Assessment of rabies exposure risk in a group of U.S. Air Force basic trainees - Texas, January 2014.

In January 2014, members of the Joint Base San Antonio (JBSA)-Lackland, Texas, preventive medicine and public health teams evaluated a U.S. Air Force basic training squadron for potential exposure in sleeping bays to rabies virus carried by Mexican free-tailed bats (Tadarida brasiliensis). Exposure to bats while asleep or otherwise unaware is an important risk factor for rabies in the United States. Over the past several decades, most indigenous human rabies infections in the United States have resulted from the bite of an infected bat, and the bite was not reported in more than half of the cases. Mexican free-tailed bats in Texas often carry rabies virus. Among 8,904 bats tested during 2001-2010, a total of 1,558 (18%) tested positive for rabies. To assess the risk to the Air Force trainees and identify those for whom rabies postexposure prophylaxis (PEP) might be indicated, Lackland preventive medicine and public health teams interviewed 922 persons (866 trainees and 56 instructors) and determined that PEP, consisting of human rabies immune globulin and the 4-dose vaccination series given over 14 days, was indicated for 200 persons (22%). This report describes the public health response to a mass indoor exposure to bats, including group-based rabies risk stratification, adverse reactions to PEP, and infestation remediation. These interventions can be considered for future mass exposures to bats.

Spread of vaccinia virus through shaving during military training, Joint Base San Antonio-Lackland, TX, June 2014.

Although naturally occurring smallpox virus was officially declared eradicated in 1980, concern for biological warfare prompted the U.S. Government in 2002 to recommend smallpox vaccination for select individuals. Vaccinia, the smallpox vaccine virus, is administered into the skin, typically on the upper arm, where the virus remains viable and infectious until the scab falls off and the epidermis is fully intact - typically 2-4 weeks. Adverse events following smallpox vaccination may occur in the vaccinee, in individuals who have contact with the vaccinee (i.e., secondary transmission), or in individuals who have contact with the vaccinee's contact (i.e., tertiary transmission). In June 2014 at Joint Base San Antonio-Lackland, TX, two cases of inadvertent inoculation of vaccinia and one case of a non-viral reaction following vaccination occurred in the security forces training squadron. This includes the first reported case of shaving as the likely source of autoinoculation after contact transmission. This paper describes the diagnosis and treatment of these cases, the outbreak investigation, and steps taken to prevent future transmission.