rabies investigations: are we chasing our tail? robyn m atkinson, phd tennessee department of health...
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Rabies Investigations: Rabies Investigations: Are we chasing our tail?Are we chasing our tail?
Robyn M Atkinson, PhD
Tennessee Department of Health
EPHLI Cohort IV
RabiesRabies
Genus – Lyssavirus – “rage”
Family – Rhabdoviridae – “Bullet Shaped”
Single stranded, negative sense, RNA virus
Travels along neurons to the brain
RabiesRabies• Canine variant rabies eliminated in 1940’s and 1950’s
• Dogs may be infected with other strain variants – 94 reported in 2004
• Raccoons, skunks, and bats —account for >85% of all reported cases of animal rabies since 1976
• Total of 21 human cases between 2000 – 2004
–15 were due to bat exposures
• No geographic boundaries for bats!
– Makes rabies endemic in contiguous US
• Every year approximately 16,000–39,000 persons receive post-exposure prophylaxis
Rabies Disease in AnimalsRabies Disease in Animals• Incubation period- unknown – can be up to 6 months or longer
• Symptoms similar to those of humans:– Hydrophobia, aerophobia, hypersalization, confusion, aggression
• No good experimental model to study natural infection
• Ironically, we DO NOT accept human specimens!
• Test only animal brains
• The animal must have either bitten or exposed a human or vaccinated family pet
• I.E. - a raccoon or a family dog bitten by a raccoon
• Reports on tested animals are sent to the provider/submitter, local regional epidemiology, and state epidemiology
• Stress the importance of pet vaccinations – including cats if outdoors
• DO NOT monitor for surveillance – the USDA-Wildlife Services handles this service
Public Health focus Public Health focus Human IllnessHuman Illness
Concern in TN Concern in TN Raccoon RabiesRaccoon Rabies
Unic
oi
Marion
Hamilton Bradley Polk
Grundy
Sequatchie
Bledsoe
Rhea
Mei
gs
McMinnMonroe
Loudon Blount
RoaneSevier
Knox
Morgan Anderson
Scott
Campbell
Claiborne
GraingerUnion
Hamblen
Jefferson
Cocke
Pickett
Overton
Fentress
Dekalb
Warren
Van
Bure
n
White
Putnam
Cumberland
Hancock
Hawkins
Greene
Was
hing
ton
Sullivan
Carter
John
son
East TN counties East TN counties Raccoon rabies Raccoon rabies
2003 – Nov 26, 2007 2003 – Nov 26, 2007
Slide provided by John Dunn
Wild Versus Domestic Animal Submissions for Rabies Testing 2005
1349
668
2460
200
400
600
800
1000
1200
1400
1600
WILD DOMESTIC
Animal Type
Nu
mb
er o
f S
ub
mis
sio
ns
TOTAL
POSITIVE
6.89% 0.15%
Eleven Most Common Animal Species Submitted in 2005
1 0 0
576
695
182023242833
109
184
254
4 0003123160
100
200
300
400
500
600
700
Animal Species
Nu
mb
er
TOTAL
POSITIVE
Time
Canine Rabies
# of Domestic Animals received for testing
Incidence of Raccoon and Skunk Rabies
# of Domestic Biting Animals Reported
Epidemiology Involvement
Variables Over Variables Over Time GraphTime Graph
# of Domestic animals submitted for testing
Epidemiology to screen all
submissions
Limit testing to animals that have demonstrated
a true risk for rabies transmission
Organized checklist to perform a risk-based
assessment to identify animals with true risk of
transmitting rabies
Epidemiology over-worked and cannot
keep up with demand
B
R
B
The lab is expected to test all
specimens submitted without asking questions
Epidemiology’s job is to protect the
public so we only become involved in
cases that are positive.
“I am not going to be the one
who gets sued because the
animal was not tested and
someone died.”
The lab is losing money because of
un-restricted and un-
necessary testing
Epidemiology time and
resources are compromised limiting their
ability to achieve the fundamental
solution
Shifting-the-Shifting-the-BurdenBurden
Program Goals:
1) To create a consistent Rabies/animal bite investigation protocol allowing for better risk assessment and communication among all stakeholders.
2) To reduce the number of domestic animals submitted for laboratory testing to those animals with a true risk of infection.
Outcome Objective:
By June 30, 2009, reduce the number of domestic animal heads submitted for testing by 50% of the previous year (July 1, 2007 to June 30, 2008).
Determinant:
The number of domestic animal heads submitted for rabies testing at Knoxville Regional Laboratory.
Focusing Question:
Why are so many domestic animal heads submitted for rabies testing?
1. By February 28, 2009, a common case investigation protocol will be ready for implementation.
Monthly meeting of all stakeholder representatives
2. By April 30, 2009, all stakeholders will be educated as to the current epidemiology of rabies in Tennessee, the current literature regarding the biology of rabies virus transmission, and the use of the new case investigation protocol.
In-service/training for all animal control partners, all county environmentalists, and all animal shelter personnel. Continuing Education Seminars for veterinarians
3. By June 30, 2009, stakeholders will create a handout or brochure for the community that outlines the social, legal, and medical aspects of a possible rabies exposure and provides information on where to seek assistance in the event of an animal bite or exposure.
Yearly rabies vaccination clinics
Program ObjectivesProgram Objectives
Current StatusCurrent Status• Began monthly meetings in August of 2008
• As of January 2009 meeting:
• outlined all stakeholders roles in an investigation
• established criteria for home observation
• determined that a public health representative will be contacted in the event a biting animal is ill and requires euthanasia and testing
• Working with one county as the process evolved:
• Reduced numbers of heads by 63%
• Cost savings for the laboratory ~ $ 3,480
• Beginning work on education materials for stakeholders and public
National National Environmental Environmental Health ServicesHealth Services
This project meets 6 of the 10 essential services:
• Inform, Educate, and Empower• Assure a competent workforce • Link people to needed services • Enforce Laws and Regulations• Develop Policies and Plans• Mobilize Community Partnerships
Questions???Questions???
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