OH III Rabies

People exposed to large amounts of aerosolized virus; contact of open wounds with saliva from a rabid animal

Rabies immune globulin (RIG) provides rapid passive immunity for ~21 days

Prophylaxis: wound treatment, local infiltration of RIG, vaccination (RV)

CDC regulates importation of dogs/cats into US; need to be current on rabies vxn w/ certificate (dog/cat/ferret/horse)

Bite (any penetration of skin by teeth), Non-bite (surgical recipients of corneas, solid organs, vascular tissue)

Raccons, skunks, foxes are most commonly infected; all bites should be considered exposures unless tested negative

Unvxn - euthanize; Vxn - revxn; Multiple exposures uncommon; exposed - slaughter; cooking inactivates rabies virus

Vaccines licensed for human use in US:

Species, circumstances of exposure, rabies epidemiology, exposing animal's health/history

Dogs usually shed rabies virus in their saliva for up to 5-10 days before clinical signs develop

Regimen Not vxn: thorough wound cleansing w/ soap/water; RIG 1/2 @ bite + 1/2 IM; Four doses (Days 0, 3, 7, 14)

Unvxn - euthanize or strict isolation for 4-6m; if vxn - revxn; overdue - booster and isolate

Confined & observed for 10 days regardless of vxn status (Do NOT vxn); strays and unwanted -> euthanize & test

Two doses of RV (day 0 and 7); follow-up (serologic testing to ensure protection 1-3 y; booster after 3 y w/o titer test

Dogs, cats, ferrets shed virus for a few days prior to, and during, clinical signs; highly variable (3-12wk domestic)

Progression to death is rapid; no effective rabies antiviral drugs

Regimen vxn: Thorough wound cleansing; RV on days 0 and 3

Highly variable; inappetance, dysphagia, CN deficits, abnorm behavior, ataxia, paralysis, altered vocalization, seizures

Rodents are not reservoirs; lagomorphs are rarely infected and have not been known to transmit rabies to humans

NASPHV recom. for domestic animals; all dogs, cats, ferrets be vaccinated; remove strays and unwanted animals

Accomplished for those exposing human/domestic animal; submit only head/brain except bats (refrig.); no antemortem test

10-12M people worldwide get post-exposure prophylaxis; pre-exposure alone may not be sufficient protection; expensive

Carnivores: oral rabies vaccines for mass vxn (raccoons/coyotes); Watch for bats (reducing pop is not plausible)

Indirect contact does not = exposure: petting, contact w/ blood/feces/urine, contact of saliva w/ skin

Domestic animals + livestock w/ frequent human contact; Vaccinate; Booster in a year of initial; 3m, 1y, every 3y

Control diff. in wildlife; NO licensed parenteral rabies vxn; enact laws to prohibit ownership, translocation

Wild mammalian carnivores and bats unavailable for testing should be considered rabid

What rabies variant is in the Midwest US + California?

Bat exposures deserve special consideration (any direct contact, esp. children, with a bat

What rabies variant is in the eastern US?

US has been declared free of canine rabies virus; Since 2000, more cats than dogs are diagnosed with rabies

Organ transplantation; no other transmission known; caring for human rabies patient is not an exposure unless they bite

What rabies variant is in Puerto Rico?

What rabies variant is in Arizona + Alaska?

Adverse events rare in animals; none for wild/hybrid animals; oral in humans is exposure; NASPHV compendium

Requires lab confirmation by positive direct fluorescent antibody test or isolation of rabies virus (cell culture)