Georgia rabies control manual / [prepared by Cherie L. Drenzek with assistance from Jimmy Clanton and Julie Fletcher]

Georgia Rabies Control Manual

Georgia

EPIDEMIOLOGY BRANCH DIVISION OF PUBLIC HEALTH DEPARTMENT OF HUMAN RESOURCES

DHR Pub. No. DPH01.31HW

February 2001 | Fourth Edition

Table of Contents

Page Number

Foreword

1

Important phone numbers

2

I. RABIES OVERVIEW

3

II. RABIES PREVENTION AND CONTROL

Legal Authority

4

Principles of Rabies Control

4

A. CONTROL METHODS IN ANIMALS

Animal Vaccination Protocols

5

Management of Animals Exposed to Rabies 6

Management of Animals that Bite Humans 8

Protocols--Quick Reference

10

B. CONTROL METHODS IN HUMANS

Rabies Biologics

12

Pre-exposure Vaccination

14

Post-exposure Vaccination

16

-Regimen and Schedule

17

-Assessing the Need for PEP

18

Decision Trees

21

Sources for Rabies Prophylactic Biologics

26

III. LABORATORY DIAGNOSIS OF RABIES

General Principles

30

Reporting & Interpreting Results

33

Submission Form

34

Serologic Testing

35

IV. BATS AND RABIES

37

V. FREQUENTLY-ASKED QUESTIONS (FAQ) ABOUT RABIES

39

VI. REFERENCES

Definitions

41

Rabies Control Law-O.C.G.A-31-19

43

Compendium of Animal Rabies Prevention and

Control, 2001

46

Foreword
The purpose of this manual is to provide current information on the control of rabies in Georgia. It is designed to be used by county health departments, hospital emergency departments, private physicians and health care practitioners, veterinarians and animal control programs. This manual should serve as an educational tool for use in all facets of community rabies control. Additionally, it is hoped that this manual will assist communities in standardizing rabies control practices within the state.
This document was prepared by Cherie L. Drenzek, DVM, MS, with assistance from Jimmy Clanton and Julie Fletcher, DVM, MPH. Credit is also given to authors of the following: 1) Georgia Rabies Control Manual, Third Edition (1996); 2) National Association of State Public Health Veterinarians (NASPHV) Compendium of Animal Rabies Prevention and Control 2001, and 3) Human Rabies Prevention--United States, 1999, Recommendations of the Advisory Committee on Immunization Practices (ACIP).
If you have any questions regarding this manual, please contact the Notifiable Diseases Epidemiology Section, Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources at (404) 657-2588.

Kathleen E. Toomey, MD, MPH
Director Division of Public Health

Paul A. Blake, MD, MPH
State Epidemiologist Epidemiology Branch

1

Important Phone Numbers
RABIES CONSULTATIONS Georgia Poison Center- (Atlanta)
*Toll Free Number County Health Departments County Animal Control Epidemiology Branch

404-616-9000 800-282-5846 See local phone directory See local phone directory 404-657-2588

STATE PUBLIC HEALTH LABORATORIES
Atlanta (Decatur) Albany Waycross

404-327-7900
229-430-4122 912-285-6000

HOSPITALS THAT STOCK RABIES BIOLOGICS

List by County

See pages 26-29

SOURCES FOR RABIES VACCINE
Connaught Laboratories, Inc. (HDCV) BioPort Corporation (RVA) Chiron Corporation (PCEC)

800-VACCINE
517-335-8120 800-CHIRON8

SOURCES FOR RABIES IMMUNE GLOBULIN
Connaught Laboratories, Inc. Bayer Corp. Pharmaceutical Division

800-VACCINE 800-288-8370

SEROLOGIC TESTING FOR HUMANS AND ANIMALS (see pages 35-36)

Atlanta Health Associates, Inc.

770-205-9091

Cumming, GA

Auburn University Virology Laboratory
College of Veterinary Medicine Auburn, AL

334-844-2659

Kansas State University Rabies Lab College of Veterinary Medicine
Manhattan, KS

785-532-4483

BLANK CERTIFICATES FOR INTERSTATE AND INTERNATIONAL MOVEMENT OF DOGS AND CATS FOR USE BY VETERINARIANS

State Veterinarian's Office, Georgia

404-656- 3671 or 3667

Department of Agriculture

2

RABIES OVERVIEW
Rabies is a viral infection transmitted in the saliva of infected mammals. The virus enters the central nervous system of the host, causing an encephalomyelitis that is almost always fatal. Although all species of mammals are susceptible to rabies virus infection, only a few species are important as reservoirs for the disease in nature. In the United States, several distinct rabies virus variants have been identified in terrestrial mammals, including major terrestrial reservoirs in raccoons, skunks, foxes, and coyotes. In addition to the terrestrial reservoirs for rabies, several species of insectivorous bats also serve as reservoirs for the disease.
Wildlife is the most important potential source of infection for both humans and domestic animals in the United States. Reducing the risk of rabies in domestic animals and limiting contact with wild animals are central to the prevention of human rabies. Vaccination of all domestic dogs, cats, and ferrets coupled with the systematic removal of stray animals that are at risk of exposure to rabid wildlife, are basic elements of a rabies control program. Georgia law requires that all owned dogs, cats, and ferrets be vaccinated against rabies by a licensed veterinarian using approved vaccines in accordance with the Compendium of Animal Rabies Prevention and Control (see pages 46-50).
In the United States, indigenously acquired rabies among humans has declined markedly in recent years. The decline is, in part, due to vaccination and animal control programs begun in the 1940s that have practically eliminated the domestic dog as a reservoir of rabies and also to the development of effective human rabies vaccine and immune globulin. In the United States since 1990, there have been 32 reported human rabies deaths (including two in Georgia--in 1991 and 2000, respectively). Although 24 (74%) of the 32 cases since 1990 have been attributed to bat-associated variants of the virus, a history of a bite was established in only two cases. Contact with bats occurred in approximately half of the other cases. In many of these cases, the bat bite was presumably not recognized nor the risk of rabies appreciated in order to seek appropriate medical attention.
Human rabies is a completely preventable disease if the risk of acquisition is appreciated and appropriate rabies post-exposure prophylaxis (consisting of both active and passive immunization) is obtained. Because rabies is a fatal disease, the goal of public health (in coordination with the medical community) is, first, to prevent human exposure to rabies by education and, second, to prevent the disease by administering rabies post-exposure prophylaxis (PEP) if exposure occurs. Tens of thousands of people are successfully treated each year after being bitten by an animal that may have rabies.
Although the decision to provide post-exposure prophylaxis rests with the patient and his or her physician, valuable consultations can be provided by the Georgia Poison Center, local health departments, or the Epidemiology Branch, Georgia Division of Public Health.
3

Legal Authority
The primary responsibility for the control of rabies in Georgia rests with county boards of health. Chapter 31-19-1 of the Official Code of Georgia Annotated (O.C.G.A.) empowers and requires each county board of health to adopt and promulgate rules and regulations for the prevention and control of rabies (see pages 43-45).
Principles of Rabies Control
As a zoonotic disease, the foundations of rabies control rest upon preventing the disease in animals, preventing the disease in humans, and methods to decrease the likelihood of exposure between humans and animal rabies vectors. Public education regarding rabies exposure risk is paramount. The following principles apply:
Rabies Exposure. Rabies is transmitted only when the virus is introduced into bite wounds, open cuts in skin, or onto mucous membranes.
Human Rabies Prevention. Rabies in humans can be prevented either by eliminating exposures to rabid animals or by providing exposed persons with prompt local treatment of wounds combined with appropriate postexposure prophylaxis (including both passive antibody administration and active immunization with cell culture vaccines). In addition, pre-exposure vaccination should be offered to persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers.
Domestic Animals. Local governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove strays and unwanted animals from the community. Recommended vaccination procedures and the licensed animal vaccines are specified in Parts I and II of the Compendium of Animal Rabies Prevention and Control (see pages 46-48). In addition, adjunct procedures which enhance rabies control include: 1) standard identification systems to verify animal rabies vaccination status; 2) local domestic animal licensure requirements; 3) requirement of interstate health certificates prior to domestic animal travel; 4) implementation of regulations governing imported domestic animals; 5) establishment of a local animal control agency responsible for stray control, leash laws, and issuance of citations for failure to vaccinate animals.
Rabies in Wildlife. The control of rabies among wildlife reservoirs is difficult. Vaccination of free-ranging wildlife or selective population reduction is not always feasible. Rabies control relies upon prevention of exposure to wildlife rabies reservoirs. This can be accomplished via public education about wildlife rabies risk and recommendations regarding avoidance of contact with wild animals.
4

Control Methods in Animals
Animal Vaccination Protocols
Parenteral animal rabies vaccines should be administered only by, or under the direct supervision of, a veterinarian. This is the only way to ensure that a responsible person can be held accountable to assure the public that the animal has been properly vaccinated. Within 1 month after primary vaccination, a peak rabies antibody titer is reached, and the animal can be considered immunized. An animal is currently vaccinated and is considered immunized if the primary vaccination was administered at least 30 days previously and vaccinations have been administered in accordance with the Compendium of Animal Rabies Prevention and Control (see pages 46-50). Regardless of the age of the animal at initial vaccination, a second vaccination should be administered 1 year later. Because a rapid anamnestic response is expected, an animal is considered currently vaccinated immediately after a booster vaccination.
Dogs, cats, and ferrets. All dogs, cats, and ferrets should be vaccinated against rabies and revaccinated in accordance with the Compendium of Animal Rabies Prevention and Control (see schedule on pages 47-48). For many licensed vaccines, the age at primary vaccination is 3 months, but be aware that for some newer combination rabies vaccines, this age is 8 weeks. If a previously vaccinated animal is overdue for a booster, it should be revaccinated with a single dose of vaccine and placed on an annual or triennial schedule, depending on the type of vaccine used.
Livestock. Vaccinating all livestock against rabies is neither economically feasible nor justified from a public health standpoint. However, consideration should be given to vaccinating livestock that are particularly valuable or that might have frequent contact with humans, such as show animals or those in petting zoos (refer to the Compendium of Animal Rabies Prevention and Control for specific vaccines licensed for use in livestock, page 47). Horses traveling interstate should be currently vaccinated against rabies.
Other Animals Wild. No parenteral rabies vaccine is licensed for use in wild animals. Because of the risk for rabies in wild animals (especially raccoons, skunks, coyotes, foxes, and bats), the Georgia Department of Natural Resources has rigid regulations which prohibit the keeping of wild and wild/domestic hybrids as pets. For further information, please see www.dnr.state.ga.us
5

