Rabies Exposures: When is Prophylaxis Recommended and Update on Communicable Disease Rule Changes Connie Austin June 2012
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
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
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
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
Burden Worldwide More than ~55,000 human rabies deaths per year Most occur in developing countries Millions of human exposures per year
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
Percent of Animal Bites Due to Various Animals Cat Other Dog
Animal Rabies in Illinois, 1992-20102010
Bat Testing in Illinois, 2000-2010
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
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
Provoked/unprovoked. What does that mean??
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
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
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
Wild animal (bat, skunk, coyote, raccoon, fox) bite Rabies PEP recommended unless can test the animal negative
Rabbits or Small Rodent Bites Rarely, if ever, require rabies PEP
Bat Exposures
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
Rabies Vaccines Available in U.S. Human Diploid Cell Vaccine Imovax (HDCV)-Sanofi Pasteur R ba t Purified Chick Embryo Cell RabAvert (PCEC)-Novartis
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
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
Rabies PEP in Illinois, 2004 18 % of persons recommended for rabies PEP should not have received rabies PEP per ACIP 41% had rabies PEP administered correctly
Incorrect Rabies PEP Administration, 2004 62 % had incorrect timing of injections 19 % had multiple problems 14 % had no RIG given 3%h had dincorrect site of finjection
Test Your Knowledge
Illinois Public Health Rabies Resources www.idph.state.il.us Animal rabies numbers Information sheets
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)
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, 2016. Emphasis on reporting by phone for those < 3 hr. State after-hours (1-800-782-7860) Syndromic surveillance Confidentiality Emergency responders
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)
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