"Memorandum (Compendium of Animal Rabies Prevention and Control, 2011) - National Association of State Public Health Veterinarians, Inc."

ADVERTISEMENT
May 31, 2011
MEMORANDUM
TO:
State Public Health Veterinarians
State Epidemiologists
State Veterinarians
Other Parties Interested in Rabies Prevention and Contr
ol
FROM:
Catherine M. Brown, DVM, MSc, MPH, Chair
Compendium of Animal Rabies Prevention and Control Committee
SUBJECT: Compendium of Animal Rabies Prevention and Control, 2011
The National Association of State Public Health Veterinarians (NASPHV) is pleased to provide
the 2011 revision of the Compendium of Animal Rabies Prevention and Control for your use and
for distribution to practicing veterinarians, wildlife rehabilitators, animal welfare organizations,
and officials in animal control, public health, wildlife management, and agriculture in your state.
This document is reviewed and revised as necessary, and the most current version replaces all
previous versions. This cover memo summarizes the most notable changes that were made to the
document and provides updates on other rabies issues.
COMPENDIUM CHANGES
Part I A.1. The national case definition for animal rabies was added for clarification of how
rabies cases are defined for public health surveillance purposes.
Part I A.9. was expanded to: clarify that the Centers for Disease Control and Prevention’s (CDC)
rabies laboratory is available for confirmatory testing and on an emergency basis to expedite
exposure management decisions; include information on testing methodology appropriate for
field testing of surveillance specimens; and to clarify that there are no reliable ante mortem
rabies tests available for use in animals.
Part I A.11. was expanded to include additional research topics that warrant further study.
Part III: The table of rabies vaccines licensed and marketed in the U.S. was updated for 2011.
Additional references have been added to provide scientific support for information provided in
the document.
1
May 31, 2011
MEMORANDUM
TO:
State Public Health Veterinarians
State Epidemiologists
State Veterinarians
Other Parties Interested in Rabies Prevention and Contr
ol
FROM:
Catherine M. Brown, DVM, MSc, MPH, Chair
Compendium of Animal Rabies Prevention and Control Committee
SUBJECT: Compendium of Animal Rabies Prevention and Control, 2011
The National Association of State Public Health Veterinarians (NASPHV) is pleased to provide
the 2011 revision of the Compendium of Animal Rabies Prevention and Control for your use and
for distribution to practicing veterinarians, wildlife rehabilitators, animal welfare organizations,
and officials in animal control, public health, wildlife management, and agriculture in your state.
This document is reviewed and revised as necessary, and the most current version replaces all
previous versions. This cover memo summarizes the most notable changes that were made to the
document and provides updates on other rabies issues.
COMPENDIUM CHANGES
Part I A.1. The national case definition for animal rabies was added for clarification of how
rabies cases are defined for public health surveillance purposes.
Part I A.9. was expanded to: clarify that the Centers for Disease Control and Prevention’s (CDC)
rabies laboratory is available for confirmatory testing and on an emergency basis to expedite
exposure management decisions; include information on testing methodology appropriate for
field testing of surveillance specimens; and to clarify that there are no reliable ante mortem
rabies tests available for use in animals.
Part I A.11. was expanded to include additional research topics that warrant further study.
Part III: The table of rabies vaccines licensed and marketed in the U.S. was updated for 2011.
Additional references have been added to provide scientific support for information provided in
the document.
1
RABIES UPDATES
The fifth World Rabies Day will be on September 28, 2011. More information is available at:
http://www.worldrabiesday.org.
The 22nd annual international conference on Rabies in the Americas (RITA) is scheduled for
October 16-21, 2011 in San Juan, Puerto Rico. More information is available at:
http://www.rabiesintheamericas.org/.
CDC’s Rabies Laboratory is attempting to collect specimens to evaluate the potential for
rabies transmission via milk from lactating animals. Over the past 15 years, CDC has received
mammary tissue and unpasteurized milk from approximately 1 rabid cow per year. To date, no
rabies virus antigen or nucleic acids have been detected. However, continued collection of
appropriate samples is critical to obtain a sufficient sample size to make evidence based
recommendations. When rabies is suspected in a lactating animal, milk and mammary tissue
should be collected and stored. If rabies is diagnosed, the milk and mammary tissue should be
shipped on dry ice to:
Dr. Charles E. Rupprecht
DASH, Building 18, Room SSB218
Centers for Disease Control and Prevention
1600 Clifton Road, NE
Atlanta, GA 30333
(404) 639-1050
Enhanced surveillance of the rabies virus variants currently circulating in the U.S. is critical for
detecting new or introduced rabies virus variants. CDC requests an aliquot of CNS tissue from:
rabid domestic animals (especially dogs); less common non-reservoir species (e.g. ruminants);
and, from rabid carnivores in areas where bats are the only enzootic rabies reservoir, for
antigenic and phylogenetic characterization. In addition, to better evaluate the potential of certain
species groups to transmit rabies, the entire head of any rodent or lagomorph testing positive for
rabies should be submitted to evaluate the presence of rabies virus in salivary glands. Where
feasible, rabies diagnostic laboratories should store the heads of highly suspect rodents and
lagomorphs until testing is completed. Positive specimens should be sent to CDC at the above
address for further analysis.