Maintained in Exhibits and in Zoological Parks. Captive animals that are not completely excluded from all contact with rabies vectors can become infected. Moreover, wild animals might be incubating rabies when initially captured; therefore, wild-caught animals susceptible to rabies should be placed in strict isolation for a minimum of 6 months before being exhibited. Employees who work with animals at such facilities should receive pre-exposure rabies vaccination. The use of pre- or post-exposure rabies vaccinations for employees who work with animals at such facilities might reduce the need for euthanasia of captive animals. Carnivores and bats should be housed in a manner that precludes direct contact with the public.
Management of Animals Exposed to Rabies
Any animal potentially exposed to rabies virus by a wild, carnivorous mammal or a bat that is not available for testing should be regarded as having been exposed to rabies.
Dogs, Cats, and Ferrets
Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanized immediately. If the owner is unwilling to have this done, the animal should be placed in strict isolation (see Definitions, pages 41-42 ) for 6 months and vaccinated 1 month before being released. Animals with expired vaccinations need to be evaluated on a case-by-case basis. Strict isolation should be conducted under the authority of the designated local rabies control agency in which the place, manner, and provisions of the confinement are specified. For example, strict isolation may take place in an animal control facility, or a double-walled isolation pen at home, depending on local requirements. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
Currently vaccinated (see Definitions, page 41) dogs, cats, and ferrets should be revaccinated immediately, kept under the owner's control, and observed for 45 days for clinical signs of rabies. During the observation period (see Definitions, page 41) the animal should not be permitted to roam and should be restricted to leash walks, if applicable. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
6

Livestock
All species of livestock are susceptible to rabies; cattle and horses are among the most frequently infected. Livestock exposed to a rabid animal and currently vaccinated with a vaccine approved by USDA for that species should be revaccinated immediately and observed for 45 days.
Unvaccinated livestock should be slaughtered immediately. If the owner is unwilling to have this done, the animal should be kept under close observation for 6 months. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
The following are recommendations for owners of unvaccinated livestock exposed to rabid animals:
If the animal is slaughtered within 7 days of being bitten, its tissues may be eaten without risk for infection, provided that liberal portions of the exposed area are discarded. Federal meat inspectors must reject for slaughter any animal known to have been exposed to rabies within 8 months.
Neither tissues nor milk from a rabid animal should be used for human or animal consumption. However, pasteurization temperatures will inactivate rabies virus; therefore, drinking pasteurized milk or eating cooked meat does not constitute a rabies exposure.
Having more than one rabid animal in a herd or having herbivore-toherbivore transmission is rare; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies might not be necessary.
Other Animals
Other animals bitten by a rabid animal should be euthanized immediately. Animals maintained in USDA-licensed research facilities or accredited zoological parks should be evaluated on a case-by-case basis. Consultations can be provided by the Epidemiology Branch, Georgia Division of Public Health, Department of Human Resources.
7

Management of Animals that Bite Humans
Dogs, Cats, and Ferrets
A healthy dog, cat, or ferret that bites a person should be quarantined for 10 days, no matter if the animal is currently vaccinated or not. Administration of rabies vaccine is not recommended during the quarantine period.
Quarantine conditions should prevent direct contact with other animals or persons. The quarantine shall be conducted under the authority of the designated local rabies control agency in which the place, manner, and provisions of the quarantine are specified. For example, quarantine may take place in a kennel in a veterinary hospital, animal control facility, commercial boarding establishment or a pen at home, depending on local requirements.
At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately (or following the locally-specified impoundment period to give owners sufficient time to claim animals) and the head submitted for rabies examination.
Other biting animals (such as canine or feline wild/domestic hybrids, etc.)
No parenteral rabies vaccines are licensed for use in animals other than dogs, cats, ferrets, and some livestock.
Since the duration of clinical signs and the period of virus shedding are unknown for many species, quarantine may not be a feasible management strategy. Prior vaccination of an animal might not preclude the necessity for euthanasia and testing if the period of virus shedding is unknown for that species.
Management of animals other than dogs, cats, and ferrets depends on the species, the circumstances of the bite, the epidemiology of rabies in the area, and the biting animal's history, current health status, and potential for exposure to rabies. Consultations can be provided by the Epidemiology Branch, Division of Public Health, Georgia Department of Human Resources.
8

Wildlife Most wild mammals that bite or otherwise expose persons should be considered
for euthanasia and rabies examination. Since the duration of clinical signs and the period of virus shedding is unknown for these species, an appropriate quarantine or isolation period cannot be determined. Assessing rabies risk and the need for rabies diagnostic testing can be guided by the following:
Wild Carnivores: Raccoons, skunks, foxes, and coyotes are the terrestrial animals most often infected with rabies. All bites by such wildlife must be considered possible exposures to the rabies virus. Signs of rabies among wildlife cannot be interpreted reliably; therefore, any such animal that exposes a person should be euthanized at once (without unnecessary damage to the head) and the brain should be submitted for rabies testing.
Rodents and lagomorphs (squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits): are almost never found to be infected with rabies and have not been known to transmit rabies to humans. Bites by these animals are usually not considered a rabies risk and do not warrant rabies testing unless the animal is sick or behaving in an unusual manner. Rodents that are considered to be a rabies risk include woodchucks or groundhogs (Marmota monax) because they are frequently large enough to survive the attack of a rabid carnivore. Approval must be obtained from the Georgia Public Health Laboratory or the Epidemiology Branch of the Georgia Division of Public Health prior to submitting a rodent for rabies testing.
Bats: A bat that bites or scratches a person should be safely captured (see pages 37-38 for instructions), immediately euthanized, and the entire animal sent to the laboratory for rabies examination. People usually know when they have been bitten by a bat. However, because bats have small teeth that may leave marks that are not easily seen, there are situations in which rabies testing and medical advice should be sought even in the absence of an obvious bite wound. These include awakening to find a bat in the room, seeing a bat in the room of an unattended child, or seeing a bat near a mentally impaired or intoxicated person. In these situations a bite cannot be definitively ruled out. When the bat is not available for testing (i.e. escapes from house, etc.) post-exposure prophylaxis should also be considered as soon as possible.
Other wild animals (opossums, otters, polecats, beavers, weasels, etc.): In most situations involving non-reservoir species, the rabies risk is relatively low. The risk is higher and, consequently, rabies testing may be indicated if the animal is found in a rabies-endemic area, has opportunity for exposure to rabies reservoirs, is large enough to survive an attack by a rabid animal, or is ill or exhibiting abnormal behavior. Consultations can be provided by the Georgia Poison Center, local health departments, or the Epidemiology Branch, Division of Public Health, Department of Human Resources.
9

PROTOCOL FOR DOGS, CATS, AND FERRETS POSSIBLY EXPOSED TO RABIES
Dog/Cat/Ferret Exposed 1 to Bat or other wild carnivorous mammal

Exposed Dog/Cat/Ferret Has Current Rabies Vaccination 2
Revaccinate Immediately & Have Owner Observe For 45 Days
Test Dog/Cat/Ferret for Rabies if it becomes ill with signs suggestive of Rabies, or dies during observation
period

Exposed Dog/Cat/Ferret Does Not Have Current Rabies
Vaccination
Test Bat or Other 3 Wild Animal

Result is Positive
Immediate Euthanasia of Exposed Dog/Cat/Ferret
If Owner Refuses Euthanasia: 1. Strict isolation for 6 months. 2. Vaccinate for rabies at month 5 of
confinement. 3. Test dog/cat/ferret if it becomes ill
with signs suggestive of rabies, or dies during confinement period.

Result is Negative
Vaccinate Dog/Cat/Ferret Against Rabies

1. Consultations regarding animal exposures can be provided by the Epidemiology Branch of the Georgia Division of Public Health at 404-657-2588.
2. An animal is currently vaccinated if the primary rabies vaccine was administered by a veterinarian at least 30 days previously and booster vaccines have been administered on an annual or triennial schedule.
3. If bat or wild animal is NOT available for testing, must proceed as if result is positive.

