One Health investigation of the first human rabies death linked to a clinically suspected rabid bull calf in Bangladesh

Rabies is a fatal and neglected zoonotic disease that remains endemic in Bangladesh. Most human cases result from dog bites, and it is not uncommon for livestock to be bitten by dogs. This report presents the first known clinically diagnosed human rabies case in Bangladesh associated with exposure to infected livestock. The case involved a 65-year-old male farmer from rural Bangladesh who died of clinically diagnosed rabies after a minor, unrecognized exposure to a bull calf suspected of having rabies. The man suffered very little hand injuries while feeding the calf, which had been showing progressive neurological symptoms consistent with rabies. Despite medical advice, he did not receive post-exposure prophylaxis (PEP), largely due to negligence. Thirty-four days after the exposure, the man began to exhibit early symptoms of rabies, including limb weakness, neck and back pain, anxiety, and early signs of hydrophobia. The illness quickly progressed to the classic features of furious rabies, such as severe hydrophobia, aerophobia, confusion, and agitation. He died 41 days after the initial exposure. This case triggered fear and panic in the local community, reflecting a broader lack of awareness about rabies, particularly its transmission from non-traditional hosts like livestock. The incident highlights the severe consequences of inadequate awareness and delayed or missed PEP following potential rabies exposure. It emphasizes the urgent need to raise public awareness about all possible transmission routes, ensure timely access to PEP for both humans and animals, stray dog vaccination and strengthen public-veterinary health collaboration in Bangladesh.