Rabies Outbreak in HIV-Positive Woman Raises Concerns About Public Health in Africa

Strategic Insights -

Researchers at the University of Zambia have reported a rare case of rabies in a pregnant woman living with HIV. The woman, in her eighth pregnancy, presented with neurological symptoms after being bitten by dogs 20 days prior. Despite receiving antiretroviral therapy and post-exposure prophylaxis, the disease rapidly progressed to rabies encephalitis, leading to her death six days later. The case highlights the need for improved knowledge and best practices in wound management and post-exposure response in Africa.

Key Takeaways:

  • The case study reports a rare instance of rabies in a pregnant woman living with HIV, where the disease rapidly progressed to rabies encephalitis despite receiving appropriate medical treatment.
  • The woman's compromised immunity due to low CD4 T-cell count and non-adherence to recommended best practices for wound management and PEP administration may have contributed to the rapid disease progression.
  • The case emphasizes the importance of capacity building for health workers and the community to improve knowledge of rabies post-exposure response in Africa.
  • The researchers highlight the need for better knowledge and best practices in wound management and post-exposure response in Africa to prevent such cases.
  • 30-year-old woman living with HIV and pregnant at the time of the case.
  • Received a 4-dose regimen of rabies post-exposure prophylaxis (PEP) starting 2 days after exposure.
  • Wound washing was not performed, and rabies immunoglobulin was not administered as recommended by the World Health Organization for category 3 exposures.
  • The disease rapidly progressed to rabies encephalitis, leading to death within 6 days of admission.
  • Reverse transcriptase polymerase chain reaction (RT-PCR) performed on cerebral spinal fluid (n = 3) and nasopharyngeal swabs (n = 2) confirmed the diagnosis of rabies infection.

Statistics:

  • The woman was in her eighth pregnancy at the time of the case.
  • She had a low CD4 T-cell count of 382.
  • The disease rapidly progressed to rabies encephalitis within 6 days of admission.
  • The case highlights the need for improved knowledge and best practices in wound management and post-exposure response in Africa.
  • 4-dose regimen of PEP was administered to the woman starting 2 days after exposure.
  • Wound washing and administration of rabies immunoglobulin as recommended by the World Health Organization were not performed.

Sources:

  • NewsRx. University of Zambia Researchers Provide Details of New Studies and Findings in the Area of HIV/AIDS (Pathogenesis of rabies in a pregnant HIV immune-compromised woman in Zambia: A case report). AIDS Weekly. October 20, 2025; p 247.
  • Pathogenesis of rabies in a pregnant HIV immune-compromised woman in Zambia: A case report. Journal of Public Health in Africa, 2025,16(1):e1-e4. (Journal of Public Health in Africa - http://www.publichealthinafrica.org)
  • AOSIS. Journal of Public Health in Africa. 2025.
  • University of Zambia. Department of Disease Control. School of Veterinary Medicine. Lusaka, Zambia.