10

RABIES PROTOCOL FOR ANIMALS WHICH HAVE BITTEN PEOPLE
Person Exposed (bitten, scratched, or other 1 ) (Refer person to physician)

Wild terrestrial mammal

Owned Dog or Cat (vaccinated or unvaccinated)

Stray Dog or Cat

(vaccination status

Livestock

Bat

unknown)

Euthanize Animal & test if appropriate species 2

Euthanize & test only if animal clearly
exhibits signs of rabies

Euthanize & test
immediately

Healthy Animal

Animal Showing Signs of Rabies

Owner Wants Animal

Owner Doesn't Want Animal

Euthanize & Test

Healthy Animal
Impound according to local protocols then euthanize & test

Quarantine for 10 Days

Euthanize & test

Test if animal becomes ill with signs suggestive of
rabies or dies during quarantine

Test if animal becomes ill with signs suggestive of rabies or dies during quarantine

Alternatively, animal may be quarantined for 10 days, and if it remains healthy, may euthanize
without testing

1. Consultations regarding exposure can be provided by the Georgia Poison Center, 24 hours a day, 7 days a week, at 1-800282-5846 or 404-616-4000.
2. The following animals are NOT CONSIDERED LIKELY TO HAVE RABIES and will not be tested except by special arrangements with the Epidemiology Branch of the Georgia Division of Public Health at 404-657-2588: chipmunk, gopher, hamster, mouse, rat, squirrel, gerbil, guinea pig, mole, rabbit, hare, shrew, vole.
11

Control Methods in Humans
Prevention of human rabies depends on eliminating exposure to rabid animals and providing exposed persons with prompt local treatment of their wounds, combined with appropriate rabies post-exposure prophylaxis (PEP) consisting of both active antibody administration and passive immunization with cell culture vaccines. In addition, pre-exposure vaccination is recommended for persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers.
Rabies Biologics
In general, two types of rabies immunizing products are available in the United States, namely, rabies vaccines and rabies immune globulin. Rabies vaccines induce an active immune response that includes the production of neutralizing antibodies. This antibody response requires approximately 7-10 days to develop and usually persists for greater than or equal to 2 years. Rabies immune globulin (RIG) provides a rapid, passive immunity that persists for only a short time (half-life of approximately 21 days).
Three formulations of inactivated rabies vaccines are currently licensed for preexposure and post-exposure prophylaxis in the United States (see below). When used as indicated, all three types of rabies vaccines are considered equally safe and efficacious. A full 1.0-mL dose is used for both pre-exposure and post-exposure prophylaxis. The HDCV formulation Imovax Rabies I.D. has recently been withdrawn from the market; therefore, there are no currently approved formulations for the intradermal dose and route for pre-exposure vaccination--all must be administered intramuscularly. Usually, an immunization series is initiated and completed with one vaccine product. No clinical studies have been conducted that document a change in efficacy or the frequency of adverse reactions when the series is completed with a second vaccine product.
Rabies biologics -- United States, 2001
A. Vaccines
1. Human Diploid Cell Vaccine (HDCV): HDCV is prepared from the PitmanMoore strain of rabies virus grown on MRC-5 human diploid cell culture, concentrated by ultrafiltration, and inactivated with beta-propiolactone. It is approved for intramuscular (IM) administration only, and is supplied in a single-dose vial containing lyophilized vaccine that is reconstituted in the vial with the accompanying diluent to a final volume of 1.0 mL just before administration.
Please note: HDCV formerly was supplied in an alternative form for intradermal administration under the name Imovax Rabies ID, which has recently been withdrawn from the market. There are no currently-
12

licensed formulations for the intradermal dose and route for preexposure vaccination.
Manufacturer: Connaught Laboratories, Inc. Product names: Imovax Rabies
2. Rabies Vaccine Adsorbed (RVA): RVA was developed and is currently manufactured and distributed in the state of Michigan by BioPort Corporation. The vaccine is prepared from the Kissling strain of Challenge Virus Standard (CVS) rabies virus adapted to fetal rhesus lung diploid cell culture. The vaccine virus is inactivated with beta-propiolactone and concentrated by adsorption to aluminum phosphate. Because RVA is adsorbed to aluminum phosphate, it is liquid rather than lyophilized. It is approved for IM administration only as a 1.0-mL dose.
Manufacturer: BioPort Corporation Product name: Rabies Vaccine Adsorbed (RVA)
3. Purified Chick Embryo Cell Vaccine (PCEC): PCEC became available in the United States in autumn 1997. It is prepared from the fixed rabies virus strain Flury LEP grown in primary cultures of chicken fibroblasts. The virus is inactivated with beta-propiolactone and further processed by zonal centrifugation in a sucrose density gradient. It is formulated for IM administration only. PCEC is available in a single-dose vial containing lyophilized vaccine that is reconstituted in the vial with the accompanying diluent to a final volume of 1.0 mL just before administration.
Manufacturer: Chiron Corporation Product name: RabAvert
B. Rabies Immune Globulin (RIG)
The two RIG products licensed in the United States are antirabies immunoglobulin (IgG) preparations concentrated by cold ethanol fractionation from plasma of hyper-immunized human donors. Rabies neutralizing antibody, standardized at a concentration of 150 IU per mL, is supplied in 2-mL (300 IU) vials for pediatric use and 10-mL (1,500 IU) vials for adult use; the recommended dose is 20 IU/kg body weight. Both RIG preparations are considered equally efficacious when used as described.
Manufacturers: Bayer Corporation Pharmaceutical Division and Connaught Laboratories, Inc.
Product names: BayRabTM and Imogam Rabies-HT
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Rabies Pre-Exposure Vaccination
Pre-exposure vaccination should be offered to persons in high-risk groups, such as veterinarians, animal handlers, and certain laboratory workers. Pre-exposure vaccination also should be considered for other persons whose activities bring them into frequent contact with rabies virus or potentially rabid bats, raccoons, skunks, cats, dogs, or other species at risk for having rabies. In addition, international travelers might be candidates for pre-exposure vaccination if they are likely to come in contact with animals in areas where dog rabies is enzootic and immediate access to appropriate medical care, including biologics, might be limited.
Pre-exposure prophylaxis is administered for several reasons. First, although preexposure vaccination does not eliminate the need for additional therapy after a rabies exposure, it simplifies therapy by eliminating the need for RIG and decreasing the number of doses of vaccine needed -- a point of particular importance for persons at high risk for being exposed to rabies in areas where immunizing products might not be available or where they might be at high risk for adverse reactions. Second, pre-exposure prophylaxis might protect persons whose post-exposure therapy is delayed. Finally, it might provide protection to persons at risk for inapparent exposures to rabies.
Pre-exposure vaccination regimens are as follows (also see table below): Intramuscular Primary Vaccination
Three 1.0-mL injections of HDCV, RVA, or PCEC should be administered intramuscularly (deltoid area) -- one injection per day on days 0, 7, and 21 or 28.
Intradermal Primary Vaccination
HDCV was formerly supplied in an alternative form for intradermal administration under the name Imovax Rabies ID, which has recently been withdrawn from the market. There are no currently-licensed formulations for the intradermal dose and route for pre-exposure vaccination.
14

Rabies pre-exposure prophylaxis schedule -- United States, 2001

==========================================================================

Type of vaccination

Route

Regimen

---------------------------------------------------------------------------------------------------------

Primary

Intramuscular

HDCV, PCEC, or RVA; 1.0 mL (deltoid area), one each on days 0*, 7, and 21 or 28

-------------------------------------------------------------------------------------------------------------------------------

Booster

Intramuscular

HDCV, PCEC, or RVA; 1.0 mL (deltoid area),

day 0* only

----------------------------------------------------------------------------------------------------------------------------HDCV= human diploid cell vaccine; PCEC = purified chick embryo cell vaccine; RVA = rabies vaccine adsorbed.
*Day 0 is the day the first dose of vaccine is administered.
Source: CDC. Human rabies prevention -- United States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48 (no. RR-1).
=========================================================================================

Note: Because the antibody response has been satisfactory after these recommended preexposure prophylaxis vaccine regimens, routine serologic testing to confirm seroconversion is not necessary except for persons suspected of being immunosuppressed.
Pre-exposure Booster Doses of Vaccine
Following completion of the pre-exposure primary vaccination regimen, certain persons whose activities bring them into frequent contact with rabies virus or potentially rabid animals may need a booster dose of vaccine if their rabiesneutralizing antibody level falls below an acceptable level (see below). The following table provides guidelines based upon level of risk:

15

Risk category
Continous Frequent
Infrequent

Typical populations

Booster recommendations

Rabies research lab workers Rabies biologics production workers

Serologic testing* every 6 months; booster vaccination when
antibody levels below acceptable level**

Rabies diagnostic lab workers Spelunkers Veterinarians and staff Animal Control Officers (endemic areas) International travelers to canine
rabies-endemic areas for>30days

Serologic testing* every 2 years; booster vaccination when antibody levels below acceptable level**

Animal Control Officers (non-endemic areas)
Veterinarians (non-endemic areas) Veterinary students

No serologic testing* or
booster vaccination needed

*Refer to pages 35-36 for information about serologic testing.
** Minimum acceptable antibody level is complete virus neutralization at 1:5 serum dilution by RFFIT. Booster dose should be administered if the titer falls below this level.
Source: CDC. Human rabies prevention -- United States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48 (no. RR-1).
Post-exposure Therapy for Previously Vaccinated Persons
If exposed to rabies, persons who have been previously vaccinated with the recommended pre-exposure regimen should receive two IM doses (1.0 mL each) of vaccine, one immediately and one 3 days later. RIG is unnecessary and should not be administered to these persons.
Rabies Post-Exposure Vaccination
In general, post-exposure prophylaxis (PEP) is indicated for persons exposed to a rabid animal in order to prevent infection with rabies virus. In the United States, the PEP regimen consists of local wound treatment, administration of one dose of immune globulin (with the exception of persons who have previously received complete vaccination regimens, either pre-exposure or post-exposure), and 5 doses of rabies vaccine over a 28-day period. Rabies immune globulin and the first dose of rabies vaccine should be given as soon as possible after exposure. Additional doses of rabies vaccine should be given on days 3, 7, 14, and 28 after the first vaccination. See chart below for specific schedule and administration instructions.

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Rabies Post-Exposure Prophylaxis Schedule

Vaccination Status

Treatment

Regimen*

Not previously vaccinated

Local Wound Cleansing

PEP should always begin with
immediate cleansing of all wounds with soap and water. If
available, a virucidal agent such as a povidone-iodine solution
should be used to irrigate the wounds.

Administer 20 IU/kg body

RIG

weight. If anatomically

feasible, the full dose should be

infiltrated around the wounds(s)

and any remaining volume

should be administered IM at an

anatomical site distant from

vaccine administration. RIG should not be administered in

the same syringe as vaccine.

Because RIG might partially

suppress active production of

antibody, no more than the

recommended dose should be

given.

Vaccine

HDCV, RVA, or PCEC 1.0 mL, IM (deltoid area)**, one each on days 0#,3,7,14,and 28.

Previously vaccinated***

Local wound cleansing

PEP should always begin with immediate cleansing of all
wounds with soap and water. If available, a virucidal agent such
as a povidone-iodine solution should be used to irrigate the
wounds.