2
Compendium of Animal Rabies Prevention and Control, 2011*
National Association of State Public Health Veterinarians, Inc. (NASPHV)
Rabies is a fatal viral zoonosis and a serious public health problem (1). All mammals are believed to be
susceptible to the disease, and for purposes of this document, use of the term “animal” refers to mammals. The
disease is an acute, progressive encephalitis caused by a lyssavirus. Rabies virus is the most important
lyssavirus globally. In the United States, multiple rabies virus variants are maintained in wild mammalian
reservoir populations such as raccoons, skunks, foxes, and bats. Although the U.S. has been declared free of
canine rabies virus variant transmission, there is always a risk of reintroduction of these variants (2-6).
The virus is usually transmitted from animal to animal through bites. The incubation period is highly variable.
In domestic animals it is generally 3-12 weeks, but can range from several days to months, rarely exceeding 6
months (7). Rabies is communicable during the period of salivary shedding of rabies virus. Experimental and
historic evidence document that dogs, cats, and ferrets shed virus a few days prior to clinical onset and during
illness. Clinical signs of rabies are variable and include inappetance, dysphagia, cranial nerve deficits, abnormal
behavior, ataxia, paralysis, altered vocalization, and seizures. Progression to death is rapid. There are currently
no known effective rabies antiviral drugs.
The recommendations in this compendium serve as a basis for animal rabies prevention and control programs
throughout the United States and facilitate standardization of procedures among jurisdictions, thereby
contributing to an effective national rabies control program. This document is reviewed and revised as
necessary. The most current version replaces all previous versions. These recommendations do not supersede
state and local laws or requirements. Principles of rabies prevention and control are detailed in Part I;
recommendations for parenteral vaccination procedures are presented in Part II; and all animal rabies vaccines
licensed by the United States Department of Agriculture (USDA) and marketed in the United States are listed
and described in Part III.
The NASPHV Committee
Consultants to the Committee
Catherine M. Brown, DVM, MSc, MPH, Chair
Donald Hoenig, VMD; AVMA
Lisa Conti, DVM, MPH
Donna M. Gatewood, DVM, MS; USDA Center for
Paul Ettestad, DVM, MS
Veterinary Biologics
Mira J. Leslie, DVM, MPH
Lorraine Moule; NACA
Faye E. Sorhage, VMD, MPH
Barbara Nay; Animal Health Institute
Ben Sun, DVM, MPVM
Raoult Ratard, MD, MS, MPH; CSTE
Charles E. Rupprecht, VMD, MS, PhD; CDC
Dennis Slate, MS, PhD; USDA Wildlife Services
James Powell, MS; APHL
Burton Wilcke, Jr., PhD; APHA
*Address all correspondence to:
Endorsed by:
Catherine M. Brown, DVM, MSc, MPH
American Public Health Association (APHA)
State Public Health Veterinarian
American Veterinary Medical Association (AVMA)
Massachusetts Department of Public Health
Association of Public Health Laboratories (APHL)
Hinton State Laboratory Institute,
Council of State and Territorial Epidemiologists (CSTE)
305 South St.
National Animal Control Association (NACA)
Jamaica Plain, MA 02130
3
Part I. Rabies Prevention and Control
A. PRINCIPLES OF RABIES PREVENTION AND CONTROL
1. CASE DEFINITION: An animal is determined to be rabid after diagnosis by a qualified laboratory as
specified in Part I.A.9. The national case definition for animal rabies requires laboratory confirmation by
either:
• A positive direct fluorescent antibody test (preferably performed on central nervous system
tissue); or
• Isolation of rabies virus (in cell culture or in a laboratory animal (8).
2. RABIES EXPOSURE: Rabies is transmitted when the virus is introduced into bite wounds, open cuts
in skin, or onto mucous membranes from saliva or other potentially infectious material such as neural tissue
(9). Questions regarding possible exposures should be directed promptly to state or local public health
authorities.
3. PUBLIC HEALTH EDUCATION: Essential components of rabies prevention and control include
ongoing public education, responsible pet ownership, routine veterinary care and vaccination, and
professional continuing education. The majority of animal and human exposures to rabies can be prevented
by raising awareness concerning: rabies transmission routes, avoiding contact with wildlife, and following
appropriate veterinary care. Prompt recognition and reporting of possible exposures to medical professionals
and local public health authorities is critical.
4. HUMAN RABIES PREVENTION: Rabies in humans can be prevented either by eliminating
exposures to rabid animals or by providing exposed persons with prompt local treatment of wounds
combined with the appropriate administration of human rabies immune globulin and vaccine. Exposure
assessment should occur before postexposure rabies prophylaxis (PEP) is initiated and should include
discussion between medical providers and public health officials. The rationale for recommending
preexposure prophylaxis and details of both pre- and post-exposure prophylaxis administration can be found
in the current recommendations of the Advisory Committee on Immunization Practices (ACIP) (9,10).
These recommendations, along with information concerning the current local and regional epidemiology of
animal rabies and the availability of human rabies biologics, are available from state health departments.
