U.S. Army Pvt. Valerie McCants, assigned to the 64th Medical Battalion, prepares one of 150 doses of rabies vaccine administered to pets in Monrovia, Liberia. Photo credit: The Department of Defense.

Infectious Diseases
Rabies: One of the World’s Oldest and Deadliest Threats to Military Soldiers
By Tom Adams, Publisher

I had the great pleasure of speaking with Peter Costa recently, founding co-organizer of the annual observance that’s become known as “World Rabies Day”, and discussing the very serious threat that Rabies, one of the world’s oldest recorded diseases, still poses to U.S. Military personnel serving both domestically and abroad.

Peter Costa has worked with the Veterinary Medical Corps, helping educate military personnel in Afghanistan and other nations about this disease and raise awareness to bring improvements
in prevention measures and medical response following an exposure.

“Soldiers were positioned on base perimeters to monitor for feral animal activity, because of the higher risks of infection to animals in those countries and the higher risks for them to
transmit the Rabies infection to humans. Instruction was given on ways to prevent animal to human contact whenever possible, but unfortunately exposures still happen as was the case several
years ago when a solder died after coming back from deployment overseas.” Rabies continues to be one of the world’s most deadly diseases. “Despite all of the emerging infectious diseases that our hospitals are up against, and including our U.S. Military, which is going into countries that are higher-risk for Rabies infection as well as a variety of other serious health issues, Rabies continues to be the deadliest disease. Of all the infectious diseases we hear about on the news such as Ebola, Zika, MERS, SARS, and recently a rise in Yellow Fever, Rabies continues to have the highest case fatality rate of any disease and kills 99.9 percent of those who become infected.”

Military health experts agree that education should begin at the pre-deployment stage, during the initial preparation of readiness. Whether or not soldiers will ever be exposed is secondary, the fact remains that if they do get exposed, their chance of survival depends on receiving prompt and proper medical care from qualified and educated health care providers. Kedrion Biopharma, the company for which Peter Costa now works, presented a poster at last year’s International Rabies in the Americas (RITA) Conference to highlight their human rabies immune globulin (HRIG), which can be stored at room temperature for up to one month. HRIG, and the rabies vaccine series along with thorough washing of wounds provides 100% protection as long as the exposure is treated in a timely manner.

[CPI] Cold-chain storage of rabies biologics has long been a topic of concern for treating rabies exposures in locations where proper refrigeration cannot be guaranteed and is often discussed at the annual RITA Conference by the world’s leading rabies researchers and scientists. Notably, Kedrion Biopharma’s HRIG product is the only HRIG with 30-day room temperature stability, which
helps reduce waste through loss prevention. The extended temperature stability may also be beneficial for use in remote areas, non-acute settings and field-based medical applications such as
wilderness medicine and armed forces operations.

Peter Costa stated that, “During my time working with the Veterinary Medical Corps, we promoted specific posters developed by the U.S. Army Public Health Command showing the basic educational points needed most for rabies prevention. The Military has so many possible areas that can be connected to the disease and this also includes a veterinary component for vaccinating and protecting working animals, guard dogs and recovery animals that are coming back into the United States”.

Costa’s current education to U.S. medical providers also includes information about a recent change to the HRIG market landscape, where a new formulation was introduced by Grifols. This formulation is a different concentration than what has been the industry standard for nearly 50 years and may cause confusion among medical providers. “This concentration change brings with it operational, clinical, and medication safety considerations, which all medical personnel must be made aware of in order to make informed treatment decisions. We have been working extensively over the past few months to describe what changes have occurred and how it impacts hospitals and practice guidelines/protocols for rabies post-exposure prophylaxis.”

Peter Costa is a public health educator and epidemiologist by training. He received a master’s degree in public health and went on to become a master certified health education specialist. He
has been recognized for his contributions to veterinary public health and human health with an honorary diploma from the American Veterinary Epidemiological Society. In 2006, the U.S.
CDC conducted a national search looking for a public health educator to help spearhead their global rabies education campaign.

They had done a national search through the state health departments, where at the time Costa was working at the North Carolina Division of Public Health and their State Public Health
Veterinarian mentioned it to him. Costa applied for the position and was selected to help a nonprofit group called the Global Alliance for Rabies Control launch a new program that is now known across the globe as World Rabies Day. This annual event is recognized by the United Nations and during 2007-2012 Costa directed all of the global awareness, education and communication efforts around Rabies prevention in over 150 countries. He dealt with religious issues, cultural barriers, and understanding why certain people are dying from rabies in different areas, and how to work with the Ministries of Health and Agriculture to help prevent the disease.

He helped to clear up misunderstandings and myths about Rabies and conceptualized novel programs like the Rabies Educator Certificate to encourage more individuals to pursue specializing
in rabies education. Costa continues to stay active in the rabies prevention community and currently serves on the International Steering Committee for Rabies in the Americas, and works with the Public Library of Science (PLOS) Neglected Tropical Diseases journal to review and edit publications on Rabies. And while he now devotes much of his time to Kedrion Biopharma,
the company that markets KEDRAB (Rabies Immune Globulin [Human]), he remains active in helping to fill the public health gap that still exists in preventing rabies — despite the long history of the disease.

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