Vector Control: Rabies, UNC-SPH 1
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Module 2. Rabies Epidemiology and Rabies Prevention and Control
Marilyn Goss Haskell, DVM MPH
NC Certified Rabies Vaccinator Training
Topics
• NC Rabies Epidemiology • Human Rabies Mortality • State Laboratory Public Health Testing
Criteria and Public Health Surveillance • Rabies – reservoirs, high risk vectors;
signs of disease in animals • Incubation and Shedding periods • Animal Control Responsibilities
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Topics (cont’d)
• Rabies Prevention in Humans –Exposure and Transmission –Bat Variant –Pre-exposure prophylaxis –Personal Protection and Behavior –Wound care and reporting
exposures –Post-exposure prophylaxis
• Public Messaging
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Learning Objectives
• Describe the Epidemiology of Rabies in North Carolina, United States and the world (Asia and Africa) and the geographical areas where rabid animals are most likely to occur in our state.
• Describe rabies public health surveillance including the location of written criteria, submission criteria of wild and domestic species of mammals to the NC SLPH and public messaging for rabies incidents.
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Learning Objectives (cont’d) • Discuss the characteristics and prevalence of rabies
including high risk animals that may be reservoirs, clinical and behavioral symptoms that animals may or may not exhibit, the types of body fluids that are infectious and types of exposures (direct, indirect and bat).Discuss the roles and responsibilities of Animal Control.
• Outline rabies prevention measures.
• Describe what rabies post-exposure prophylaxis (PEP) is used for and who should assess people that are exposed for PEP.
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Rabies Epidemiology
6 Source: JAVMA, Vol 243 No. 6, September 15, 2013
Vector Control: Rabies, UNC-SPH 2
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Confirmed Rabid Mammals North Carolina, 1952-2013, n =
11,049
0
100
200
300
400
500
600
700
800
900
19
52
19
57
19
62
19
67
19
72
19
77
19
82
19
87
19
92
19
97
20
02
20
07
20
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Bat Rabies; 1st Identified 1963 Raccoon Rabies; 1st Identified 1991
One human rabies case (ERV*); first NC reported
human rabies since
1955
Source: NC State Laboratory of Public Health Updated January 2014
Human - Last
Reported Canine
Variant case in NC - 1955
*ERV = Eastern Raccoon Variant
Human Rabies Mortality
Worldwide
• Canine Variant overwhelmingly
– ~60,000 deaths per year worldwide
– >99% of human cases
– Asia and Africa mostly
– >50% children < 15 years
• US - past 25 years, a few cases per year
– Bat Variant http://www.who.int/rabies/en/ 9 10 http://slph.ncpublichealth.com/virology-serology/rabies.asp
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Vector Control: Rabies, UNC-SPH 6
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Rabies Positive Mammals by Species, NC 2013
n = 380 positive; 4314 tested
Species % Positive by
Species Tested
Dog 0.6
Cat 1.8
Goat 3.1
Cattle 4.5
Bat 2.2
Raccoon 42.6
Fox 47.7
Skunk 63.2
Total % Positive 8.9
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BAT, 28
CAT, 20
COW, 4
DOG, 5
FOX, 62
GOAT, 2 RACCOON, 204
SKUNK, 55
91.8% Wild mammals
Source: NC State Laboratory of Public Health; Updated February 2014
Rabies Vaccinations Required by Law Dogs, Cats and Ferrets
NCGS 130A-185. Vaccination required
(a) Vaccination required. - The owner of an animal listed in this subsection over four months of age shall have the animal vaccinated against rabies.
(1) Cat.
(2) Dog.
(3) Ferret
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Rabies Positive Dogs and Cats, NC, 1991 - 2013 (n = 512)
0
5
10
15
20
25
30
35
40
45
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
Dog
Cat
VACCINATE YOUR PETS, RABIES KILLS Source: NC State Laboratory of Public Health; Updated January 2014
Vector Control: Rabies, UNC-SPH 7
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Animal Control Responsibilities
• Enforce North Carolina Rabies Laws
(NCGS 130A-184 to 130A-204.)
