In June 2002, ten students and two teachers from a King County middle school spent two weeks in Ecuador, primarily in rural areas. Shortly after returning home, two members of the group were reported to Public Health with enteric infections. During routine investigation of the enteric illnesses, Public Health learned that, while staying at a resort in Ecuador, the students had also had direct contact with a coatimundi, a wild mammal in the raccoon family.

All members of the group were contacted; four of the students reported direct contact with the coatimundi, resulting in either a bite or scratch. At the time, resort staff told the group that no medical follow-up was needed because the animal was a domesticated pet, and it was "current on all its shots". Although kept as a pet by the resort, the coatimundi is a wild animal species and there is no rabies vaccine licensed for such animals. Ecuador, like many areas of the developing world, is highly endemic for rabies. Additionally, the signs and symptoms of rabies in wildlife are not clear-cut, and a healthy-appearing wild animal can still expose humans to rabies. The incubation period for rabies in wild animals has not been established, so quarantine of a wild animal for a known time period, as is done with dogs, is not helpful in determining the need for rabies post-exposure prophylaxis (PEP).

According to the Centers for Disease Control and Prevention (CDC), rabies PEP is recommended for a bite from a wild animal, unless the animal has been euthanized and the brain tests negative for rabies. Rabies PEP may be considered for lower-risk exposures, such as a scratch from a wild animal, on a case-by-case basis. The benefits and risks of rabies PEP were discussed with the four persons reporting bite or scratch exposures; all four elected to initiate rabies PEP.

In many areas of the world rabies remains highly endemic. All travelers to developing countries should be warned about the risk of exposure to rabies, told to avoid contact with all animals, and advised to seek immediate medical evaluation if a bite or scratch exposure occurs. Additionally, all travelers should be instructed to reduce the risk of rabies after a bite or scratch by immediately and thoroughly washing the wound with soap and water. The need for tetanus prophylaxis and other wound management following a bite exposure should also be evaluated. Although rabies vaccination is not required in order to enter developing countries, pre-exposure vaccination may be recommended for persons who will be: 1) visiting remote areas where medical care is difficult to obtain or may be delayed, or 2) staying longer than one month in an area where dog rabies is common. To report an animal bite to Public Health, call (206) 296-4774 or the 24-hour hotline at (206) 296-4782. If you have questions about rabies PEP or reporting animal bites, contact Eric Winder at (206) 205-3053. For more information about rabies PEP, go to the following sites and select "rabies": www.metrokc.gov/health/prevcont, or www.cdc.gov/health/default.htm

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