RIG

RIG should not be administered.

Vaccine

HDCV, RVA, or PCEC 1.0 mL, IM (deltoid area)**, one each on days 0#,3.

*These regimens are applicable for all age groups, including children.** The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children, the outer aspect of the thigh may be used. Vaccine should never be administered in the gluteal area. *** Any person with a history of pre-exposure vaccination with HDCV, PCEC or RVA; prior post-exposure prophylaxis with HDCV, PCEC or RVA. # Day 0 is the first day of vaccine administration, not necessarily the day of exposure. Source: CDC. Human rabies prevention -- United States, 1999: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48 (no. RR-1).

17

Assessing Need for PEP
Administration of rabies PEP is a medical urgency, not a medical emergency. Persons who have been bitten by animals suspected or proven to be rabid should begin PEP as soon as possible. However, very long incubation periods (up to 1 year) have been reported in humans. Thus, when a documented or likely exposure has occurred, PEP is indicated regardless of the length of the delay, provided the clinical signs of rabies are not present.
Health care providers should evaluate each possible exposure to rabies and when necessary consult with the Georgia Poison Center or public health officials regarding the need for rabies PEP.
In the United States, the following factors should be considered in the rabies risk assessment before PEP is initiated:
type of exposure (bite vs. nonbite) the geographic location of the incident the type of animal that was involved circumstances of the exposure (provoked or unprovoked) the vaccination status of animal whether the animal can be safely captured and tested for rabies
In general, the highest risk of rabies transmission is associated with bite exposure from terrestrial wild carnivores or bats (see Decision Trees A and A-1). Raccoons, skunks, foxes, and coyotes are the terrestrial animals most often infected with rabies. All bites by such wildlife must be considered possible exposures to the rabies virus. PEP should be initiated as soon as possible after patients are exposed to wildlife unless the animal has already been tested and shown not to be rabid. In addition, bats are increasingly implicated as important wildlife reservoirs for variants of rabies virus transmitted to humans. In all instances of potential human exposures involving bats, the bat in question should be safely collected, if possible, and submitted for rabies diagnosis. Rabies PEP is recommended for all persons with bite, scratch, or mucous membrane exposure to a bat, unless the bat is available for testing and is negative for evidence of rabies. PEP might also be appropriate even if a bite, scratch, or mucous membrane exposure is not apparent when there is reasonable probability that such exposure might have occurred (see pages 37-38 for more specific information about bats and rabies).
The likelihood of rabies in a domestic animal varies by region; hence, the need for PEP also varies. In the continental United States, rabies among dogs is reported most
18

commonly along the United States-Mexico border and sporadically in areas of the United States with enzootic wildlife rabies. During most of the 1990s, more cats than dogs were reported rabid in the United States. The majority of these cases were associated with the epizootic of rabies among raccoons in the eastern United States. The large number of rabies-infected cats might be attributed to fewer cat vaccination laws, fewer leash laws, and the roaming habits of cats. In many developing countries, dogs are the major vector of rabies; exposures to dogs in such countries represent an increased risk of rabies transmission. In the United States, a currently vaccinated dog, cat, or ferret is unlikely to become infected with rabies (see Decision Tree B ). Although all species of livestock are susceptible to rabies, they are infrequently found to be infected (see Decision Tree C). Cattle and horses are among the most frequently reported rabid livestock; in many cases these animals have a previously reported history of exposure to a wildlife rabies reservoir, such as raccoon, skunk, or bobcat. Small rodents (e.g., squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, and mice) and lagomorphs (including rabbits and hares) are almost never found to be infected with rabies and have not been known to transmit rabies to humans (see Decision Tree D). An unprovoked attack by an animal is more likely than a provoked attack to indicate that the animal is rabid. Bites inflicted on a person attempting to feed or handle an apparently healthy animal should generally be regarded as provoked.
Refer to chart below and to the Decision Trees on pages 21-25 for specific guidelines.
19

Rabies Post-Exposure Prophylaxis Guide

Animal type

Evaluation and disposition Post-exposure prophylaxis

of animal

recommendations

Dogs, cats, and ferrets

-Healthy and available for 10 day quarantine

Persons should not begin
PEP unless animal develops clinical signs of rabies.*

-Rabid or suspected rabid Immediate PEP.

-Unknown (e.g., escaped)

Consult Georgia Poison Center or public health
officials.

Skunks, raccoons, foxes and most other carnivores;
bats

Regarded as rabid unless animal proven negative by
laboratory tests**

Consider immediate PEP.

Livestock, small rodents,
lagomorphs (rabbits and hares), large rodents
(woodchucks and beavers), and other mammals

Consider individually.

Consult Georgia Poison
Center or public health officials. Bites of squirrels,
hamsters, mice, rats, most other rodents, and rabbits
almost never require PEP.
Larger rodents may be a risk.

*During the 10-day observation period, begin PEP at the first sign of rabies in a dog, cat, or ferret that has bitten someone. If the animal exhibits clinical signs of rabies, it should be euthanized immediately and tested.

**The animal should be euthanized and tested as soon as possible. Discontinue vaccine if rabies test results are negative.

20

A. HIGH RISK ANIMALS Decision Tree for Wild Carnivore Exposure

Did an exposure occur?

NO
Rabies treatment not necessary

YES
Is animal available for testing?

NO
Begin rabies treatment ASAP

YES
Will results be available within 48 hours of exposure? (If exposure was to
head or neck and results will not be available within 24 hrs. of exposure,
begin rabies treatment ASAP).

NO
Begin rabies treatment ASAP; stop if results are
negative.

YES Are results POSITIVE?

NO
Rabies treatment not necessary

YES
Begin rabies treatment ASAP

21

A-1. HIGH RISK ANIMALS Decision Tree for Bat Exposure
Did an exposure occur?

NO
Rabies treatment not necessary
NO
Begin rabies treatment ASAP

YES or UNCERTAIN (due to circumstances)
Is bat available for testing?
YES
Will results be available within 48 hours of exposure? (If exposure was to
head or neck and results will not be available within 24 hrs. of exposure,
begin rabies treatment ASAP).

NO
Begin rabies treatment ASAP; stop
if results are negative.

YES
Are results POSITIVE?

NO
Rabies treatment not necessary

YES
Begin rabies treatment ASAP

22

B. INTERMEDIATE RISK ANIMALS Decision Tree for Dog, Cat, or Ferret Exposure

NO
Rabies treatment not necessary

Did an exposure occur?
YES
Is animal available for quarantine/testing?

NO
Did animal exhibit signs of rabies at time of exposure?

YES
Did animal exhibit signs of rabies at time of exposure?

NO Was exposure provoked?

YES Begin rabies treatment ASAP

NO

YES

Is animal currently vaccinated against rabies?

NO or Unknown
For head or neck exposures begin rabies treatment ASAP; else begin
within 5 days if animal is not found.

YES
Rabies treatment almost never necessary

Has animal bitten before?

NO or Unknown
Is animal currently vaccinated against
rabies?

YES
Rabies treatment probably not necessary

NO or Unknown
Rabies treatment probably not necessary

YES
Rabies treatment not necessary

NO
Rabies treatment not necessary if animal tests negative or is healthy for 10 days. Call county health department or county animal control for instructions for testing
or quarantine of animal.

YES
Begin rabies treatment ASAP unless animal brain can be tested within 48 hours of exposure (within 24 hours for head or neck exposures) and is negative for rabies. Instruct patient to call county animal control or county health department to arrange for testing. Treatment may be stopped if animal brain tests negative prior to
completion of the series.
23

C. LOW RISK ANIMALS Decision Tree for Livestock Exposure

Did an exposure occur?

NO
Rabies treatment not necessary
NO
Rabies treatment almost never necessary

YES
Did animal clearly exhibit signs of rabies at time of exposure?
YES
Is animal available for testing?

NO
Begin rabies treatment ASAP

YES
Begin rabies treatment ASAP unless animal brain can be tested within 48 hours of exposure (within 24 hours for
head and neck exposures) and is negative for rabies. Treatment may be stopped if animal brain tests negative
prior to completion of the series.

24

D. VERY LOW RISK ANIMALS Decision Tree for Rodent & Rabbit Exposure

Did an exposure occur?

NO
Rabies treatment not necessary
NO
Did animal clearly exhibit signs of rabies at
time of exposure?

YES
Was exposure provoked?
YES
Rabies treatment almost never necessary

NO
Rabies treatment almost never necessary
NO
Begin rabies treatment ASAP

YES
Is animal available for testing?
YES
Begin rabies treatment ASAP unless animal brain can be tested within 48 hours of exposure (within 24 hours for
head and neck exposures) and is negative for rabies. Treatment may be stopped if animal brain tests negative
prior to completion of the series.

25

HOSPITAL EMERGENCY DEPARTMENTS AND/OR HEALTH DEPARTMENTS THAT STOCK OR CAN OBTAIN RABIES PROPHYLACTIC BIOLOGICS WITHIN 24 HOURS, BY GEORGIA COUNTY, FEBRUARY, 2001

COUNTY
APPLING BACON BALDWIN BARROW BARTOW BEN HILL BERRIEN BIBB BIBB BROOKS BULLOCH BURKE CAMDEN CANDLER CARROLL CHARLTON CHATHAM CHATHAM CHATHAM CLARKE CLARKE CLAYTON COBB

NAME

CITY

TELEPHONE

Appling General Hospital

Baxley

912-367-9841

Bacon County Hospital

Alma

912-632-8961

Oconee Regional Medical Ctr. Milledgeville 478-454-3505

Barrow Medical Center

Winder

770-867-3400

Cartersville Medical Center Cartersville 770-382-1530

Dorminy Medical Center

Fitzgerald

229-424-7100

Berrien County Hospital

Nashville

229-686-7471

Coliseum Medical Center

Macon

478-765-7000

Medical Center of Central GA Macon

478-633-1451

Brooks County Hospital

Quitman

229-263-4171

Bulloch Regional Medical Ctr. Statesboro

912-486-1000

Burke County Hospital

Waynesboro 706-554-4435

Camden Medical Center

St. Mary's

912-576-4400

Candler County Hospital

Metter

912-685-5741

Tanner Medical Center

Carrollton

770-836-9666

Charlton Memorial Hospital Folkston

912-496-2531

Candler General Hospital

Savannah

912-692-6000

Memorial Medical Center

Savannah

912-350-8000

St. Joseph's Hospital

Savannah

912-925-4100

Athens Regional Medical Ctr. Athens

706-549-9977

St. Mary's Hospital of Athens Athens

706-548-7581

Southern Regional Medical Ctr. Riverdale

770-991-8000

Cobb County Health Dept.

