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EO 003.02. RABIES. RABIES. References : Control of Communicable Diseases Manual, 18 th Edition, 2004 Borden - Registration & Control of Domestic Animals; ftp://borden.mil.ca/bor/english/bbsai/208_e.doc C. Ontario Public Health Standards – Rabies Prevention & Control

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eo 003 02

EO 003.02

RABIES

rabies
RABIES

References:

  • Control of Communicable Diseases Manual, 18th Edition, 2004
  • Borden - Registration & Control of Domestic Animals;ftp://borden.mil.ca/bor/english/bbsai/208_e.doc

C. Ontario Public Health Standards – Rabies Prevention & Control

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/protocols/rabies_prevention.pdf

rabies identification
Rabies - Identification
  • Almost invariably fatal acute viral encephalomyelitis.
  • Onset heralded by: sense of apprehension, headache, fever, malaise & indefinite sensory changes referred to site of a preceding animal bite;
  • Excitability & aerophobia are frequent symptoms;
  • The disease progresses to paresis or paralysis, spasms of swallowing muscles leading to fear of water, delirium and convulsions.
rabies identification1
Rabies - Identification
  • Without medical intervention, usual duration is 2 – 6 days followed by death usually due to respiratory paralysis.
  • Diagnosis: FA staining of brain tissue or virus isolation in mouse or cell cultures. Presumptive diagnosis is by specific FA staining of frozen skin sections from the back of neck. Serological diagnosis is based on neutralization tests in mice or cell culture.
rabies infectious agent
Rabies - Infectious agent

Rabies Virus

a rhabdovirus of the genus Lyssa-virus;

all genus are antigentetically related but antibody & nucleotide sequencing shows differences according to animal species or geographical location of origin.

rabies occurrence
Rabies - Occurrence
  • World wide, with an estimated 65,000 to 87,000 deaths each year, almost all in developing countries;
  • Most human deaths follow dog bites when post exposure prophylaxis was not available.
rabies reservoir
Rabies - Reservoir
  • Wild & domestic canines including: dogs, foxes, wolves, skunks, racoons, & other biting mammals;
  • Developing countries – dogs primary reservoir;
rabies reservoir1
Rabies - Reservoir
  • Infected populations of vampire, frugivorous & insectivorous bats in Canada, USA & Europe;
  • Rabbits, squirrels, chipmunks, rats & mice are rarely infected & their bite rarely calls for rabies prophylaxis.
rabies mode of transmission
Rabies - Mode of Transmission
  • Virus laden saliva of rabid animal, introduced through bite or scratch;
  • Airborne spread has been demonstrated where bats roost & in lab setting but very rare;
  • Infected vampire bats to domestic animals is common in Latin America;
  • In the USA, rabid insectivorous bats rarely transmit rabies to animals.
rabies incubation period
Rabies - Incubation period
  • Usually 3 to 8 weeks, rarely as short as 9 days or as long as 7 years.
  • Depends on:
    • wound severity;
    • wound site in relation to nerve supply and distance from brain;
    • amount & strain of virus; and
    • protection benefit of clothing.
rabies period of communicability
Rabies - Period of Communicability
  • In dogs & cats, usually 3 to 7 days before the onset of clinical signs and throughout the course of disease;
  • Longer periods - 14 days observed in Ethiopian dogs; and
  • Other studies in bats have shown 12 days & 8 days for skunks before symptoms are present.
rabies susceptibility
Rabies - Susceptibility
  • All mammals are susceptible to varying degrees;
  • Humans are more resistant to infection than several other animal species;
  • A study in Islamic Republic of Iran showed, of those bitten by a proven rabid animal and not treated, about 40% developed disease.
methods of control preventive measures
Methods of Control - Preventive Measures
  • Register, license & immunize all dogs and cats;
  • Capture stray dogs & maintain active surveillance of rabies in animals;
  • Detain & clinically observe for 10 days any dog or cat that bites a person. Strays can be put down & examined for rabies by fluorescent microscopy;
  • Immediately submit to a lab the intact head of suspect animals (packed in ice – not frozen) for viral antigen testing (FA staining); or if not available, by microscopic examination for Negri bodies, followed by mouse inoculation;
methods of control
Methods of Control
  • Put down unimmunized cats or dogs bitten by a rabid animal;
  • Cooperative programs with wildlife authorities to reduce fox, skunks, racoons & other host of sylvatic rabies from areas of human habitation & campsites;
  • Oral immunization of wildlife reservoirs using airdrops of bait containing attenuated or recombinant vector vaccine;
  • Personnel at high risk such as Veterinarians should be vaccinated & antibody tested every 2 years with boosters as required.
control of patient contacts the environment
Control of Patient, Contacts & the Environment
  • Report to local health authority;
  • Isolation: contact isolation for respiratory secretions for duration of the illness;
  • Concurrent disinfection: Of saliva & soiled articles (medical personnel should be aware of hazards & wear rubber gloves, protective gowns & protection from coughing patients);
control of patient contacts the environment1
Control of Patient, Contacts & the Environment
  • Quarantine: Not applicable;
  • Immunization of contacts: Contacts with open wounds or mucous membrane exposure to patient’s saliva must receive specific wound & anti-rabies treatment (Human Rabies Immune Globulin); and
  • Investigation of contacts & source of infection: Search for rabid animal & for other people/animals bitten.
epidemic measures
Epidemic Measures
  • Establish area control under authority of laws, regulations & ordinances, in cooperation with appropriate wildlife conservation & animal health authorities;
  • Immunize dogs & cats through officially sponsored, intensified mass programs through temporary & emergency stations;
  • In urban areas of industrialized countries, strict enforcement of regulations requiring collection, detention and killing of strays. Control the dog population through castration/spaying;
  • Immunization of wildlife: baits containing vaccine has successfully contained fox rabies in western Europe and Canada
disaster implications
Disaster Implications

