Rabies Exposure from Infected Horse Bite in an Urban Setting: A Case Study from Mongolia

Abstract

Rabies is a highly fatal zoonotic disease that causes an estimated 60,000 human deaths each year, many of which occur in Africa and Asia where the disease is likely underreported. Uncontrolled transmission of rabies presents a major threat to public health in countries such as Mongolia, where 26% of the population lives a pastoralist lifestyle characterized by increased interaction with livestock animals. Here, we report a case of rabies exposure in a six-year-old male after being bitten by a horse in both the head region and the leg. At the suspicion of rabies, post-exposure prophylaxis (PEP) was initiated, with the patient receiving four doses of PEP vaccine as well as a single treatment of rabies immunoglobulin. The horse was later confirmed to be rabies-positive through rapid antigen testing and RT-PCR. Human rabies exposure from horses is unusual within Mongolia, given that historically over 70% of human rabies cases within the country are attributed to dogs, wolves, or foxes. This case further emphasizes the need for more routine vaccination of domestic animals within Mongolia. Additionally, animal bites, even from animals not frequently associated with rabies, should be treated as possible rabies exposure events.