Marietta

770-514-2383

DISTRICT
9-2 9-2 5-2 10-0 1-1 8-1 8-1 5-2 5-2 8-1 9-2 6-0 9-3 9-2 4-0 9-2 9-1 9-1 9-1 10-0 10-0 3-3 3-1

26

COUNTY NAME

CITY

TELEPHONE

COBB COBB COBB COFFEE COLQUITT COOK CRISP DEKALB DEKALB DEKALB DOUGHERTY DOUGHERTY DOUGLAS DOUGLAS EFFINGHAM ELBERT EMANUEL EVANS FLOYD FULTON FULTON GLYNN GORDON GWINNETT

Wellstar Cobb Hospital

Austell

770-732-4000

Wellstar Kennestone Hospital Marietta

770-793-5000

Smyrna Hospital

Smyrna

770-434-0710

Coffee Regional Hospital

Douglas

912-384-1900

Colquitt Regional Medical Ctr. Moultrie

229-985-3420

Memorial Hospital of Adel

Adel

229-896-2251

Crisp Regional Hospital

Cordele

229-276-3100

Dekalb Medical Center

Decatur

404-501-1000

Dunwoody Medical Center

Atlanta

770-454-2000

Northlake Regional Med. Ctr. Tucker

770-270-3001

Phoebe Putney Memorial Hosp. Albany

229-883-1800

Southwest Health District

Albany

912-430-6225

Wellstar Douglas General Hosp. Douglasville 770-949-1500

Parkway Medical Center

Lithia Springs 770-732-7777

Effingham County Hospital

Springfield

912-754-6451

Elbert Memorial Hospital

Elberton

706-283-3151

Emanuel County Hospital

Swainsboro 478-237-9911

Evans Memorial Hospital

Claxton

912-739-2611

Floyd Medical Center

Rome

706-802-2000

Grady Memorial Hospital

Atlanta

404-616-4307

Hughes Spalding Child.Hosp. Atlanta

404-616-4373

SE GA Regional Med Ctr.

Brunswick

912-466-7000

Gordon Hospital

Calhoun

706-629-2895

Eastside Medical Center

Snellville

770-979-0200

DISTRICT
3-1 3-1 3-1 9-2 8-2 8-1 7-0 3-5 3-5 3-5 8-2 8-2 3-1 3-1 9-1 10-0 6-0 9-2 1-1 3-2 3-2 9-3 1-1 3-4

27

COUNTY
GWINNETT GWINNETT HALL HENRY HOUSTON IRWIN JACKSON JASPER JEFF DAVIS JEFFERSON JENKINS LANIER LAURENS LIBERTY LOWNDES LOWNDES MACON MCDUFFIE MONROE MUSCOGEE MUSCOGEE MUSCOGEE PEACH PUTNAM RANDOLPH

NAME

CITY

TELEPHONE

GHS/Gwinnett Medical Center Lawrenceville 770-995-4321

GHS/Joan Glancy Mem. Hosp. Duluth

678-584-6800

Northeast Georgia Med. Ctr. Gainesville 770-535-3553

Henry General Hospital

Stockbridge 770-389-2200

Houston Medical Center

Warner Robins 478-922-4281

Irwin County Hospital

Ocilla

229-468-3800

BJC Medical Center

Commerce

706-335-1000

Jasper Memorial Hospital

Monticello

706-468-6411

Jeff Davis Hospital

Hazlehurst

912-375-7781

Jefferson Hospital

Louisville

478-625-7000

Jenkins County Hospital

Millen

478-982-4221

Louis Smith Memorial Hospital Lakeland

229-482-3110

Fairview Park Hospital

Dublin

478-275-2000

Liberty Memorial Hospital

Hinesville

912-369-9400

Smith Hospital, Inc.

Hahira

229-794-2502

South Georgia Medical Center Valdosta

229-333-1000

Flint River Community Hospital Montezuma 478-472-3100

McDuffie County Hospital

Thomson

706-595-1411

Monroe County Hospital

Forsyth

478-994-2521

Doctors Hospital

Columbus

706-571-4262

Medical Center-Columbus

Columbus

706-571-1200

St. Francis Hospital, Inc.

Columbus

706-322-8281

Peach County Hospital

Fort Valley 478-825-8691

Putnam General Hospital

Eatonton

706-485-2711

SW GA Regional Med Ctr.

Cuthbert

229-732-2181

DISTRICT
3-4 3-4 2-0 4-0 5-2 8-1 10-0 5-2 9-2 6-0 6-0 8-1 5-1 9-3 8-1 8-1 7-0 6-0 5-2 7-0 7-0 7-0 5-2 5-2 7-0

28

COUNTY NAME

CITY

TELEPHONE

RICHMOND Medical College Georgia

Augusta

RICHMOND University Hospital

Augusta

ROCKDALE

Rockdale Hospital

Conyers

SCREVEN

Screven County Hospital

Sylvania

SPALDING

Spalding Regional Hospital

Griffin

STEWART

Stewart-Webster Hospital

Richland

SUMTER

Sumter Regional Hospital

Sumter

TATTNALL

Tattnall Memorial Hospital

Reidsville

THOMAS

John D.Archbold Mem.Hosp. Thomasville

TIFT

Tift General Hospital

Tifton

TOOMBS

Meadows Regional Hospital Vidalia

TROUP

West Georgia Medical Center LaGrange

UPSON

Upson Regional Medical Center Thomaston

WALTON

Walton Medical Center

Monroe

WARE

Satilla Regional Hospital

Waycross

WASHINGTON Memorial Hospital

Sandersville

WAYNE

Wayne Memorial Hospital

Jesup

WILKES

Wills Memorial Hospital

Washington

706-721-3221 706-722-9011 770-918-3000 912-564-7426 770-228-2721 229-887-3366 229-924-6011 912-557-4731 229-228-2000 229-382-7120 912-537-8921 706-882-1411 706-647-8111 770-267-8461 912-283-3030 478-552-3901 912-427-6811 706-678-2151

DISTRICT
6-0 6-0 3-4 6-0 4-0 7-0 7-0 9-2 8-2 8-1 9-2 4-0 4-0 10-0 9-2 5-2 9-2 6-0

29

LABORATORY DIAGNOSIS OF RABIES
General Principles of Rabies Diagnosis in Animals
The rapid and accurate laboratory diagnosis of rabies infections in animals is essential for timely administration of rabies post-exposure prophylaxis and may also aid in defining current epidemiologic patterns of rabies and in recognizing the need for the development of rabies control programs. In Georgia, animal rabies diagnosis is provided by the three laboratories of the Georgia Public Health Laboratory (GPHL).
The direct fluorescent antibody test (dFA) is most frequently used to diagnose rabies in animals. All rabies laboratories in the United States perform this test on the brain tissue of animals suspected of having rabies. This test has been thoroughly evaluated for more than 40 years, and is recognized as the most rapid and reliable of the tests for routine use. The dFA test is based on the principle that an animal infected by rabies virus will have rabies virus protein (antigen) present in its tissue. Because rabies is present in nervous tissue (and not blood like many other viruses) the ideal tissue to test for the presence of rabies antigen is brain. The most important part of a dFA test is flourescein-labeled anti-rabies antibody. When labeled antibody is added to rabies-suspect brain tissue, it will bind to rabies antigen if it is present. Unbound antibody can be washed away and the areas where the antigen has bound antibody will appear as a bright fluorescent apple green color when viewed with a fluorescence microscope. If rabies virus is absent, there will be no staining.
Specimen collection and labeling
A key factor in obtaining reliable laboratory results is the condition of the specimen when received by the laboratory. Shipping of specimens should be coordinated with the county health department or animal control officer. Containers for shipment are available from county health departments or from GPHL Laboratory Supply (404-3277904).
Submission Guidelines
1. Only specimens received in good condition with at least two identifiable brain parts are approved for reporting test results.
2. For a specimen to be accepted for testing, there must have been exposure of a human or domestic animal to the suspected rabid animal
3. The laboratories are not equipped to handle whole carcasses: Only the HEAD is accepted as a specimen, except for bats and animals of similar size, which should be submitted whole. Whole carcasses of any larger animal will be returned to the sender for resubmission of the HEAD ONLY.
30

4. The following guidelines are recommended for the removal of animal heads: (whenever possible, this procedure should be performed by a person who has received pre-exposure rabies vaccine.)
Rubber gloves and protective clothing as well as face and eye protection should be worn while the head is being removed and packaged.
Sever the head between the foramen magnum and the atlas. Local veterinarians can assist in this removal.
Allow fluids and blood to drain from the head. Keep as clean as possible and place the head in a double plastic bag for transport to the laboratory.
If fleas or ticks are present, spray insecticide into the plastic bag containing the head before closing. Do not send maggots.
Cutting surfaces and instruments should be thoroughly cleaned with detergent and water and disinfected. Gloves should also be cleaned and disinfected or discarded following use.
5. Only brain material (not the entire head) of very large animals (e.g. cows, horses, etc.) will be accepted due to limitations for handling in the laboratory. Removal of the brain should only be attempted by a veterinarian. Whole heads of large animals received by the laboratory will be returned to the sender for resubmission of the BRAIN ONLY.
6. Rodents (rats, mice, gerbils, hamsters, guinea pigs, chipmunks, voles, squirrels, moles, etc.) and rabbits are not usually involved in the rabies cycle and will not be accepted for testing without prior arrangements with the Epidemiology Branch (404-657-2588) or the State Public Health Laboratory to which the specimen is being sent (Atlanta (Decatur): 404-3277900; Albany: 229-430-4122; Waycross: 912-285-6000.)
7. If specimens cannot be delivered to the laboratory immediately, refrigerate but DO NOT FREEZE. Frozen specimens cannot be tested until they thaw, which may cause a delay in reporting.
8. Do NOT send tissue in a preservative such as formalin, as rabies testing cannot be performed on such specimens.
31

