1. Rabies and Public Health History Epidemiology Pathogenesis Response

2. History  A recognized disease as early as 2300 BC  Aristotle wrote about rabies in 322 BC  Saliva of rabid dogs was recognized as “venomous” in the 1 st century AD

3. History  First documented case in US Virginia, 1753  Colonial times-1950s Dogs highest vector risk  1960s-today Wildlife greatest reservoir

4. Historyzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzz  Raccoon rabies: Noticed in FL in mid 50s Spread to VA in 1970s Seen everywhere but sw VA  Skunk rabies Present in low levels in sw VA since 1960s

7. Epidemiology

9. Cases of Animal Rabies, Virginia, 1999-2003

10. Rabies distribution

11. Disease Transmission  Almost always a bite  Virus cannot enter intact skin  Virus can cross mucus membranes Less efficient  Breaks in skin are a risk only if wet saliva gets in wound

12. Pathogenesis  Virus enters the body  Virus enters NM junctions  Travels via peripheral nerves to spinal cord  Then to brain stem and forebrain

13. Disease in Animals  Two major clinical types in dogs and cats Furious Restless, irritable, disoriented, seizures More common in cats Paralytic Extremity paralysis, altered bark, salivating More common in dogs

14. The Disease in Man  Initial clinical symptoms include anxiety, headache, mild fever, irritation at bite site  Progresses to muscle spasms, difficulty swallowing, hydrophobia  Clinical course is typically short

15. Rabies Timeline incubation exposurevirus shed.signsdeath dogs10 d-6 m0-5d0-8d hu5d-6y2-14d Other???

16. Laboratories  Fairfax County HD  Norfolk HD  DCLS Southwest Micro lab.  DCLS Central lab.

17. Testing  An animal involved in significant human exposure.  An animal involved in significant domestic animal exposure.  A bat when significant human exposure can not reasonably be determined.

18. Significant exposure  Bite  Saliva contact with mucus membrane or skin break

19. Testing  Direct Fluorescent Antibody (DFA) May be used on fresh or decomposed tissue. Produces sensitive and rapid results. Considered the most reliable of all available technologies. Daily quality control steps assure accuracy.

20. Principles of DFA Fluorochrome-labeled Antibody to Rabies Virus Rabies Virus infected Cell Labeled Antibody- Rabies Virus

21. DFA Results < Positive Brain Negative Brain >

22. Public Health Response

23.  Human exposed to dog, cat or ferret Observe animal for 10 days Test if illness or death w/in observation period Should be discussed with health director IS NOT DEPENDENT ON VACCINATION STATUS

24. Public Health Response  Human exposed to livestock Typically 10-14 days observation Possibly testing + Post exposure tx. (PEP)

25. Public Health Response

26.  Vaccinated dog, cat or ferret exposed Proof of current immunization Immediate booster 45 days confinement Testing if signs of rabies develop

27. Public Health Response  Unvaccinated dog, cat, ferret exposed Euthanize or 6 months isolation Vaccinate one month prior to release Test if signs of rabies develop

28. Public Health Response  Expired vaccination Euthanize or 6 month isolation Vaccinate immediately and one month prior to release Depending on the circumstances, some of these animals can be considered as currently vaccinated

29. Public Health Response  Livestock exposed Vaccinated Boost and 3 months observation Unvaccinated Immediate slaughter or 6 months observation

30. Public Health Response  Wildlife exposures No observation time High risk species Low risk species Test when possible or situation warrants

31. Public Health Response  Control/Education Vaccinate dogs and cats Wildlife vaccination initiatives Animal control Avoid direct contact with wildlife Pre-exp. vaccination for high risk professions

32. Public Health Response  Control/Education Prompt attention to bites Good communication with all parties involved in follow up Prompt PEP when necessary

33. Recent cases in Virginia  1998-unknown exposure, silver haired bat variant, prison in work program  2003-raccoon variant, no history of exposure, diagnosed 3 months after death

34. Rabies Fun Facts  Early treatments for rabies in people included: Total immersion in salt water Lighting gunpowder in wounds Blood letting

35. Rabies Fun Facts  Famous bite victims: Emily Bronte Cardinal Crescence, 1532  Rabies was eradicated from the Scandinavian countries as early as 1832  Some MDs used to advise that if a dog drank after biting, the dog could not be rabid

36. Interesting situations  Concerning non-bite exposures Bat Raccoon Goat  Concerning low risk exposures Monkey

37. Post Exposure Potpourri  Peruvian PEP  Old PEP  PEP reactions

38. Good Resources  www.vdh.virginia.gov VDH Programs Epidemiology Program Zoonotic and Environmental Epi.

39. Good Resources  www.cdc.gov/healthypets  www.cdc.gov/ncidod/dvrd/rabies  www.nasphv.org

40. Questions?