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Jennifer House, DVM, MPH, ACVPM
Animal Bites and Rabies Control for Indiana
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Jennifer House, DVM, MPH, ACVPMVeterinary Epidemiologist
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Rabies Virus
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Rabies
• Transmission
–Bite wounds that break skin
–Virus infected saliva contaminating scratches or mucous membranesscratches or mucous membranes– 0.1% develop rabies
–Medical procedures– Transplants from infected donors
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Incubation Period
• Normal is 3-12 weeks (humans)
• Range may be 9 days to 7 years
• ***Long incubation period allows time to • ***Long incubation period allows time to wait for treatment in certain situations
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Rabies In Dogs
Exposure
Incubation Prodromal
period
excited
phase
Paralytic
phase
Death
Dogs shed rabies virus during this time
No more than 4-7 days prior to symptoms
Incubation
Period
7 - 125 days
period
1-3 days
phase
1-7 days
phase
2-5 days
More affectionate?Shy and seek seclusion?Snappy and irritable?(behavior change)
Very agitatedRoamBite anythingDrooling
Paralysis of massetermusclesDrooling (foaming)
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Rabies in Humans
Incubation
Period
Exposure
First Symptom
Prodrome
Acute
Neurological
phase
Neurological signs
Coma Recovery
Death
Onset Coma
Period
20 -60 days
Prodrome
2 -10 days
phase
2-10 days
Coma
0 -14days
Recovery
fever, anorexia, nausea, headache, malaise, lethargy, pain or tingling at bite site
hyperventilation, CNS signs, paresis, hydrophobiaconfusion, delirium, hallucinations, hyperactivity
Hypoventilation, apnea, hypotension, cardiac arrhythmia or arrest, coma
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Rabies Virus Variants - 2009
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Source: Centers for Disease Control and Prevention, November 2010
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Summary Of Human RabiesSince 1990, US
• BATS!
• In-apparent bites?
• Not recognizing bite or not reporting
• Rabies is not always suspected by medical • Rabies is not always suspected by medical personnel when clinical signs develop
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Recent Human Cases in the US
• 45 Cases in United States (1995-2010)
– 34 bat variant
• 4 organ/tissue transplantations
– 8 canine variant (foreign origin)– 8 canine variant (foreign origin)
– 3 other variants
• Raccoon
• Mongoose
• Fox
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Incidence in Animals (IN)
• Bat variant is endemic – 24 positive bats in 2010
• Skunk variant occasionally (2004)
• Other variants are not currently present,
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• Other variants are not currently present, but may be introduced at anytime– How?
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Rabies, Indiana 2000 - 2010
Year Bat Horse Skunk Human
2000 15
2001 15
2002 31 1 1
2003 312003 31
2004 11 1
2005 11
2006 11 1
2007 13
2008 11
2009 39 1
2010 24
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Indiana Positive Bats
14
810
12
14
16
18
20
22
0 0 0 01
3 3
8
3
01
0
2
4
6
8
10
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2009 2010 2011
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Skunks Rabies, 1990 - 2010
• 1996 – 1• 1997 – 4• 1998 – 1• 2002 – 1• 2002 – 1• 2004 – 1
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Submissions -ISDH Rabies Lab
642
435390
366
289
443
345
263 273300
400
500
600
700
77 87
289
10068
263 273
82 67
0
100
200
300
Dog Cat Bat High Risk
Terrestrail
Other
2008 2009 2010
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Last Rabies Positive Submission
Species Year Species Year
Dog 1989 Cat 1984
Horse 2002 Skunk 2004
Fox 1990 Cow 1986Fox 1990 Cow 1986
Pig 1967 Ground Hog 1983
Raccoon 1979 Bat 2011
Goat 1967 Mouse 1970
Opossum 1968 Human 2006, 2009
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Human Rabies Cases (IN)
• Between 1900 and 1949 – 120 cases
• Between 1950 and 1959– 10 cases
• After 1959 – 2 cases• After 1959 – 2 cases
– 2006
– 2009
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PUBLIC HEALTH AND RABIES PREVENTION IN HUMANS
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Public Health Issues
• Animal bites that potentially expose individuals to rabies
• Issues are:• Issues are:– Does the animal have rabies
– Is post exposure prophylaxis needed
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Laws and Regulations
• Management of Animal Bites to Humans– 410 IAC 1-2.3
• Animal bites; specific control measures– Section 52– Section 52
• Authority: IC 16-41-2-1 Affected: IC 15-17-6-11; IC 16-41-2; IC 16-41-9
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Quarantine Regulations
• 10 day bite Quarantine
• 6 month exposure Quarantine
• What is the difference?
• Why is there a difference?
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Source: Centers for Disease Control and Prevention, November 2010
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Risk of rabies transmission
• Degree of exposure
• Circumstances of bite
• Behavior of biting animal
• Vaccination status• Vaccination status
• Prevalence of rabies - geographic area
• SPECIES of animal involved
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Summary, Rabies in Indiana
• Indiana’s primary reservoir = ?
• Indiana’s secondary reservoir = ?
• Rabies vaccination can prevent transmission from reservoirs
• Rabies vaccination can prevent transmission from reservoirs
• Human exposures to bites/saliva from wildlife and domestic animals must continue to be evaluated
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Bats and Rabies
• ~ 1% of bats carry rabies virus
• May or may NOT show symptoms
• Bites don’t always leave visible marks
• Most exposure occur when bats enter human living quarters
• Photo: Green River Health District, KY
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courtesy of Nebraska Department of Health and Human Services
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More about Bat Exposure!
• Bat bites may not be noticed because bat teeth are very tiny and razor sharp.
• Examining a person for a bat bite is unreliable, because bat bites can be no bigger than a needle prick.unreliable, because bat bites can be no bigger than a needle prick.
• ANY direct contact with a bat should be considered a possible rabies exposure.
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Proximity Exposures
• Photo by Kevin Lilly
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Bat Exclusionhttp://wildlifehotline.info/
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When should you submit a bat for Rabies testing?
• Bite human or domestic pet
• Direct contact with human or pet
• Proximity exposures• Proximity exposures
• Photo: Green River Health District, KY
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Low risk animals
• Not usually considered rabies exposures
• Treatment or testing is not normally necessarynot normally necessary
• Evaluate for unusual circumstances that may indicate possible rabies
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JENNIFER HOUSE
Veterinary EpidemiologistIndiana State Department of HealthIndiana State Department of Health317-233-7272
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