Laboratory Submission Form
A Rabies History/Report Form #3062 should accompany each specimen submitted for rabies examination. This form should be filled out completely and legibly, making sure to include accurate addresses and phone numbers for use in reporting results.
Blank forms may be found on page 34 of this manual and also on the Georgia Division of Public Health website at http://health.state.ga.us. (Note: during the summer of 2001, the current form will be undergoing revision; new forms will be distributed when available).
Once results have been entered on the original Rabies Submission Form, it is forwarded to the Epidemiology Branch for review, data entry and file retention for a period of 3 years.
Specimen Shipment Guidelines
Containers for shipment are available from county health departments or from GPHL Laboratory Supply (404-327-7904). Rabies testing is available Monday through Friday.
Properly package the specimen by placing the severed animal head in a double plastic bag and secure the bag by twisting and knotting. For bats or similar size animals, do not remove the head, but submit whole. For large animals (e.g. cows, horses, etc.) submit the BRAIN ONLY.
Place the large plastic bag down into the styrofoam container. Add ice packs. DO NOT USE DRY ICE.
Place the sealed bag containing the specimen on top of the ice packs in the container. Seal the styrofoam shipper. Place the completed submission form in the brown envelope, and tape to the lid of the sealed shipper. Place the shipper in the cardboard box and tape the address for shipment. Do not seal the box until shipment, so the agent can inspect the container.
The package should be shipped PREPAID to the nearest Public Health laboratory using the method of shipment that will assure prompt delivery. CONTAINERS WITH SPECIMENS CANNOT BE SENT THROUGH THE MAIL. Addresses and telephone numbers of laboratories are as follows:

Albany Regional Laboratory 1109 N. Jackson Street
Albany, Georgia 31701-2022 Telephone: 229-430-4122

Atlanta (Decatur) Laboratory 1749 Clairmont Road
Decatur, Georgia 30033-4050 Telephone: 404-327-7900

Waycross Regional Laboratory 1101 Church Street
Waycross, Georgia 31501-3525 Telephone: 912-285-6000

32

Any bite case with a strong probability of human rabies exposure should be handled with utmost speed. Where possible, hand deliver such specimens after telephoning ahead to advise the laboratory of the expected time of arrival.
Avoid shipping specimens on weekends or holidays unless prior approval has been obtained from the laboratory manager. Special instructions regarding labeling will be needed to ensure that weekend courier or security personnel are notified to receive the specimen from the carrier. A better alternative is to place the specimen in double plastic bags as described above and refrigerate until shipment can be made when the laboratory is in operation Monday through Friday.
Reporting and interpretation of results
Rabies testing is available Monday through Friday. Due to the time required tissue fixation, reports will ordinarily be issued the next business day following receipt of the specimen, provided that the specimen is received by 10:00 a.m. Reporting will be delayed on specimens that are frozen.
Specimens received on Friday or those involved in emergency situations (severe human head or neck exposures or human exposures for which emergency testing has been approved by the Epidemiology Branch at 404657-2588) will be tested and reported the same day received, provided they arrive in the laboratory by 10:00 a.m. Otherwise results will be reported the following business day.
If the brain is decomposed or damaged to the point that the laboratory is uncertain as to whether the specimen is, in fact, the appropriate brain tissue, testing will not be done unless there is human exposure. Report will read "UNSATISFACTORY" with the comment: "Test requires at least two identifiable brain parts." With human exposure, routine testing is performed. If POSITIVE, the report will so state. If NEGATIVE, a report of "UNSATISFACTORY" will be made with the comment: "Test requires at least two identifiable brain parts." In this situation, an unsatisfactory test result should be managed as if POSITIVE.
All positive and unsatisfactory rabies results are telephoned immediately to the submitter listed on the Rabies History/Report Form, with a follow-up hard copy of the report sent by mail. Reports of negative results are mailed.
33

Any bite case with a strong probability of human rabies exposure should be handled with utmost speed. Where possible, hand deliver such specimens after telephoning ahead to advise the laboratory of the expected time of arrival.
Avoid shipping specimens on weekends or holidays unless prior approval has been obtained from the laboratory manager. Specimens should not be shipped unless scheduled delivery is prior to 2:00pm on Friday. Place the specimen in double plastic bags as described above and refrigerate until shipment can be made when the laboratory is in operation Monday through Friday. Emergency situations may be addressed by contacting the laboratory manager.
Reporting and interpretation of results
Rabies testing is available Monday through Friday. Due to the time required for brain tissue preparation, specimens that are received by 10:00am will be reported the next business day. Reporting will be delayed on specimens that are frozen.
Specimens received on Friday or those involved in emergency situations (severe human head or neck exposures or human exposures for which emergency testing has been approved by the Epidemiology Branch at 404657-2588) will be tested and reported the same day received, provided they arrive in the laboratory by 10:00 a.m. Otherwise results will be reported the following business day.
If the brain is decomposed or damaged to the point that the laboratory is uncertain as to whether the specimen is, in fact, the appropriate brain tissue, testing will not be done unless there is human exposure. The report will read "UNSATISFACTORY" with the comment: "Test requires at least two identifiable brain parts." With human exposure, routine testing is performed. If POSITIVE, the report will so state. If NEGATIVE, a report of "UNSATISFACTORY" will be made with the comment: "Test requires at least two identifiable brain parts." In this situation, an unsatisfactory test result should be managed as if POSITIVE.
All positive and unsatisfactory rabies results are telephoned immediately to the submitter listed on the Rabies History/Report Form, with a follow-up hard copy of the report sent by mail. Reports of negative results are mailed. The Albany and Waycross Regional Laboratories telephone all reports.
33

GEORGIA DEPARTMENT OF HUMAN RESOURCES
RABIES HISTORY AND REPORT FORM

Appendix I

LAB USE ONLY: RABIES NUMBER: __________________ DATE RECEIVED:_______________________________ LABORATORY RESULTS: POSITIVE - Evidence of Rabies NO EVIDENCE OF RABIES UNSATISFACTORY (Fluorescent Antibody) LABORATORY COMMENTS:______________________________________________________________________________________ EXAMINED BY:________________________________________________ DATE REPORTED:__________________________________

1. Report to: Name ___________________________________ Address___________________________________ City __________________________, Ga. Zip Code ______________ Phone No. (____)___________________

2. Physician: Name___________________________________ Address ___________________________________ City_________________________, Ga. Zip Code____________ Phone No. (____)___________________

3. County of Animal: _______________________ 4. Type of Animal Submitted: Dog (breed ________________________) Bat
Other (specify) ______________________________

Cat Fox Raccoon Skunk

5. Animal Classification: Pet Wild Stray If stray, length of time in vicinity _______________________________

6. Owner/Submitted By/Person Bitten/ Other: Name ________________________________ Address ________________________________________________________

City ________________________________,Ga. Zip Code _______________ Phone No. ________________________________

7. Was animal normally ill-tempered toward: a. Owners Yes No

b. Strangers Yes No

8. Check any of the following symptoms which were present within five days of animal's death:

Excitability

Wandering from home

Unusually vicious

Difficulty swallowing

Hind leg paralysis

Howling

9. Date of onset of this illness:___________________________________

Sagging jaw

Restlesness

Slobbering

Loss of appetite

Other __________________

10. Has animal recently fought with a suspected rabid animal? No

Yes, Date _________________

11. Date of Death _______________________ Killed Died 12. Veterinarian who observed the animal: ______________________________________________________

Phone No. _______________________

Diagnosis: _______________________________

13. Has animal been vaccinated against rabies?

No

Yes, Date_________________

14. PERSONS BITTEN (If scratched by claws, please indicate)

Name

Race Sex Age Date Bitten Part of Body

Severity of Bite

15. If any of the above have received antirabies treatment, please give name and date 16. Explain manner and cause of exposure in detail

17. History obtained by:

Phone No.

