Connie Austin June 2012

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1 Rabies Exposures: When is Prophylaxis Recommended and Update on Communicable Disease Rule Changes Connie Austin June 2012

2 Rabies Transmission Bite from infected mammal (not birds, amphibians, reptiles) Possibly if saliva from infected animal entered wound Infectious material-brain, spinal cord, saliva Contact with blood, urine, feces, etc. are not considered exposures

3 Pathogenesis Virus replicates at site of bite Travels up nerves to brain Rabies post-exposure prophylaxis (PEP) will work unless virus has entered nerve tissue Incubation period is usually 3-8 weeks

4 Reporting of Animal Bites and Potential Rabies Exposures in Illinois Animal bites are reportable to animal control Potential human exposure to rabies is reportable to public health including any administration of rabies PEP Coordination between animal control and public health to share information

5 Distribution Rabies is distributed on all continents (with the exception of Antarctica) Several areas are considered free of the disease, including many islands in Pacific Oceania

6 Burden Worldwide More than ~55,000 human rabies deaths per year Most occur in developing countries Millions of human exposures per year

7 Rabies In The U.S. Human rabies uncommon (1-8 cases per year); ~ 20,000 40,000 human exposures per year Approximately 7,000 10,000 animal rabies cases diagnosed per year

8 Percent of Animal Bites Due to Various Animals Cat Other Dog

9

10

11 Animal Rabies in Illinois,

12 Bat Testing in Illinois,

13 Animal Bite Consultations Species of the biting animal Type of exposure-bite/non-bite Availability for testing or observation If domestic dog or cat Circumstances of the bite Amount of terrestrial animal rabies virus circulating Geographic location

14 Species of the biting animal Domestic dog, cat or ferret Small rodent or rabbit Wild animals (ex. fox, skunks, raccoons) Bat Exotic animal Livestock or horse

15 Provoked/unprovoked. What does that mean??

16 Domestic dog, cat or ferret. Healthy, provoked bite, available for 10 day confinement No rabies PEP would be recommended During 10 day confinement If li i l i di t b t t d f If clinical signs or dies, must be tested for rabies

17 Domestic dog, cat or ferret. Unprovoked bite or acting abnormally Animal must be tested for rabies Treat person unless you can test brain quickly and it is rabies negative

18 Escaped cat or dog bite. Provoked, not acting abnormally. With current rabies situation in Illinois, no PEP recommended unless in an area where rabies has occurred in multiple terrestrial animals

19 Wild animal (bat, skunk, coyote, raccoon, fox) bite Rabies PEP recommended unless can test the animal negative

20 Rabbits or Small Rodent Bites Rarely, if ever, require rabies PEP

21 Bat Exposures

22 POSTEXPOSURE PROPHYLAXIS Provided to patients after rabies exposure Consists of wound care, rabies immune globulin, and vaccine If prompt and proper, survival virtually p p p p, y assured

23 Rabies Vaccines Available in U.S. Human Diploid Cell Vaccine Imovax (HDCV)-Sanofi Pasteur R ba t Purified Chick Embryo Cell RabAvert (PCEC)-Novartis

24 Postexposure Prophylaxis Wash lesions well with soap and water Infiltrate rabies immune globulin (20 IU/kg) into and around the margin of the bites Administer vaccine on days 0,3,7 and 14 Only need dose 5 if immunosuppressed

25 POSTEXPOSURE PROPHYLAXIS Urgency rather than emergency, per se Depends in part upon the animal species, exposure details, rapidity of diagnostic testing, and epidemiology of rabies in the local area Consultation with knowledgeable public health officials should be routine

26 Rabies PEP in Illinois, % of persons recommended for rabies PEP should not have received rabies PEP per ACIP 41% had rabies PEP administered correctly

27 Incorrect Rabies PEP Administration, % had incorrect timing of injections 19 % had multiple problems 14 % had no RIG given 3%h had dincorrect site of finjection

28 Test Your Knowledge

29 Illinois Public Health Rabies Resources Animal rabies numbers Information sheets

30 Proposed Rules Changes Diseases to be added Extensively drug resistant organisms Animal rabies Chikungunya Babesiosis Lab-acquired recombinant organism Influenza admission into ICU Diseases to be removed Giardia Probable CJD (Confirmed CJD still reportable)

31 Rule Changes (continued) - Reporters reporting Pilots and masters are added to the list of mandatory reporters Electronic lab reporting from labs is required unless an exemption is received by Jan 1, Emphasis on reporting by phone for those < 3 hr. State after-hours ( ) Syndromic surveillance Confidentiality Emergency responders

32 Rule Changes - Time Frames of Reporting Diphtheria and polio immediate reporting Clarified that even if the case is a suspect, should be reported for high consequence pathogens All high consequence diseases within 3 hrs and some 24 hours if not biot (ex. tularemia, brucella, hantavirus)

33 Rule Changes (continued) Outbreaks Outbreak foodborne, waterborne and non foodborne water borne better designated Foodhandler definition and contacts in restaurant t outbreak setting Adds information on exclusion from work and release specimens for foodhandlers and health care workers for various diseases

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