October 9, 20146:30 – 8:00 pm

Jefferson County Public HealthMount Bierstadt Room

Rabies in Colorado◦ Public Health Concerns for Practitioners◦ Colorado Rabies data

Rabies in Jefferson County◦ Jefferson County Data

Prevention and Public Education◦ Protecting Clinic Staff

Cat Vaccination Proposal Veterinarian Electronic Vaccination Reporting

proposal

October 9, 2014

Jennifer House, DVM, MPH, DACVPMState Public Health Veterinarian

Colorado Department of Public Health and Environment

303-692-2628jennifer.house@state.co.us

An infectious disease (virus) of the central nervous system that may affect any mammal.

~ 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

Bites from bats might not be noticed Examining a person for a bite is not reliable Any direct contact between a bat and a

human or domestic pet should be considered a possible rabies exposure

courtesy of Nebraska Department of Health and Human Services

Bite to a human Direct contact with human or pet◦ Do NOT tell pet owner to release bat

Proximity exposures

Low risk animals Not usually considered

rabies exposures Treatment or testing is

not normally necessary Evaluate for unusual

circumstances that may indicate possible rabies

0

20

40

60

80

100

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Case

Cou

nt

Year

Bats

Skunks

Other Wildlife

Domestic

2007-2008 2009

2010 2011

Rabies ForumOctober 9, 2014

Jefferson County Public HealthDavid Volkel

dvolkel@jeffco.us303-271-5730

RABIES

Human Rabies in the US (CDC)

2011 - 4 (1 survivor, Bat, Dog Haiti,Dog Afghanistan)

2010 - 2 (Vampire Bat/Mexico, Bat/US)2009 - 4 (1 survivor, 3 Bats, India dog) 2008 - 2 (Bat, Mexico Fox)2007 - 1 (Bat)2006 - 3 (2 Bats & Philippines dog)2005 - 1 (Bat)2004 - 8 (1 survivor, bat bite, donor and

3 from Transplants)2003 - 3 (Dog & Bat & Unknown)2002 - 3 (Bats)2001 - 1 (Philippines dog)2000 - 5 (4 Bats, Africa dog) 1999 - 0 1998 - 1 (Bat)

Over half cases from 1980 are from bats

Rabid bats-all states except Hawaii

Human Exposure to Rabies in the US

WHO

• Estimated that 40,000 people a year have contact with potentially rabid animals and receive rabies PEP

• Rabies PEP is a medical urgency, not a medical emergency, but decisions must not be delayed

Animal Rabies in the US (CDC 2010)

• 5,666 cases in wild animals

• 92% of all reported cases - wild animals

• 8% domestic animals • (303 cats, 71 cattle, 69 dogs)

• Raccoons (36.5%), Bats (23.2%), Skunks (23.5%), Foxes (7%), others including rodents and lagomorphs (2%)

Rabies in the USA (CDC 2008)

Rabies in Colorado by Species and Year (CDPHE)

• Bats Every year (most counties)• Skunk 2014 (Adams, Arapahoe, Boulder, Elbert, • Larimer, Pueblo, Weld)• Cat 2014 Yuma• Cat 2013 (Larimer, Logan, Washington,

Weld)• Cat 2012 (Cheyenne)• Cat 2008 (Cheyenne) last in Co was 1985• Dog 2003 (Morgan County) (Texas)

• Human 1931 (El Paso County)

• Due the reemergence of skunk rabies in 2008 there have been rabies cases in – Horse, Cow, Mountain Lion, Fox, Raccoon, Bison, & Coyote

2014 Skunk Rabies (9/19/14)

1

9

3

1

1

1

6

1

Rabies Tests Jefferson County (10/3/2014)

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Total 69 50 70 70 133 90 60 79 107 102 141 147 137

DOMESTIC

Total 29 32 38 28 42 42 22 30 38 30 39 46 27

WILD

Bats

POS

24

5

13

1

17

2

26

3

79

17

36

1

24

5

34

2

44

5

46

9

63

11

55

7

82

11Total 40 18 32 42 91 48 38 49 69 72 102 101 110

Wildlife/Pet Interaction Bites, puncture wounds, blood, saliva, direct physical contact, in pets mouth. Test wildlife or confine the pet

– Current vaccination: re-vaccinate now & home observation for 45 days

– Expired (with 2 in the past) re-vaccinate at 0 and in 30 days with a 90 home quarantine

– No vaccination – High Risk: euthanasia recommended if owner unwilling the animal must be placed in 90 day quarantine at a secure facility and then 90 days at home with vaccinations at 0, 21, and 60 days. ~ $20.00 a night for secure facility.

