rabies: review and guidelines updates julia murphy, dvm, ms, dacvpm state public health veterinarian...

Rabies:Rabies: Review and Guidelines Review and Guidelines

UpdatesUpdatesJulia Murphy, DVM, MS, DACVPM Julia Murphy, DVM, MS, DACVPM State Public Health VeterinarianState Public Health Veterinarian

Division of Environmental EpidemiologyDivision of Environmental EpidemiologyOffice of EpidemiologyOffice of Epidemiology

Why rabies?Why rabies?

20,000 – 40,000 people exposed to rabies 20,000 – 40,000 people exposed to rabies each year in U.S.each year in U.S.

Infection is almost always fatalInfection is almost always fatal

Public health costs (detection, prevention, Public health costs (detection, prevention, control) > $300,000,000 annually in U.S.control) > $300,000,000 annually in U.S.

Rabies is endemic in VirginiaRabies is endemic in Virginia

Rabies in the NewsRabies in the News

Richmond Times DispatchRichmond Times DispatchThursday, February 9, 2006Thursday, February 9, 2006


NEWS RELEASE

FOR IMMEDIATE RELEASE: April 13, 2006

Rabid Raccoon Found in the Pungo/Blackwater Area of Virginia BeachOn April 10, 2006, a Virginia Beach resident collected a raccoon on the 1500 block of Morris Neck Road. When the animal was found, it was apparently injured. As a result, the raccoon was turned over to a licensed animal rehabilitator. Within 24 hours, the raccoon started to display symptoms of rabies and died shortly after. Specimens of the raccoon were submitted to the Norfolk Department of Public Health – Bureau of Laboratories on April 11, 2006.

Three rabid animals, all raccoons, have been identified in Virginia Beach this calendar year.


Richmond Times DispatchRichmond Times DispatchWednesday, August 2, 2006Wednesday, August 2, 2006


85-year-old wards off attack by rabid cat85-year-old wards off attack by rabid catBY JEFF STURGEON Feb 7, 2007BY JEFF STURGEON Feb 7, 2007ROANOKE -- Bleeding from three bites and ROANOKE -- Bleeding from three bites and wearing only the housecoat she had on to wearing only the housecoat she had on to retrieve her newspaper, an 85-year-old woman retrieve her newspaper, an 85-year-old woman upended an attacking, rabies-crazed cat. With upended an attacking, rabies-crazed cat. With her hand tight around its tail, she beat the feline her hand tight around its tail, she beat the feline into submission against a nearby utility pole in into submission against a nearby utility pole in front of her house.front of her house.

Rabies - OutlineRabies - Outline

VirusVirus

Disease and diagnosisDisease and diagnosis

Animal epidemiology – U.S. and VAAnimal epidemiology – U.S. and VA

Human epidemiology – U.S. and VAHuman epidemiology – U.S. and VA

Domestic animal controlDomestic animal control

Human preventionHuman prevention

Commonly asked questionsCommonly asked questions

Rabies VirusRabies Virus

Rhabdovirus – bullet shapeRhabdovirus – bullet shape

Inactivated by drying, high temperatures, Inactivated by drying, high temperatures, sunlight, most disinfectantssunlight, most disinfectants

Survives freezingSurvives freezing

Rabies Virus - TransmissionRabies Virus - Transmission

Most commonly through the bite and virus-Most commonly through the bite and virus-containing saliva of an infected animalcontaining saliva of an infected animalVirus can Virus can not not enter intact skinenter intact skinOther possible routesOther possible routes Contamination of mucous membranes Contamination of mucous membranes Scratches - only if contaminated with wet Scratches - only if contaminated with wet

saliva or CNS materialsaliva or CNS material AerosolAerosol Transplantation Transplantation

Rabies virus-PathogenesisRabies virus-Pathogenesis

Virus enters the bodyVirus enters the body

Virus enters NM junctionsVirus enters NM junctions

Travels via peripheral nerves to spinal Travels via peripheral nerves to spinal cordcord

Then to brain stem and forebrainThen to brain stem and forebrain

Rabies virusRabies virus

incubationincubationexposureexposure sheddingshedding signssigns deathdeath

Dogs/Dogs/ 10 d-6 m10 d-6 m 0-5d0-5d 0-8d0-8dCatsCats

HuHu 5d-6y5d-6y 2-14d2-14d

OtherOther ?? ?? ??

