter of course, but because rabies is almost always 100% fatal it is important to ensure that the case has been managed correctly.

The most frequent causes of failure of post-exposure prophylaxis are delays in administering the first vaccine dose or immunoglobulin, failure to complete the vaccine course and failure of correct wound management.

Question 1: What questions need to be asked?

Continue to Answer 1