• Investigate exposures to domestic animals
and humans
• Capture and impound animals
• Implement ten day confinements and six month quarantines
• Submit animal specimens for testing to NC State Laboratory Public Health (SLPH)
What causes rabies?
• RNA virus
• Very tiny, microscopic
• Affinity for Nerves
• Highest Case Fatality Rate
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Incubation and Shedding Periods
Animal exposed to rabies virus
Onset of signs of disease
Incubation period
up to 6 months
Excretion of virus from salivary glands
Shedding period
Death
3-7 days
Appears healthy – non infectious
Incubation:
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A bite introduces the virus …
Incubation:
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The virus starts to move from the site of the bite …
Incubation:
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The virus has reached the CNS …
Vector Control: Rabies, UNC-SPH 8
Incubation
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Signs of disease appear…
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Any mammal can get rabies
“Spillover”
High Risk Species
• Raccoons (land reservoir)
• Bats (reservoir)
• Red and Gray Foxes
• Striped and Spotted Skunks)
• Bobcats
• Coyotes
• Wild Carnivores
• Beavers
• Groundhogs (Woodchuck)
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Animals that CANNOT give you rabies
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How do rabid animals behave?
• May not show clinical signs. • Lethargy, vomiting, anorexia • Ataxia, weakness, paralysis, seizures • Excess salivation, difficulty swallowing,
self mutilation • May be unusually aggressive or friendly
or isolate itself.
• Abnormal behavior for the species
What is an exposure to rabies ?
Any bite, scratch or other situation in which saliva or Central Nervous System (CNS) tissue or tears* from a potentially
rabid or confirmed rabid animal enters an open wound, or comes in contact with a mucous membrane by entering the eye,
mouth or nose.
*World Health Organization Expert Consultation on Rabies. Second Report;
2013. http://apps.who.int/iris/bitstream/10665/85346/1/9789241209823_eng.pdf 48
Vector Control: Rabies, UNC-SPH 9
How is rabies transmitted?
• Bites – Highest risk, most common
• Non-bites – a risk – consult local health dept.
Saliva or Tears to open wound (scratch)
Saliva or Tears to mucous membrane
Nervous tissue to open wound (scratch)
Nervous tissue to mucous membrane
• Bats – any potential direct contact requires a careful risk assessment
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Recent Human Rabies Cases - USA
• Most recent human cases over the last 30 years have been caused by
Bats = bat variant rabies
• Cases average about 1-2 per year
50 http://phil.cdc.gov/phil/details.asp
Why do Bats Pose Such a Risk?
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Seasonality of Positive Bats in NC, 2002 - 2013 (n = 347)
52 Source: NC State Laboratory of Public Health; Updated February 2014
What is a bat exposure?
• Thorough evaluation of all potential exposures
• If more than 1 bat, is there an infestation?
• If a single bat was it captured and tested?
• Direct contact with bat? • Was bat found in the same room with:
• a previously sleeping person, • a previously unattended child,
mentally disabled person, or intoxicated person
• Request help from Veterinary Public Health 919-733-3419
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Human Rabies – South Carolina, 2011
In situations in which bats are physically present and the person(s) cannot exclude the possibility of a bite, postexposure treatment should be considered.
Unless it was a solitary bat, and prompt testing of the bat has ruled out rabies infection.
http://www.cdc.gov/mmWr/preview/mmwrhatml/mm6232a2.htm 54
Vector Control: Rabies, UNC-SPH 10
Prevention of Rabies
• Knowledge
• Caution
• Common sense
• Personal Protection
• Pre-exposure vaccination
• Postexposure management
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• Veterinarians and staff
• Laboratory workers
• Animal control officers
• Shelter workers
• Wildlife workers
• Travelers to rabies endemic countries; at risk
http://www.cdc.gov/rabies/news/RabVaxupdate.html
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Who should receive Pre-exposure Vaccination against rabies?