Rabies Virus - VariantsRabies Virus - Variants

Associated with certain animal Associated with certain animal speciesspecies

Associated with certain geographic Associated with certain geographic areas (except bats)areas (except bats)

Spillover to other speciesSpillover to other species

Vaccines protect against all variantsVaccines protect against all variants

Rabies Virus - VariantsRabies Virus - Variants

Reservoirs of virus variants, U.S.Reservoirs of virus variants, U.S. RaccoonRaccoon SkunkSkunk FoxFox CoyotesCoyotes Bats – several speciesBats – several species

Distribution of Major Terrestrial Reservoirs of Rabies in the United States and Puerto Rico

Rabies Animal Epidemiology, VARabies Animal Epidemiology, VA

Two terrestrial wildlife rabies variants – Two terrestrial wildlife rabies variants – raccoon and skunkraccoon and skunk Spillover to other wild and domestic animalsSpillover to other wild and domestic animals Raccoon – endemic in most areas with Raccoon – endemic in most areas with

cyclingcycling Skunk – confined to southwest VA Skunk – confined to southwest VA

Multiple bat variants Multiple bat variants Occasional spilloverOccasional spillover

Rabies – risk of transmission by Rabies – risk of transmission by animal typeanimal type

High riskHigh risk Carnivores (raccoons, skunks, foxes)Carnivores (raccoons, skunks, foxes) Large rodents (groundhogs in raccoon areas)Large rodents (groundhogs in raccoon areas) Opossums (in raccoon endemic areas)Opossums (in raccoon endemic areas) BatsBats

Low riskLow risk Small rodents (squirrels, chipmunks)Small rodents (squirrels, chipmunks) Rabbits, haresRabbits, hares

Evaluate circumstancesEvaluate circumstances Exotic animals/hybridsExotic animals/hybrids LivestockLivestock

Rabies - Animal EpidemiologyRabies - Animal Epidemiology

Rabies – Wild Animal Rabies – Wild Animal Epidemiology, U.S.Epidemiology, U.S.

Rabies - Domestic Animal Rabies - Domestic Animal Epidemiology, U.S.Epidemiology, U.S.

Domestic Animal EpidemiologyDomestic Animal Epidemiology

Animal Rabies Statistics-VirginiaAnimal Rabies Statistics-Virginia SpeciesSpecies 20042004 2005 20062005 2006

Raccoons 267 247 311Raccoons 267 247 311Skunks 89 122 156Skunks 89 122 156Foxes 56 57 80Foxes 56 57 80Bats 17 24 17Bats 17 24 17Cats 25 28 39Cats 25 28 39Cows 10Cows 10 6 8 6 8DogsDogs 3 3 4 6 4 6BobcatsBobcats 1 1 1 6 1 6SheepSheep 0 0 6 0 0 6 << 5/yr = beaver, coyote, deer, donkey, goat, groundhog, 5/yr = beaver, coyote, deer, donkey, goat, groundhog, horse, horse,

opossum, otter, rabbit, ratopossum, otter, rabbit, rat

Number of Rabid Raccoons and Total Number of Rabid AnimalsVirginia, 1980 - 2006

0

100

200

300

400

500

600

700

8001

98

0

19

81

19

82

19

83

19

84

19

85

19

86

19

87

19

88

19

89

19

90

19

91

19

92

19

93

19

94

19

95

19

96

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

Year

Nu

mb

er

Ra

bid

All Animals

Raccoons

Percent of Animals Testing PositiveVirginia, 1989 - 2006

0%

2%

4%

6%

8%

10%

12%

14%

16%

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

Year

% P

osi

tive

% positive

Human Rabies Epidemiology, U.S.Human Rabies Epidemiology, U.S.

51 cases, 1990 – 2006 51 cases, 1990 – 2006

10 (21.3%) infected outside US10 (21.3%) infected outside US Often regions with canine variantOften regions with canine variant

Majority of cases bat associatedMajority of cases bat associated History of a bite established in only a History of a bite established in only a

few casesfew cases

Rabies-Symptoms in HumansRabies-Symptoms in Humans

Initial clinical symptoms include anxiety, Initial clinical symptoms include anxiety, headache, mild fever, irritation at bite siteheadache, mild fever, irritation at bite site

Progresses to muscle spasms, difficulty Progresses to muscle spasms, difficulty swallowing, hydrophobiaswallowing, hydrophobia

Clinical course is typically shortClinical course is typically short

Human Rabies EpidemiologyHuman Rabies EpidemiologyVirginia CasesVirginia Cases

1953 – veterinary hospital worker1953 – veterinary hospital worker Unknown exposureUnknown exposure

1998 – prisoner in work program1998 – prisoner in work program Unknown exposureUnknown exposure Pipistrel/silver-haired bat variantPipistrel/silver-haired bat variant

2003 – office worker2003 – office worker Unknown exposureUnknown exposure Raccoon variantRaccoon variant

Rabies – signs and symptoms in Rabies – signs and symptoms in animalsanimals

Clinical presentation is variableClinical presentation is variable

Early – vague, nonspecificEarly – vague, nonspecific

Behavioral – more or less aggressive, Behavioral – more or less aggressive, vocalizationvocalization