5. DOMESTIC ANIMAL VACCINATION: Multiple vaccines are licensed for use in domestic animal
species. Vaccines available include: inactivated or modified live virus vectored products; products for
intramuscular and subcutaneous administration; products with durations of immunity from one to 4 years;
and products with varying minimum age of vaccination. The recommended vaccination procedures and the
licensed animal vaccines are specified in Parts II and III of this compendium, respectively. Local
governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and
ferrets and to remove strays and unwanted animals. Such procedures in the United States have reduced
laboratory confirmed cases of rabies in dogs from 6,949 in 1947 to 93 in 2009 (2). Because more rabies
cases are reported annually involving cats (274 in 2009) than dogs, vaccination of cats should be required
(2). Animal shelters and animal control authorities should establish policies to ensure that adopted animals
are vaccinated against rabies.
6. RABIES IN VACCINATED ANIMALS: Rabies is rare in vaccinated animals (11-13). If such an
event is suspected, it should be reported to public health officials; the vaccine manufacturer; and USDA,
Animal and Plant Health Inspection Service, Center for Veterinary Biologics (Internet:
http://www.aphis.usda.gov/animal_health/vet_biologics/vb_adverse_event.shtml; telephone: 800-752-
6255). The laboratory diagnosis should be confirmed and the virus variant characterized by the Centers for
Disease Control and Prevention (CDC) rabies reference laboratory. A thorough epidemiologic investigation
4
including documentation of the animal’s vaccination history and a description of potential rabies exposures
should be conducted.
7. RABIES IN WILDLIFE: The control of rabies among wildlife reservoirs is difficult (14). Vaccination
of free-ranging wildlife or selective population reduction is useful in some situations (15), but the success of
such procedures depends on the circumstances surrounding each rabies outbreak (see Part I. C.). Because of
the risk of rabies in wild animals (especially raccoons, skunks, coyotes, foxes, and bats), the American
Veterinary Medical Association, American Public Health Association, Council of State and Territorial
Epidemiologists, National Animal Control Association and the National Association of State Public Health
Veterinarians strongly recommend the enactment and enforcement of state laws prohibiting their
importation, distribution, translocation, and private ownership.
8. RABIES SURVEILLANCE: Enhanced laboratory-based rabies surveillance and variant typing are
essential components of rabies prevention and control programs. Accurate and timely information and
reporting is necessary to: guide human PEP decisions; determine the management of potentially exposed
animals; aid in emerging pathogen discovery; describe the epidemiology of the disease; and assess the need
for and effectiveness of vaccination programs for domestic animals and wildlife. Every animal submitted for
rabies testing should be reported to CDC to evaluate surveillance trends. Electronic laboratory reporting and
notification of animal rabies surveillance data should be implemented (16). Optimal information on animals
submitted for rabies testing should include species, point location, vaccination history, rabies virus variant
(if rabid), and human or domestic animal exposures. Rabid animals with a history of importation within 60
days into the United States are immediately notifiable by state health departments to CDC; all indigenous
cases should follow standard notification protocols (17). Integration with standard public health reporting
and notification systems should facilitate the transmission of the above data elements.
9. RABIES DIAGNOSIS:
a) The direct fluorescent antibody (DFA) test is the gold standard for rabies diagnosis. The DFA test
should be performed in accordance with the established national standardized protocol
(http://www.cdc.gov/rabies/docs/standard_dfa_protocol_rabies.pdf) by a qualified laboratory that has
been designated by the local or state health department (18,19). Animals submitted for rabies testing
should be euthanized (20,21) in such a way as to maintain the integrity of the brain so that the laboratory
can recognize the anatomical parts. Except in the case of very small animals, such as bats, only the head
or brain (including brain stem) should be submitted to the laboratory. To facilitate prompt laboratory
testing, submitted specimens should be stored and shipped under refrigeration without delay. The need
to thaw frozen specimens will delay testing. Chemical fixation of tissues should be avoided to prevent
significant testing delays and because it might preclude reliable testing. Questions about testing of fixed
tissues should be directed to the local rabies laboratory or public health department.
b) Rabies testing should be available on an emergency basis to expedite exposure management
decisions (18). When confirmatory testing is needed by state health departments (e.g., inconclusive
results, unusual species, mass exposures), the CDC rabies laboratory can provide results within 24 hours
of submission (22).
c) A direct rapid immunohistochemical test (DRIT) is being used by trained field personnel in
surveillance programs for specimens not involved in human or domestic animal exposures (23-26). All
positive DRIT results need to be confirmed by DFA testing at a qualified laboratory.
d) Currently, there are no USDA licensed rapid test kits commercially available for rabies diagnosis.
Unlicensed tests should not be used due to several concerns: the sensitivity/specificity are not known;
the tests have not been validated against current standard methods; the excretion of virus in the saliva is
intermittent and the amount varies over time; any test result would need to be confirmed by more
5
ADVERTISEMENT

Download "Memorandum (Compendium of Animal Rabies Prevention and Control, 2011) - National Association of State Public Health Veterinarians, Inc."

466 times
Rate
4.6(4.6 / 5) 33 votes