PrevMed2- Rabies

• zoonotic viral encephalomyleitis of mammals
• caused by Lyssavirua (fam Rhabdoviridae)
• almost always fatal once clinical signs occur
• globally, dogs are the source of the vast majority of human rabies deaths

• Globally- Dogs
• Asia, Africa- Dogs
• South America- vampire bats
• Developed countries- terrestrial carnivores (raccoon, skunk, fox, coyote), BATS (most human cases in U.S. come from bats)

oral rabies vaccine

through saliva or brain/ nervous system tissue when introduced to a bite wound, open cut, or onto mucous membranes

• Bite- any penetration of skin by teeth
• Non-bite- contamination of open wounds, MMs
• Bat bites are hard to find/ identify- treat any person who has come into contact with a bat and unsure if bitten or not

• virus introduced through bite wound, open skin wound, or MM
• travels along nerves from site of bite to brain
• virus multiplies in brain, leading to inflammation
• virus moves from brain to salivary glands and saliva, where virus is shed

as short as 2 weeks, as long as 1 year

no, and behavior remains normal

• compendium of animal rabies prevention and control
• READ THIS DOCUMENT for exam

whenever a person is bitten by a dog or other mammal, a report must be made of this bite within 24 hours to the health commissioner of the district in which the bite occurred

• the animal must be quarantined under an order issued by the health commissioner- for no less than 10 days from which the person was bit (why?--> if they are shedding virus at the time of the bite, by 10 days later they should be showing signs of disease or dead)
• animal cannot be released from quarantine until it has been properly vaccinated against rabies by a DVM
• if animal dies, the head should be submitted

• if the wild animal is not available for rabies testing, the domestic animal should be regarded as exposed and next steps depend on vaccination status
• veterinarian should report to health department
• mammal should be confined until determine to be rabies free

• Post-mortem testing- Direct fluorescent antibody on brain tissue (brain stem and cerebellum)
• Human Dx- saliva, serum, CSF, hair follicle tested; ante-mortem Dx requires many tests

• no effective treatment once clinical signs appear
• rabie post-exposure prophylaxis (PEP) given before onset of symptoms is nearly 100% effective (wound cleansing, rabies Ig, rabies vaccine)- no time limit to give PEP

• previously unvaccinated people- 4 doses of vaccine IM, rabies Ig with first vaccine
• previously vaccinated people- 2 doses of vaccine and no rabies Ig

Ohio Department of Health State Laboratory

• no ante mortem test can reliably diagnose all positive cases
• false neg can lead to human cases; false pos can lead to animal euthanasia
• Serum antibody test cannot differentiate vaccinate from infection; often not positive until well into clinical phase
• Saliva testing- shedding is inconsistent; can trust your positives more than your negatives (1 virion can cause infection and no be detected)
• DFA Direct Flurorescent Antibody of Brain tissue (gold standard)

DFA (Direct Fluorescent Antibody) of Brain Tissue- brains stem (full section essential for negative diagnosis), cerebellum

• wear PPE to cover exposed skin, protect eyes and MMs (goggles and face mask at a minimum)
• don't use power tools (can aerosolize virus)
• should be previously vaccinated
• DO NOT SUBMIT LIVE ANIMALS, don't damage the head when euth

• Small vermin: (bats, rats, chipmunks) send entire body
• Small Animals: (cats, dogs) send entire head
• Large Animals/ Horned animals: send entire brain (special exception for trained vets- send entire brainstem and 3 lobs of cerebellum)

• keep specimen refrigerated
• do not fix tissues
• avoid freezing (may delay testing, repeated freezing/ thawing degrades sample)
• double bag, cover sharp edges
• ship in styrofoam cooler with ice packs

• "Biologic Substance, Category B", UN 3373 label
• Category B= human or animal material being transported for diagnostic or investigational purposes
• overnight courier, not on Friday or before a holiday

• incineration is ideal
• the virus can survive freezing
• virus is destroyed by burning, desiccation, sunlight, and almost all disinfectants
• deep burial acceptable but only in some jurisdictions

in the deltoid muscle

• rapid fluorescent focus inhibition test (RFFIT)- virus neutralization test- quantifies ability to neutralize the virus 9not just amount of antibodies)
• complete neutralization at 1:5 dilution of better, otherwise, booster vaccine recommended

every 2 years (frequent, but not continuous, risk)

a rabid cat exposes 7 times the number of people as a rabid wild animal

• all dog bites and rabies exposures are required to be reported in all states, regardless of vaccination status of the animal
• Ohio requires reporting of all mammal bites
• in Ohio, report to the local health department whose jurisdiction the bite took place in

• scratch with saliva contamination
• inhalation of aerosolized rabies virus
• saliva, brain, or other neural tissue coming in contact with broken skin or MMs

any mammal bite that breaks the skin

• bite or scratch with saliva
• finding the bat in a room with a pet, sleeping person, child, otherwise impaired individual who cannot recall or communicate contact with bat

• petting or touching a rabid animal
• contact with something a rabid animal touched (unless wet from the mouth)
• contact with urine or blood
• skunk spray

• neurologic signs--> euthanasia and submit head
• no signs--> 10 day quarantine for healthy animals that have bitten a human (vets do not have authority to order quarantine, local health department)

• no more than a few days prior to onset of symptoms (1-3 days pre-clinical shedding w/o symptoms)
• 1-3 days pre-clinical shedding, 3-5 days clinical illness prior to death, +2 days for abundance of caution

bitten or had potential saliva exposure to a rabies positive animal or suspect positive, a wild carnivore, a bat, any animal displaying signs of rabies

• Currently vaccinated with proof: booster and 45 day quarantine
• Overdue with proof: booster and 45 day quarantine
• Overdue, no proof: as unvaccinated or paired serology
• Unvaccinated dog, cat, or ferret that is exposed: euthanasia and testing; if doubt as to exposure may isolate 4 months (K,Fe) or 6 months (ferret)

• certificate signed by a licensed veterinarian
• vaccine approved for that species

• inside
• confined in an outdoor double barrier enclosure
• on a leash under control of a responsible adult
• do not take off premises or change ownership
• no new pets in home
• limit human contact, do not touch saliva