Physical – appetite loss, paralysis, Physical – appetite loss, paralysis, seizures, coma, deathseizures, coma, death

Behavior or physical signs or symptoms Behavior or physical signs or symptoms that are clearly abnormalthat are clearly abnormal

Rabies Control – Domestic Animals Rabies Control – Domestic Animals and Humansand Humans

Animal and human Animal and human vaccinationvaccination

Animal controlAnimal control

Pre- and Pre- and postexposure postexposure managementmanagement

Rabies Control – Human ExposureRabies Control – Human Exposure

What constitutes an exposure?What constitutes an exposure? Any bite, scratch, or other situation where Any bite, scratch, or other situation where

saliva or central nervous system tissue from a saliva or central nervous system tissue from a potentially rabid animal enters an open fresh potentially rabid animal enters an open fresh wound or contacts a mucous membrane by wound or contacts a mucous membrane by entering the eye, mouth, or nose.entering the eye, mouth, or nose.

Rabies Control - Human ExposureRabies Control - Human Exposure

Scratches:Scratches: A scratch should be evaluated like any other A scratch should be evaluated like any other

open wound, i.e. did saliva or some other open wound, i.e. did saliva or some other virus containing material (cerebral spinal fluid, virus containing material (cerebral spinal fluid, brain) contaminate the wound while it was brain) contaminate the wound while it was fresh. A scratch in and of itself fresh. A scratch in and of itself is notis not an an exposure unless the paws were soaked with exposure unless the paws were soaked with saliva, e.g., cat is salivating/drooling saliva, e.g., cat is salivating/drooling profusely or paws are visibly wet.profusely or paws are visibly wet.

Rabies Control – Domestic Animal Rabies Control – Domestic Animal ExposureExposure

What constitutes an exposure?What constitutes an exposure? Any circumstance where saliva or central Any circumstance where saliva or central

nervous system tissue from a potentially rabid nervous system tissue from a potentially rabid animal did have or could have had direct animal did have or could have had direct contact with mucous membranes or a break in contact with mucous membranes or a break in the skin of a domestic animalthe skin of a domestic animal

Note: The actual witnessing of a bite or Note: The actual witnessing of a bite or attack by a potentially rabid animal is not attack by a potentially rabid animal is not required for an exposure to have occurredrequired for an exposure to have occurred

Rabies Control Guidelines for Rabies Control Guidelines for HumansHumans

Human exposed to a dog, cat, or ferretHuman exposed to a dog, cat, or ferret Any dog, cat, or ferret (vaccinated or Any dog, cat, or ferret (vaccinated or

unvaccinated) that bites a person must be unvaccinated) that bites a person must be confined for 10 days observationconfined for 10 days observation

Veterinary evaluation at first sign of illnessVeterinary evaluation at first sign of illness If thought to be rabies, euthanize and testIf thought to be rabies, euthanize and test Do not vaccinate during confinementDo not vaccinate during confinement Discuss all human exposures with District Discuss all human exposures with District

Health DirectorHealth Director

Rabies Control Guidelines for Rabies Control Guidelines for Domestic Animal ExposureDomestic Animal Exposure

Human bitten by livestockHuman bitten by livestock 10 – 14 day observation (if normal health and 10 – 14 day observation (if normal health and

behavior, no exposure history, area not rabies behavior, no exposure history, area not rabies endemic)endemic)

Consider euthanasia, testing, human PEPConsider euthanasia, testing, human PEP

Rabies Control Guidelines for Rabies Control Guidelines for HumansHumans

Pre exposure seriesPre exposure series High risk occupations: DVMs, ACOs, LVTsHigh risk occupations: DVMs, ACOs, LVTs Titers every 2 yearsTiters every 2 years Boosters Boosters if exposed or low titerif exposed or low titer Should Should nevernever receive RIG receive RIG

Post exposure series (for those Post exposure series (for those

with no prior vaccination)with no prior vaccination) RIG plus five vaccinationsRIG plus five vaccinations

Rabies Control – Domestic Animal Rabies Control – Domestic Animal VaccinationVaccination

Virginia code requires dogs and cats to be Virginia code requires dogs and cats to be vaccinated by 4 months of agevaccinated by 4 months of age

Booster dose given 1 year after initial Booster dose given 1 year after initial vaccinationvaccination

Thereafter, should vaccinate every year or Thereafter, should vaccinate every year or every 3 years, depending on vaccine typeevery 3 years, depending on vaccine type

Encourage use of 3 year vaccineEncourage use of 3 year vaccine

Rabies Control – Domestic Animal Rabies Control – Domestic Animal VaccinationVaccination