Serologic Testing Issues
All persons tested during several CDC studies 2-4 weeks after completion of preexposure and post-exposure rabies prophylaxis in accordance with ACIP guidelines have demonstrated an antibody response to rabies. Therefore, serum samples from patients completing pre-exposure or post-exposure prophylaxis do not need to be tested to document seroconversion unless the person is immunosuppressed. If titers are obtained, specimens collected 2-4 weeks after completing the pre-exposure or post-exposure prophylaxis regimen should completely neutralize challenge virus at a 1:5 serum dilution by the Rapid Fluorescent Focus Inhibition Test (RFFIT). Although antibody levels do not define a person's immune status, they are markers of continuing immune response.
In animals, neutralizing antibody titers have been shown to be imperfect markers of protection. Antibody titers will vary with time since the last vaccination. Evidence of circulating rabies virus neutralizing antibodies should not be used as a substitute for current vaccination in managing rabies exposures or determining the need for booster vaccinations.
Considering these issues, serologic testing to quantitate antibody levels after rabies vaccination in humans and animals is applicable in the following cases:
A person at "continuous risk" of exposure to rabies should have a serum sample tested for rabies antibody every six months (see page 16). This includes rabies laboratory workers and rabies biologic production workers.
A person at "frequent risk" of exposure to rabies should have a serum sample tested for rabies antibody every two years (see page 16). This includes: rabies diagnostic workers, spelunkers, veterinarians and their staff, animal control workers, wildlife workers, and travelers visiting foreign areas of endemic rabies for more than one month.
Domestic animals (dogs and cats) being exported to "rabies free" countries may have a reduced quarantine period with proof of rabies immunization and a serological test result demonstrating the presence of greater than 0.5 I.U./ml of rabies antibody. CONTACT INDIVIDUAL COUNTRIES FOR IMPORT REQUIREMENTS. Keep in mind there is not an established "protective" titer in animals. Individual interpretation is the responsibility of the submitting veterinarian.
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There are two types of RFFIT tests depending on the request: a screen test simply tells the patient/client if a booster of rabies vaccine is indicated and serum is tested at two dilutions. An end-point titer is used to determine the exact titer and is tested at serial five-fold dilutions until an end-point is reached. This test is indicated for those who want to know their exact titer and for animals being exported to some rabies free countries. Testing requires two milliliters (mls) of serum.
Laboratories conducting rabies serologic testing
(Note: phoning the laboratory in advance for correct forms, testing costs, and proper instructions is recommended).
Dr. Deborah J. Briggs, Director/RFFIT Mosier Hall Kansas State University 1800 Denison Avenue Manhattan KS 66506-5600 785-532-4483 e-mail: rabies@vet.ksu.edu Forms and information also available on the web at www.vet.ksu.edu/depts/rabies/index.htm
Atlanta Health Associates, Inc. 309 Pirkle Ferry Road, Suite D300 Cumming, GA 30040 770-205-9091 800-717-5612 770-205-9021 (fax)
Department of Pathobiology Virology Laboratory 261 Greene Hall Auburn University, AL 36849 334-844-2659
36

BATS AND RABIES
An emerging pattern in the epidemiology of human rabies in the United States is that bat-related virus variants were identified from 24 (74%) of the 32 cases of human rabies diagnosed in the United States from 1990-2000. A definitive history of a bat bite was established in only two cases. Contact with bats occurred in approximately half of the other cases. Rabies is transmitted only when the virus is introduced into bite wounds or open cuts in skin or onto mucous membranes. However, these epidemiologic data suggest that transmission of rabies virus can occur from minor, seemingly unimportant, or unrecognized bites from bats. Awareness of the facts about bats and rabies can help people protect themselves, their families, and their pets.
Rabies Prevention Tips
It is not possible to tell if a bat has rabies by looking at it. Rabies can be confirmed only in a laboratory. However, any bat that is active by day, is found in a place where bats are not usually seen (for example, in a room in the house or on the lawn), or is unable to fly, is far more likely than others to be rabid. Such bats are often the most easily approached. Therefore, it is best never to handle any bat.
Bat bites are not always visible. Therefore, in situations in which a bat is physically present and there is a possibility of exposure, the person should seek medical advice and the bat should be safely captured (see below) and submitted to a rabies laboratory for testing. If rabies cannot be ruled out by laboratory testing, or, if the bat is not available for testing, people with a reasonable probability of an exposure may be recommended for rabies postexposure prophylaxis. Scenarios that may indicate a reasonable probability of exposure to rabies include:
A child picks up a live bat; An adult touches a bat without seeing the part of the body they touched;
A bat flies into a person and touches bare skin;
A person steps on a bat with bare feet;
A person awakens to find a bat in the room with him/her;
A bat is found near an infant, toddler, or mentally impaired or intoxicated person
Assistance with bat capture may be provided by a local animal control agency or health department. If professional help is immediately unavailable, the bat may be safely captured by following these steps:
37

Safe bat capture
Equipment needed: leather workgloves; small box or coffee can; piece of cardboard; tape.
When the bat lands, approach it slowly, while wearing the gloves, and place the box or coffee can over it. Slide the cardboard under the container to trap the bat inside.
Tape the cardboard to the container securely, and punch small holes in the cardboard, allowing the bat to breathe.
If any possible contact between the bat and a person or domestic animal has occurred, do not release the bat. Contact the health department or animal control agency to make arrangements for rabies testing.
If no human or pet exposure has occurred, take the container outdoors immediately and release the bat away from people and pets.
Some bats live in buildings, and there may be no reason to evict them if there is little chance for contact with people. However, bats should always be prevented from entering living quarters or occupied spaces in homes, churches, schools, and other similar areas where they might contact people and pets. Assistance with "bat-proofing" homes can be provided by an animal-control or wildlife conservation agency. Another excellent resource is Bat Conservation International at www.batcon.org
If there is suspicion that a pet or domestic animal has been bitten by a bat, contact a veterinarian or health department for assistance immediately and have the bat tested for rabies. Remember to keep vaccinations current for cats, dogs, ferrets, and other animals.
Citation is given to the Centers for Disease Control for information contained in the brochure, "Bats and Rabies: A Public Health Guide"
38

FREQUENTLY-ASKED QUESTIONS (FAQ) ABOUT RABIES
What is the incubation period of rabies in animals and humans?
The incubation period is the time between exposure and onset of clinical signs of disease. The incubation period may vary from a few days to several years, but typically lasts 1 to 3 months. This period is quite long because the rabies virus spreads slowly through the nerves to the spinal cord and brain. There are no signs of illness during the incubation period; rabies virus is not transmissible during this time. When the virus reaches the brain, it multiplies rapidly and passes to the salivary glands. At this point clinical signs of rabies are evident and rabies virus could be transmitted via saliva.
How can I protect my pet from rabies?
First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs. Second, maintain control of your pets by keeping cats and ferrets indoors and keeping dogs under direct supervision. Third, spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly. Lastly, call animal control to remove all stray animals from your neighborhood since these animals may be unvaccinated or ill.
Why does my pet need the rabies vaccine?
Although the majority of rabies cases occur in wildlife, most humans are given rabies vaccine as a result of exposure to domestic animals. This explains the tremendous cost of rabies prevention in domestic animals in the United States. While wildlife are more likely to be rabid than are domestic animals in the United States, the amount of human contact with domestic animals greatly exceeds the amount of contact with wildlife. Your pets and other domestic animals can be infected when they are bitten by rabid wild animals. When "spillover" rabies occurs in domestic animals, the risk to humans is increased. Pets are therefore vaccinated by your veterinarian to prevent them from acquiring the disease from wildlife, and thereby transmitting it to humans.
Will the rabies vaccine make me sick?
Adverse reactions to rabies vaccine and immune globulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling, or itching at the injection site, have been reported. Rarely, symptoms such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported. Local pain and low-grade fever may follow injection of rabies immune globulin.

What if I cannot get rabies vaccine on the day I am supposed to get my next dose?
Consult with your doctor or state or local public health officials for recommended times if there is going to be a change in the recommended schedule of shots. Rabies prevention is a serious matter and changes should not be made in the schedule of doses.
Should I be concerned about rabies when I travel outside the United States?
Yes. Rabies and the rabies-like viruses can occur in animals anywhere in the world. In most countries, the risk of rabies in an encounter with an animal and the precautions necessary to prevent rabies are the same as they are in the United States. When traveling, it is always prudent to avoid approaching any wild or domestic animal.
The developing countries in Africa, Asia, and Latin America have additional problems in that dog rabies is common there and preventive treatment for human rabies may be difficult to obtain. The importance of rabid dogs in these countries, where tens of thousands of people die of the disease each year, cannot be overstated. Unlike programs in developed countries, dog rabies vaccination programs in developing countries have not always been successful. Before traveling abroad, consult a health care provider, travel clinic, or health department about your risk of exposure to rabies and how to handle an exposure should it arise. Medical assistance should be obtained as soon as possible after an exposure.
Can rabies be transmitted from one person to another?
The only documented cases of rabies caused by human-to-human transmission occurred among 8 recipients of transplanted corneas. Investigations revealed each of the donors had died of an illness compatible with or proven to be rabies. The 8 cases occurred in 5 countries: Thailand (2 cases), India (2 cases), Iran (2 cases) the United States (1 case), and France (1 case). Stringent guidelines for acceptance of donor corneas have reduced this risk. In addition to transmission from corneal transplants, bite and nonbite exposures inflicted by infected humans could theoretically transmit rabies, but no such cases have been documented. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces) does not constitute an exposure and does not require post-exposure prophylaxis. In addition, contact with someone who is receiving rabies vaccination does not constitute rabies exposure and does not require post-exposure prophylaxis.
Citation is given to the Centers for Disease Control for information contained in their rabies website : http://www.cdc.gov/ncidod/dvrd/rabies/default.htm

