Beware Of Rabies

By EUGENE LINDEN

Shortly after the Fourth of July weekend, 11-year-old Kelly Ahrendt complained to her parents that she did not feel well and was having trouble sleeping. But the Ahrendts, a family of nine living on a small farm in Mamakating, New York, had no real hint of the horror to come. On July 7, Kelly said her knuckles and arm hurt, and the next day was taken to the doctor. According to the family, he thought that some cartwheels she did earlier in the week might have caused the arm pain. As for her other symptoms, the doctor suspected strep throat and an ear infection; he took a throat culture and prescribed antibiotics. Reassured, the Ahrendts left for a camping trip in upstate New York, near Lake George.

The vacation came to an abrupt end when Kelly became feverish and began hallucinating. Despite intensive care at three different hospitals and the best efforts of doctors to figure out what was wrong, she kept getting worse. She had muscle spasms, salivated uncontrollably and suffered bouts of terror. She recoiled from her mother and father and even her own hair. During one lucid moment the little girl told her parents, "I'm sorry, I know I shouldn't be afraid of you, but I can't help it." On July 11, three days before her 12th birthday, she died with doctors still mystified.

It was not until a month later that tests revealed the stunning cause of Kelly's death: rabies. The finding was baffling because the girl had not reported being bitten or scratched by an animal, and all the Ahrendts' pets and livestock had been vaccinated. Though it may never be known how Kelly got the virus, she could have had some contact with an infected animal that she thought nothing of at the time. Rabies is so rare in Americans (Kelly was the first New Yorker to die of it since 1954) that the doctors had little reason to suspect the disease. And by the time they saw her, they probably couldn't have done anything to save her. If they had known much earlier that she had been exposed to a rabid animal, she could have been treated through vaccination. But once symptoms appear (typically 30 to 40 days after infection), the disease is almost invariably fatal.

Since 1980 only 18 people have died of rabies in the U.S., and 10 of those victims became infected in other countries. But the threat is rising. Largely eradicated from pets by vaccination programs, the virus has re-emerged as a widespread problem among wild populations of mammals, particularly raccoons, skunks, foxes and bats. Nationwide, the number of reported rabies cases in animals has almost doubled, from about 4,700 in 1988 to 8,645 last year. Raccoons (4,311 cases) eclipsed skunks (2,334) as the No. 1 carriers. Dr. Charles Rupprecht, chief of the rabies section at the Centers for Disease Control and Prevention (CDC), calls the rapid spread "one of the most intensive wildlife rabies outbreaks in history."

Humans may be partly to blame. In 1977, according to one theory, Virginia's hunters felt there was a shortage of raccoons in the region. As a result, perhaps several thousand raccoons were imported both legally and illegally from Southeastern states, and some of those animals apparently harbored rabies. Since then, raccoon rabies has been moving outward from Virginia and West Virginia at a rate of 25 to 40 miles a year and has invaded all Northeastern states except Vermont, Maine and Rhode Island. In New York, which now leads the nation in animal-rabies cases (1,761 last year), the number of people who got shots after they thought they were exposed to the disease has risen more than tenfold, from 81 in 1989 to 1,088 last year.

While rabies in the U.S. has been confined almost totally to animals, it can still be a human scourge, especially in developing countries. In India 25,000 people died from the disease in 1989. Unofficial estimates of the annual worldwide death toll range from 50,000 to 100,000.

First described 3,800 years ago in Mesopotamia, rabies has always inspired a special terror because of the gruesome and inexorable way it progresses once it takes hold of a victim. It attacks the nervous system, producing symptoms such as irrational furies, fearfulness and foaming at the mouth. The difficulty that patients have in swallowing water or food led to the disease's other common name: hydrophobia. Since the virus moves through the body inside nerve tissue rather than the blood, the disease triggers no antibodies and can't be detected during its incubation. Once it reaches the brain, death is virtually inevitable.

The human response to rabies can be as savage as the disease's symptoms. In 1986 a rabid cat bit a woman in central Pennsylvania. Before long, a mob armed with shotguns and baseball bats approached an enclosure where an 80-year-old man kept dozens of cats. The group fired shots in the air before cooling down and deciding to back off.

Destroying animals, of course, is no way to control the disease. About 60% of the raccoon population would have to be eliminated before the virus would be curbed. A better idea, says CDC's Rupprecht, is to vaccinate wild animals, just as pets are given protection. He helped develop an experimental oral vaccine for raccoons as a research veterinarian at Philadelphia's Thomas Jefferson University and the Wistar Institute, a biomedical research center. The vaccine is contained in bait and dropped into areas where raccoons roam. In tests done in New Jersey, the animals ate the bait, and many of them developed antibodies to the virus.

Rabies is harder to spot than many people think; its carriers do not always appear to be crazed and menacing. In fact, they may seem tame or merely sick, inviting kindly passersby to make the potentially fatal error of coming to their aid. A bite or scratch is not absolutely necessary: two victims have picked up rabies in caves from breathing air contaminated by infected bats.

With a few simple measures, families can minimize the risks. First, they should get pets inoculated, particularly those that might encounter other animals. Last year health officials destroyed 290 rabid cats and 182 infected dogs. In rural and suburban areas, people should keep pets behind fences so they will have little contact with wild animals; garbage and pet food should be kept indoors to discourage furry intruders from entering backyards.

Parents and children should know the warning signals in both pets and wild animals. Loss of coordination, increased aggressiveness or even a strange meow or bark in an unvaccinated pet may be a sign that it should be confined and watched for 10 days. When confronted with a wild animal behaving unnaturally, people should resist the impulse to help and should notify the police. In fact, all wildlife should be observed from a distance. Says Dr. Mark Chassin, New York State health commissioner: "If a nocturnal animal like a raccoon is on a main street at noon in New York, one should assume it's rabid."

If bitten or otherwise exposed, the victim should wash the wound immediately with soap and water and then get medical help. The rabies vaccination, first developed by Louis Pasteur in 1885, used to be an extremely painful series of 14 to 21 shots in the abdomen. In recent years, a much gentler but equally effective set of five shots in the arm has become available.

The vaccination often costs more than $1,000, but that is a small price for stopping the virus. While a disease as old and resilient as rabies may never be eradicated, it can be controlled -- if everyone stays alert to the danger.

With reporting by Hannah Bloch/New York