Rabies and Utah Public Health: Surveillance and Epidemiology

Dallin Peterson

Zoonotic/Vectorborne Epidemiologst

Utah Department of Health

Rabies and Public Health

• Who wrote the first record of canine rabies?

– Cardanus (1525 A.D.)

– Homer in the Iliad ( 850 B.C.)

– Democritus (500 B.C.)

– Aristotle (4th century B.C.)

Question 1

• Celsus (Greek Physician)

• American Settlers-Madstones

Historical Treatments

Pasteur and Prophylaxis (PEP)

• 1885 Rabies PEP

• Joseph Meister

Rabies in Utah

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Linear (Bat)

• How does rabies develop in humans?

a. Viremia in blood stream

b. Migrates along the nervous system

c. Both a and b

d. Neither a or b

Question 2

Brief Pathway of Rabies

Human Rabies Signs and Symptoms

• Prodromal Phase

• Neurologic Phase

Clinical Illness

• Duration of illness is 7-10 days

– Respiratory paralysis

• Almost always fatal

• Human

– Average 3-8 weeks

– 9 day incubation period

• Animals

– Average 1-3 months

Incubation Period

• What animals vectors do we need to worry about being infected with rabies?

Question 3

Animal Vector and Non-VectorVectors Non-Vectors

Wildlife Reservoirs for RabiesDistribution of Major Rabies Virus Variants, 2008 to 2014

Source: CDC.gov/rabies

Animal Clinical Symptoms

• Two common types of rabies

– “Furious” rabies

– Paralytic or “dumb” rabies

When can an animal transmit disease?

• Depends on animal and strain of virus

Animals showing no symptoms may transmit disease!

What is an exposure?

• Two types:

– Bite Exposure

– Non-Bite Exposure

• Modes of Transmission

– Bite

– Scratch

– Breaks in the skin

– Mucous Membrane

– Airborne

What to do following possible exposure?

1. Don’t panic

2. Clean the wound with soap and water

3. Seek medical attention

4. Consult with health department

Testing Flow Chart

Animal Quarantine

• Human exposure from domestic animal

• Vaccinated domestic animal from wild animal

• Unvaccinated domestic animal from wild animal

• Human exposure from wild animal

Post-Exposure Prophylaxis (PEP)

• Should begin as soon as possible following exposure

– Medical urgency, not emergency

• PEP

– Rabies Immune globulin (RIG) (Day 0)

– Four doses of rabies vaccine (Days 0, 3, 7, and 14)

Pre-Exposure Prophylaxis

• High risk groups

• 3 doses of rabies vaccine on days 0, 7, and 21 or 28

• Does not eliminate need for health care following exposure

• Reduces # vaccinations following exposure

• May provide protection when exposure not apparent

• Clean wound

• No Rabies Immune Globulin

• Vaccine 1.0 mL on day 0 and 3

Post exposures PEP for Previously Immunized Individuals

Rabies Appeal Document

• For a 170 pound person

• 10.3 ml HRIG = 6 x 2ml vials @ $131 = $ 786

• 4 vials rabies vaccine @ $203 = $ 812Total biologicals cost $ 1,598

Programs for underinsured or uninsured

• http://www.cdc.gov/rabies/medical_care/programs.html

Post-exposure Cost

Rabies Vaccines • Purified Chick Embryo Cell Vaccine

(PCEC)

• Human Diploid Cell Vaccine (HDCV)

• Adverse reactions

Animal Laboratory Testing• Euthanized animal

• Leak-proof container with wet ice

• Received within 72 hours of collection

• Complete Rabies Test Request Form

• Contact Public Health for Requisition Form– http://health.utah.gov/epi/diseases/rabies/UDOH_Rabies_Testing_Request_Form.

pdf

• What measures would you take if this circumstance?

– You receive a phone call from an individual who one morning, found a dead bat on the floor after waking up.

Question 4

Laboratory Testing

• Animal

–Direct Fluorescence Antibody (DFA)

– Tissue from the animal’s brain

Positive test

Negative test

Human Laboratory Testing

• Antemortem Specimens

– Saliva

– Neck Biopsy

– Serum

– Cerebral Spinal Fluid

• Postmortem– Brain biopsy

• Consult with State Health Department before specimens collection

Rabies Testing Request Form

Source: http://health.utah.gov/epi/diseases/rabies/UDOH_Rabies_Testing_Request_Form.pdf

Questions?