Observations & Quarantines (2010-2014)

Currently Vaccinated45 day observation

(41)

Expired Vaccination90 day quarantine

(31)

High Risk180 day quarantine

(31)

Cat Dog Cat Dog Cat Dog

Bat Wild Bat Wild Bat Wild Bat Wild Bat Wild Bat Wild

2010 1 1 3

2011 1 3 1 1 2 3

2012 2 5 2 1 1 1 3 1 1 3

2013 9 4 1 1 5 2 3 1

2014 2 1 1 8 9 2 8 4 1 2 3

14 1 13 13 1 15 3 12 12 4 3 12

Total Bats 46 Cats/Bats 27 Dogs/Bats 19

Total Wild 57 Cats/Wild 20 Dogs/Wild 37

Wildlife/Pet Interaction (2010-2014)

• Current Vaccination – Cats 15 (14 bats/1 wild animals)– Dogs 26 (13 bats/13 wild animals)

• Expired Vaccination– Cats 16 (1 bat/15 wild animals)– Dogs 15 (3 bats/12 wild animals)

• High Risk – Cats 16 (12 bats/4 wild animals)– Dogs 15 (3 bats/12 wild animals)

State Legislation Requiring Rabies Vaccination of Cats and Dogs (CDC, 2009)

Prevent Rabies In Animals

• Vet exams of pets on a regular basis • Vaccinations up-to-date for all domestic pets and

valuable livestock• Keep cats and ferrets indoors and keep dogs

under direct supervision• Spay or neuter reduces unwanted pets that are

not vaccinated regularly• Animal control will remove all stray animals as

these animals may be unvaccinated or ill

10 day bite Quarantine◦ When do you use this one?

6 month exposure Quarantine◦ What about this one?

What is the difference? Why is there a difference? Does it really matter?

Rabies In Dogs

Exposure

Incubation Period

7 - 125 days

Prodromalperiod

1-3 days

excited phase

1-7 days

Paralyticphase

2-5 days

Death

More affectionate Shy and seek seclusionSnappy and irritable

Very agitatedRoamBite anythingDrooling

Paralysis of massetermuscles

Drooling (foaming)

Dogs shed rabies virus during this time

No more than 4-7 days prior to symptoms

Normal is 3-12 weeks Range may be 9 days to 7 years

***Long incubation period allows time to wait for treatment in certain situations

Rabies Prevention Guidance• Human Rabies Prevention-United States,

2008 Recommendations of Practices (ACIP)– MMWR: May 23, 2008 / 57 (RR-03);1 – 28 – MMWR Update: March 19, 2010 / 59(02);1-9

• Animal : Compendium of Animal Rabies Prevention and Control, 2011 (NASPHV)

– http://www.nasphv.org/Documents/RabiesCompendium.pdf

38

3 doses of vaccine◦ Day 0, 7, and 21 (or 28)

Need booster doses after exposure◦ No RIG!◦ Day 0◦ Day 3

~ cost is $220-260/vaccine

Effective if given after exposure Anytime before symptoms develop Can be shipped to HCP overnight

(manufacturer) Expensive!

Given once (day 0) Immediate, passive antibodies Weight based (20 IU/kg) Given at the site of bite If no known bite or bite area is too small for full dose—give in a large muscle group

Small dose Given in muscle (arm) 4 doses over 2 weeks◦ Day 0 (with RIG)◦ Day 3◦ Day 7◦ Day 14

Day 0 is the date when the 1st vaccine was given NOT when the exposure occurred

Colorado Rabies Task Force, 2012 How to Guide

https://www.colorado.gov/pacific/cdphe/rabies

Jennifer HouseState Public Health VeterinarianColorado Department of Public Health and

Environment

303-692-2628jennifer.house@state.co.us

Jefferson County Board of Health Support for Ordinance Changes

Jefferson County Board of County Commissioners Animal Control Ordinance Change Public Hearing

Letters of Support: Jim Rada, Director

Jefferson County Public HealthEnvironmental Health Services Division

645 Parfet StreetLakewood, CO 80215

jrada@jeffco.us

0

5

10

15

20

25

30

35

40

Domestic

Wildlife, non-skunk

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5

10

15

20

25

30

35

Other Wildlife

Domestic

Bat

Skunk