Virginia code requires vaccine administration by Virginia code requires vaccine administration by currently licensed veterinarian or veterinary currently licensed veterinarian or veterinary technician under direct supervisiontechnician under direct supervisionVeterinarians must practice in a licensed facilityVeterinarians must practice in a licensed facilityException – rabies clinics outside licensed Exception – rabies clinics outside licensed facilityfacility Governing body finds number of resident Governing body finds number of resident

veterinarians inadequateveterinarians inadequate Clinic approved by LHD and local governmentClinic approved by LHD and local government


ConfinementConfinement House animal in a building, pen, or other House animal in a building, pen, or other

escape-proof method or enclosureescape-proof method or enclosure Do not remove animal unless on leash and Do not remove animal unless on leash and

under control of responsible adultunder control of responsible adult Owner should notify Health Department at first Owner should notify Health Department at first

sign of illness and take to veterinariansign of illness and take to veterinarian


Strict isolationStrict isolation House animal in a kennel at a veterinary House animal in a kennel at a veterinary

hospital, animal control facility, commercial hospital, animal control facility, commercial boarding establishment, or pen at homeboarding establishment, or pen at home

Pen design should prevent direct contact Pen design should prevent direct contact between animal and human or other animalbetween animal and human or other animal

Pen design should allow for feeding, watering, Pen design should allow for feeding, watering, cleaning (see example in Guidelines)cleaning (see example in Guidelines)

District Health Director or designee should District Health Director or designee should approve penapprove pen


Vaccinated dog, cat, or ferret exposed to Vaccinated dog, cat, or ferret exposed to proven or suspected rabid animalproven or suspected rabid animal Should receive immediate booster of vaccine Should receive immediate booster of vaccine Confine for 45 days observationConfine for 45 days observation Veterinary evaluation at first Veterinary evaluation at first

sign of illnesssign of illness If thought to be rabies, If thought to be rabies,

euthanize and testeuthanize and test


Unvaccinated dog, cat, or ferret exposed Unvaccinated dog, cat, or ferret exposed to proven or suspected rabid animalto proven or suspected rabid animal If available, test exposing animalIf available, test exposing animal If exposing animal unavailable, euthanize If exposing animal unavailable, euthanize

exposed animal or 6 months strict isolationexposed animal or 6 months strict isolation Veterinary evaluation at first sign of illnessVeterinary evaluation at first sign of illness If thought to be rabies, euthanize and testIf thought to be rabies, euthanize and test Vaccinate exposed animal before release Vaccinate exposed animal before release

from 6 months isolationfrom 6 months isolation


Dog, cat, or ferret with expired vaccination Dog, cat, or ferret with expired vaccination exposed to proven or suspected rabid animalexposed to proven or suspected rabid animal Immediate booster to exposed animal (unless Immediate booster to exposed animal (unless

euthanized)euthanized) If available, test exposing animalIf available, test exposing animal If exposing animal unavailable, 6 months strict If exposing animal unavailable, 6 months strict

isolation for exposed animalisolation for exposed animal Contact Office of Epidemiology to discuss situations Contact Office of Epidemiology to discuss situations

wherewhere vaccination is recently expiredvaccination is recently expired


Vaccinated livestock exposed to proven or Vaccinated livestock exposed to proven or suspected rabid animalsuspected rabid animal Immediate boosterImmediate booster If available, test exposing animalIf available, test exposing animal Confine in manner routine for speciesConfine in manner routine for species 45 day observation45 day observation


Unvaccinated livestock exposed to proven Unvaccinated livestock exposed to proven or suspected rabid animalor suspected rabid animal Euthanize immediately, orEuthanize immediately, or 6 months physically separated from 6 months physically separated from

unexposed animals if possibleunexposed animals if possible If available, test exposing animalIf available, test exposing animal

Rabies ResourcesRabies Resources

www.vdh.virginia.gov

www.cdc.gov

www.aphis.usda.gov/ws/rabies/index.htmlwww.aphis.usda.gov/ws/rabies/index.html

Rabies Control Rabies Control Messages for the PublicMessages for the Public

Keep rabies vaccinations up-to-date on dogs, Keep rabies vaccinations up-to-date on dogs, cats, and ferretscats, and ferretsSupervise pets so they do not come into contact Supervise pets so they do not come into contact with wild animalswith wild animalsCall animal control to remove straysCall animal control to remove straysEnjoy wild animals from afarEnjoy wild animals from afarNever adopt wild animalsNever adopt wild animalsTeach children never to handle unfamiliar Teach children never to handle unfamiliar animalsanimalsPrevent bats from entering living quartersPrevent bats from entering living quarters

rabies: review and guidelines updates julia murphy, dvm, ms, dacvpm state public health veterinarian...

Documents

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symptoms of rabies

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virus variants

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licensed animal rehabilitator

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