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???