Clinical rabies in an HIV-positive pregnant mother with surviving newborn

Abstract

In South Sudan, rabies is a serious public health burden with an estimated 204 deaths per year. According to the Global Alliance for Rabies Control 2024 report, this is exacerbated by limited dog vaccination coverage and high annual cost of rabies treatment and control, with approximately 9,290 people receiving post-exposure prophylaxis (PEP) annually. In Pariang and the surrounding area, dog bites are very common. In the last two years, four patients died in the hospital due to clinical rabies. Reported cases of clinical rabies in pregnancy with surviving infants are very rare. A 2019 non-systematic review reported only 16 cases worldwide, with four identified in Africa. There
are few reported cases of rabies exposure among Human Immunodeficiency Virus (HIV) positive individuals, but none of them was in pregnancy. This is a case report of an HIV-positive pregnant mother who was referred to Pariang Civil Hospital at 37 weeks of gestation with a history of a dog bite six weeks previously, restlessness, inability to swallow, hydrophobia, vomiting, fear, hypersalivation, and fever. Diagnosis of clinical rabies in pregnancy was made, and an emergency Caesarean Section was done with a live baby girl. The mother died 49 hours after delivery. The baby received nevirapine syrup at birth and tested negative for HIV at six weeks and at nine months but does not seem to have received rabies vaccine. One year later, she has no symptoms of rabies. This case report highlights the unique co-occurrence of clinical rabies and HIV infection in a pregnant mother, with a good outcome for the newborn. Community awareness, ensuring the availability of rabies vaccines in all health facilities, plus mass vaccination of dogs and the elimination of street dogs may
help reduce rabies cases in Greater Pariang and South Sudan at large.