A potential problem if the disease is newly introduced in an area where there are

many stray dogs or wild animals

international measures
International Measures

Strict compliance by common carriers and

travellers with national laws and regulations

in rabies-free countries

Immunization of animals, certificates of health and origin or microchip identification of animals may be required

post exposure prophylaxis
Post Exposure Prophylaxis

Protection in humans is provided by administration of Human (HRIG) or Equine (ERIG) rabies IMMUNE GLOBULIN at the site of the bite as soon as possible after exposure to neutralize the virus, and then giving the VACCINE at a different site to elicit active immunity.

post exposure prophylaxis1
Post Exposure Prophylaxis

WHO Recommendations:

  • category I – touching or feeding animals, licks on the skin:
    • No treatment required;
  • category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin:
    • Administer vaccine;
  • category III – single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks; exposure to bat bites or scratches:
    • Administer vaccine.
post exposure prophylaxis guide
Post Exposure Prophylaxis Guide

Not Previously Vaccinated:

  • Wound cleaning with soap & water (irrigate with virucidal agent if available);
  • Human Rabies Immune Globulin (HRIG). 20 IU/Kg body weight. Also Rabies Vaccine Absorbed (RVA), 1 ml day0, 3, 7, 14 and 28;
post exposure prophylaxis guide1
Post Exposure Prophylaxis Guide

Previously vaccinated:

  • Wound cleaning (as above);
  • HRIG should NOT be administered;
  • RVA on days 0 and 3.
borden registration and control of domestic animals
Borden - Registration and Control of Domestic Animals
  • All dogs at CFB Borden must be licensed.
  • Registration is subject to the following conditions:
    • Payment of registration fee;
    • Valid immunization certificate for rabies;
    • Owner must ensure license tag is on animal at all times.
borden rabies policy
Borden – Rabies Policy
  • An animal suspected of biting someone will be quarantined at the SPCS shelter for 10 days & the owner is responsible for all costs;
  • A sick domestic pet is to be quarantined by the owner to eliminate the possibility of the disease being contracted by other animals or humans.
rabies prevention control protocol
Rabies Prevention & Control Protocol

Management of suspected rabies exposure:

  • Notification:
  • Investigation;
  • Risk assessment;
  • Animal Management
  • Vaccine Management;
  • Rabies prophylaxis administration; and
  • Reporting
rabies prevention control protocol1
Rabies Prevention & Control Protocol

Notification

Any person who has information concerning an animal bite or contact that may result in rabies in persons shall notify the medical officer of health with the information;

rabies prevention control protocol2
Rabies Prevention & Control Protocol

Investigation

  • Written procedures/SOP
  • Upon receipt of notification, the board of health will investigate within 24 hrs
  • The board of health shall collect data concerning each case
rabies prevention control protocol3
Rabies Prevention & Control Protocol
  • Person exposed:
    • Name, sex, DOB, age, weight;
    • Personal contact information;
    • Has person seen a physician - Physician info;
    • Persons rabies immunization status – vaccine type & dates;
    • Is person immunocompromised
rabies prevention control protocol4
Rabies Prevention & Control Protocol

Exposure incident

  • Date of exposure;
  • suspect animal information, species;
  • Geographical location of exposure incident;
  • Type of expose: Bite, non-bite, bat;
  • Anatomical location of exposure; and
  • Exposure circumstances; and
  • Animal behaviour.
rabies prevention control protocol5
Rabies Prevention & Control Protocol
  • Animal Owner (if owned):

Name, sex, DOB

address & phone #;

  • Animal:

Species and description;

