Human rabies---Virginia, 2009.

On October 28, 2009, CDC notified the Virginia Department of Health (VDH) of suspected rabies in a Virginia man aged 42 years. Earlier that day, an infectious disease physician in Virginia had contacted CDC requesting confirmatory diagnostic testing and reported initiating treatment with the Milwaukee protocol after consultation with staff at the Medical College of Wisconsin. This report summarizes the patient's exposure history, clinical course, and treatment, and describes efforts to identify close contacts requiring postexposure prophylaxis (PEP). According to family members, the patient had reported an encounter with a dog while in India approximately 3 months before symptom onset. On October 29, infection with a rabies virus was confirmed by direct fluorescent antibody testing of a nuchal skin biopsy, and reverse transcription-polymerase chain reaction (RT-PCR) typed the virus as a variant associated with dogs in India. The patient died on November 20. Public health authorities conducted rabies exposure assessments of 174 persons associated with the patient, and 32 persons (18%) initiated rabies PEP. This is the seventh case of rabies reported in the United States acquired abroad since 2000. This case highlights the importance of raising public awareness of rabies, particularly the risk for rabies exposures in association with travel to rabies-endemic countries, and the importance of initiating PEP promptly after a potential exposure.