Pre-exposure Immunization Regimen for People
• 3 doses of Rabies Vaccine
• Days 0, 7, and 21 or 28
• Where? Local Health Department, Physician or Travel Clinic
• RFFIT Titers – every 2 years
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Rabies Titers – Every 2 years
• Used to assess response to vaccination only! • CDC recommendation - Every 2 years • If low you will need one rabies booster • *Presence of an adequate titer does not
remove the need for PEP if indicated! • Local Health Department or Private Physician http://www.cdc.gov/rabies/resources/acip_recommendations.html
Postexposure Rabies Vaccination for People - Not Previously Vaccinated
I. Wound Cleansing; Tetanus
• +/- Antibiotics (HCP)
II. 4 Doses of Vaccine
(5 if immune compromised)
• Days 0, 3, 7, 14
• AND
III. Human Rabies
Immune Globulin (HRIG)20 IU/kg body weight, Day 0
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Postexposure Rabies Vaccination for People - Previously Vaccinated
I. Wound Cleansing
15 minutes
II. Tetanus;
• +/- Antibiotics (HCP)
II. Two Doses of Vaccine
Days 0, 3
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Vector Control: Rabies, UNC-SPH 11
Personal Protection Around Animals and their Body Fluids
• Wash your hands often after handling animals, or wear waterproof gloves, if possible
• Don’t touch your eyes, nose or mouth while handling animals
• Do not kiss animals or let them lick you • Do not eat around animals http://www.nasphv.org/Documents/ModelInfectionControlPlan.d
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CDC: Zoonotic Disease: When Humans and Animals Intersect
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Personal Protection Around Animals and their Body Fluids
• Get Rabies and Tetanus Pre-exposure prophylaxis • Wear waterproof gloves when cleaning up
after animals • Wear appropriate PPE for animals in
quarantine • Wear mask and eye goggles when
aerosolization may occur • If you are bitten, wash the wound for 15
mins under running water & soap; see a doctor (Tetanus, antibiotics, wound care)
http://www.nasphv.org/Documents/ModelInfectionControlPlan.doc
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Public Messaging Wildlife, Stray and Feral Animals
• Do not approach, feed, handle, or take in wildlife and stray animals
• If you see an animal acting strange -avoid it; report it to animal control
• Do not feed pets outside; secure garbage
• Keep pets currently vaccinated against rabies
• Supervise pets when outside
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Public Messaging Wildlife, Stray and Feral Animals
• If you are bitten…
• get to a safe place,
• report bite to animal control,
• wash the wound for 15 mins under running water & soap;
• see a doctor (Tetanus, antibiotics, wound care)
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Zoonotic Disease Information
• CDC: Healthy Pets Healthy People
http://www.cdc.gov/healthypets/index.htm
• CDC: Zoonotic Disease: When Humans and Animals Intersect
http://www.cdc.gov/247/cdcfastfacts/zoonotic.html
• CDC: Zoonotic Disease Factsheet
http://www.cdc.gov/24-7/pdf/zoonotic-disease-factsheet.pdf
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Zoonotic Disease Information
• CDC: National Center for Emerging and Zoonotic Infectious Diseases http://www.cdc.gov/ncezid/
• The Center for Food Security and Public Health http://www.cfsph.iastate.edu/Zoonoses/index.php
• The Merck Veterinary Manual http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/220100.htm
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The Center for Food Security and Public Health http://www.cfsph.iastate.edu/DiseaseInfo/fastfacts.php
Vector Control: Rabies, UNC-SPH 12
Zoonotic Disease Information • http://www.nasphv.org/Documents/VeterinaryPrecautions.pdf • http://www.nasphv.org/Documents/ModelInfectionControlPla
n.doc
• http://www.nasphv.org/Documents/ModelInfectionControlPlan.doc
• Zoonotic Disease Tutorial – Wisconsin
http://svmweb.vetmed.wisc.edu/pbs/zoonoses/
• http://www.vetinfo.com/zoonose.html • http://www.vet.cornell.edu/fhc/brochures/zoonoticdisease.ht
ml
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1902 Mail Service Center
Raleigh NC 27699-1900
Phone: (919) 733-3410
FAX: (919) 733-9555
http://epi.publichealth.nc.gov/cd/diseases/vph.html
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Veterinary Public Health
Contact Information
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