Animals name and age;

previous animal contacts;

rabies immunization status; and

the status of any other animals residing with the suspect animal.

rabies prevention control protocol6
Rabies Prevention & Control Protocol

Risk assessment

  • Type of exposure (bite, non-bite, bat);
  • Anatomical location of exposure;
  • Risk of rabies in the animal species involved;
  • Presence of rabies in the area where incident occurred;
  • Behaviour & health status of the implicated animal;
  • Exposure circumstances (provoked or not);
  • Rabies immunization status of the animal; and
  • Rabies immunization status of the human.
rabies prevention control protocol7
Rabies Prevention & Control Protocol

Animal Management

  • The board of health shall ensure, when a dog, cat or ferret requires a 10 day observation period, that the animal is confined and isolated from all other animals and persons;
  • The board of health shall check vaccine status of any animal involved in a human exposure incident & if not vaccinated – ensure they are after the 10 day isolation period;
  • The board of health shall notify & furnish particulars to the nearest district veterinary of the CFIA as soon as possible when an animal is rabid or suspected of being in contact with an animal that is rabid.
rabies prevention control protocol8
Rabies Prevention & Control Protocol

Rabies prophylaxis administration

The board of health shall ensure individuals that have been bitten by a bat who require treatment have access to rabies PEP within 24 hours after the decision is made that PEP is required.

rabies prevention control protocol9
Rabies Prevention & Control Protocol

Other animal-related rabies administration:

  • PEP should be started as soon as possible after exposure & should be offered regardless of elapsed time;
  • Based on risk assessment, and if the specimen is received at the lab within 48 hours of exposure, treatment may be withheld until Flourescent Antibody Test (FAT) result is available. The FAT result can be obtained within 6 to 24 hrs of receipt at the lab;
rabies prevention control protocol10
Rabies Prevention & Control Protocol

3. If the suspected animal is a cat, dog or ferret, and is available for observation, then immunization of the human may be withheld pending the animal’s status during the 10 day observation period. If the animal shows signs of rabies during the period, PEP should be initiated. If the animal rabies test returns negative, then the PEP can be discontinued.

rabies prevention control protocol11
Rabies Prevention & Control Protocol

4. For bites to the head, face or neck: Incubation period could be as little as 7 days. For these bites, prophylaxis should begin immediately & not be delayed for lab testing. Considerations that could delay this include:

i. if the animal is a pet;

ii fully vaccinated;

iii the bite was provoked; and

iv there is a low prevalence of rabies in the area

rabies prevention control protocol12
Rabies Prevention & Control Protocol
  • If rabies exposure is considered likely, such as exposure in a country with endemic canine rabies, then PEP should never be delayed.

6. The vaccine series may be discontinued after consultation with public health experts if the FAT is negative;

rabies prevention control protocol13
Rabies Prevention & Control Protocol

7. Serological testing:

  • Healthy pers immunized with post-exposure regimen do not need post-immunization antibody determinations;
  • Serological testing may be advisable in the following situations:
    • Pers whose immune response may be reduced by illness, medication or advanced age;
    • After vaccine schedule deviations; or
    • For testing status of immune protection from pre-exposure immunization upon being exposed to a suspect rabid animal;
rabies prevention control protocol14
Rabies Prevention & Control Protocol
  • When assessing the immune protection post vaccine series, tests should be conducted 2 weeks after the last dose;
  • Where antibody levels are required, a sample of 5 ccs whole clotted blood or serum should be submitted to the nearest Ont Agency for Health Protection & Promotion regional lab;
  • The purpose of the sample shall be indicated for lab prioritizing;
  • Acceptable anti-body test is a titre of >0.5IU/mL by the rapid fluorescent-focus inhibition test;
rabies prevention control protocol15
Rabies Prevention & Control Protocol

Reporting

The board of health shall report data for individuals receiving PEP as specified in the integrated Public Health Information System (iPHIS) or any other method specified by the ministry and shall comply with the minimum data elements identified in:

  • Regulation 569 (reports) under the HPPA;
  • Disease specific user guides published by the ministry; and
  • Bulletins and directives issued by the ministry.
rabies prevention control protocol16
Rabies Prevention & Control Protocol

Human Case Management

  • The board of health, upon receiving a report of suspect or confirmed human rabies, reports immediately to the ministry verbally. The data is then entered in iPHIS within one business day of notification.
responsibility of owner
Responsibility of Owner

Disposition of a dead animal

  • The owner of a dead animal shall dispose of the animal within 48 hours of it’s death.

Disposition of a fallen animal

  • When an animal is known or suspected to have died from an infectious or reportable disease, the owner shall dispose of it IAW the directions of an inspector under the Health of Animals Act (Canada). In no case may the animal be disposed of by natural disposal