DEFINITIONS
Currently Vaccinated Against Rabies - An animal is "currently vaccinated" and is considered immunized against rabies if a vaccination certificate documents that the animal received a USDA-approved primary rabies vaccine from a licensed veterinarian at least 30 days previously and that booster vaccinations have been administered on an annual or triennial schedule, in accordance with the Compendium of Animal Rabies Prevention and Control (see pages 46-48) or as described on the individual vaccine label.
Exposure Rabies exposure occurs when the virus is introduced into bite wounds or open cuts in skin or onto mucous membranes. Two categories of exposure, bite and nonbite, should be considered:
Bite: Any penetration of the skin by teeth constitutes a bite exposure. All bites, regardless of location, represent a potential risk of rabies transmission. Keep in mind that bites by some animals, such as bats, can inflict minor injury and thus be undetected.
Nonbite: The contamination of open wounds, abrasions, mucous membranes, or theoretically, scratches, with saliva or other potentially infectious material (such as neural tissue) from a rabid animal constitutes a nonbite exposure. Nonbite exposures from terrestrial animals rarely cause rabies. However, occasional reports of transmission by nonbite exposure suggest that such exposures constitute sufficient reason to consider postexposure prophylaxis.
Non-Exposure - Other contact by itself, such as being in the vicinity of, petting or handling an animal, or coming in contact with blood, urine, or feces does NOT constitute an exposure and does NOT require post-exposure rabies treatment. Because desiccation and ultraviolet irradiation inactivate the rabies virus, in general, if the material containing the virus is dry, the virus can be considered noninfectious.
Confinement A general term referring to the restriction of an animal to a building, pen, or other escape-proof enclosure to monitor for clinical signs of rabies. There are two specific types of confinement, depending upon the circumstances of the encounter:
Quarantine (for animal-human encounters)--the 10-day period of confinement for a domestic animal (dog, cat, or ferret only) which has bitten a person, no matter if the animal is currently vaccinated or not. Quarantine conditions should prevent direct contact with other animals or persons. The quarantine shall be conducted under the authority of the
41

designated local rabies control agency in which the place, manner, and provisions of the quarantine are specified. For example, quarantine may take place in a kennel in a veterinary hospital, animal control facility, commercial boarding establishment or a pen at home, depending on local requirements. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
Strict Isolation (for animal-animal encounters)--confinement of an animal exposed or potentially exposed to rabies in a manner that prevents direct contact with other animals or persons. In most cases, this term applies to an unvaccinated domestic animal exposed to a rabid wild animal; the duration of strict isolation should be six months. Strict isolation should be conducted under the authority of the designated local rabies control agency in which the place, manner, and provisions of the confinement are specified. For example, strict isolation may take place in an animal control facility, or a double-walled isolation pen at home, depending on local requirements. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
Observation period -(animal-animal encounters) for currently-vaccinated domestic animals (dogs, cats, ferrets, and in some cases, livestock) exposed to a rabid wild animal, the observation period is the 45-day period in which the animal is kept under the owner's control to monitor for clinical signs of rabies to develop. During the observation period, the animal should not be permitted to roam and should be restricted to leash walks, if applicable. At the first sign of illness or behavioral change in the animal, the local rabies control agency should be notified and the animal should be evaluated by a veterinarian. If clinical signs are suggestive of rabies, the animal should be immediately euthanized and tested for rabies.
Provoked Attack - An attack is considered to be "provoked" if a domestic animal is placed in a situation such that an expected reaction would be to bite or attack. Examples include invasion of an animal's territory, attempting to pet or handle an unfamiliar animal, startling an animal, breaking up an animal fight, running or bicycling past an animal, assisting an injured or sick animal, trying to capture an animal, or removing food, water, or other objects in the animal's possession.
Unprovoked Attack - An attack or bite is considered to be "unprovoked" when none of the above conditions for a "provoked" attack are met; essentially, the animal strikes for no apparent reason.
42

GEORGIA RABIES CONTROL LAW
Administrative rules and regulations--As to control of rabies, see Official Compilation of Rules and Regulations of the State of Georgia, Rules of Department of Human Resources, Chapter 290-5-2.
I. OPINIONS OF THE ATTORNEY GENERAL
Control of rabies generally is delegated to county boards of health, and control of dangerous drugs is vested with the State Board of pharmacy and state drug inspector (now director of Georgia Drugs and Narcotics Agency). 1975 Op. Atty. Gen. No. 75-23.
Expense of confining animals included in county board's budget--Local county boards of health should prescribe rules for prevention and control of rabies by providing for vaccination, tagging, and certification of dogs, and for confinement of any animal which exhibits any signs of rabies; cost of such confinement would be an expense of county board of health to be included in its budget which is submitted to local taxing authorities under provision of section 31-3-14, 1965-66 Op. Atty. Gen. No. 65-21.
Responsibility of county boards of health regarding strays and unwanted dogs--Local county boards of health should adopt rules and regulations relative to catching and impounding of strays and unwanted dogs. 1965-66 Op. Atty. Gen. No. 65-21.
II. OFFICIAL CODE 31-19, CONTROL OF RABIES 31-19-1. Responsibility for Control
Each county board of health shall have primary responsibility for the control of rabies within its jurisdiction. Such boards, in addition to their other powers, are empowered and required to adopt and promulgate rules and regulations for the prevention and control of such disease.
31-19-2. Powers of department in infected area.
The department may declare any county or any area therein or any group of counties or areas therein where rabies exists to be an infected area and may provide for immunization and such other measures as shall be indicated for the prevention and control of the disease.
43

31-19-3. Licensing and regulation of animals by local authorities.
The governing authorities of each county and municipality are authorized and required, in the control of rabies, to require regulation or licensing of animals.
31-19-4. Duty of notification.
It shall be the duty of any person bitten by any animal reasonably suspected of being rabid immediately to notify the appropriate county board of health. It shall be the duty of the owner, custodian, or person having possession and knowledge of any animal which has bitten any person or animal or of any animal which exhibits any signs of rabies to notify the appropriate county board of health and to confine such animal in accordance with rules and regulations of the county board of health.
31-19-5. Inoculation of canines and felines against rabies.
The county boards of health are empowered and required to adopt and promulgate rules and regulations requiring canines and felines to be inoculated against rabies and to prescribe the intervals and means of inoculation, the fees to be paid in county sponsored clinics, that procedures be in compliance with the recommendations of the National Association of State Public Health Veterinarians for identifying inoculated canines and felines, and all other procedures applicable thereto. As used in this chapter, the term "inoculation against rabies" means the administering by a licensed veterinarian of antirabies vaccine approved by the department.
31-19-6. Certificates of inoculation: tags.
Reserved. Repealed by Ga. L. 1992, p. 2089, sec. 2, effective July 1, 1992.
31-19-7. County rabies control officer.
(a) The county board of health shall appoint a person who is knowledgeable of animals to be the county rabies control officer. It shall be the duty of the county rabies control officer to enforce this chapter and other laws which regulate the activities of dogs.
(b) The county governing authority of each county is authorized to levy a fee not to exceed 50 cents for each dog, such fee to be collected by the veterinarian administering the antirabies vaccine required by this chapter. This fee shall be in addition to that provided for in Code Section 31-19-5. If any county has no resident veterinarian, the out-of-county veterinarian administering the antirabies vaccine and collecting the fee provided for by this Code section shall forward to the treasurer of the county of the dog owner's residence the fee prescribed by that county's governing authority.
44

(c) The fees collected under this Code section shall be used to help in paying the salary of the county rabies control officer. 31-19-8. Joint administration of chapter by adjoining counties. The governing authority of each county may devise and implement plans whereby this chapter, as amended, is administered jointly with one or more adjoining counties. 31-19-9. Applicability to municipalities with rabies control laws. This chapter shall not apply to municipalities which already have a rabies control law unless and until such law is repealed. 31-19-10. Penalty. Any person who violates any provision of this chapter or any rule or regulation adopted pursuant thereto shall be guilty of a misdemeanor.
45

Compendium of Animal Rabies Prevention and Control, 2002* National Association of State Public Health Veterinarians, Inc. (NASPHV)

The purpose of this Compendium is to provide rabies information to veterinarians, public health officials, and others concerned with rabies prevention and control. These recommendations serve as the basis for animal rabies-control programs throughout the United States and facilitate standardization of procedures among jurisdictions, thereby contributing to an effective national rabies-control program. This document is reviewed annually and revised as necessary. Vaccination procedure recommendations are contained in Part I; all animal rabies vaccines licensed by the United States Department of Agriculture (USDA) and marketed in the United States are listed in Part II; Part III details the principles of rabies control.

Part I: Recommendations for Parenteral Vaccination Procedures

A. VACCINE ADMINISTRATION: All animal rabies vaccines should be restricted to use by, or under the direct supervision of, a veterinarian.

B. VACCINE SELECTION: Part II lists all vaccines licensed by USDA and marketed in the United States at the time of publication. New vaccine approvals or changes in label specifications made subsequent to publication should be considered as part of this list. Any of the listed vaccines can be used for revaccination, even if the product is not the same brand as previously administered vaccines. Vaccines used in state and local rabies control programs should have a 3-year duration of immunity. This constitutes the most effective method of increasing the proportion of immunized dogs and cats in any population.

C. ROUTE OF INOCULATION: All vaccines must be administered in accordance with the specifications of the product label or package insert. Adverse reactions and vaccine failures should be reported to USDA, Animal and Plant Health Inspection Service, Center for Veterinary Biologics at (800) 752-6255 or by e-mail at CVB@usda.gov.

D. WILDLIFE AND HYBRID ANIMAL VACCINATION: The efficacy of parenteral rabies vaccination of wildlife and hybrids (the offspring of wild animals crossbred to domestic dogs and cats) has not been established, and no such vaccine is licensed for these animals. Zoos or research institutions may establish vaccination programs which attempt to protect valuable animals, but these should not replace appropriate public health activities that protect humans.

E. ACCIDENTAL HUMAN EXPOSURE TO VACCINE: Human exposure to parenteral animal rabies vaccines listed in Part II does not
constitute a risk for rabies infection. However, human exposure to vaccinia-vectored oral rabies vaccines should be reported to state health officials.1

F. IDENTIFICATION OF VACCINATED ANIMALS: Agencies and veterinarians may adopt the standard tag system to aid in the administration of animal rabies control procedures.

1. RABIES TAGS

CALENDAR YEAR
2002 2003

COLOR
Orange Green

SHAPE
Oval Bell

2. RABIES CERTIFICATE: All agencies and veterinarians should use the NASPHV Form #51, "Rabies Vaccination Certificate," which can be obtained from vaccine manufacturers. Computer-generated forms containing the same information are acceptable.

THE NASPHV COMMITTEE Suzanne R. Jenkins, VMD, MPH, Chair Michael Auslander, DVM, MSPH Lisa Conti, DVM, MPH William B. Johnston, DVM Mira J. Leslie, DVM Faye E. Sorhage, VMD, MPH
*Address all correspondence to: Suzanne R. Jenkins, VMD, MPH Virginia Department of Health Office of Epidemiology Post Office Box 2448, Room 113 Richmond, VA 23218

CONSULTANTS TO THE COMMITTEE James E. Childs, ScD; Centers for Disease Control
and Prevention (CDC) Mary Currier, MD, MPH; CSTE Nancy Frank, DVM, MPH; AVMA Council on Public Health and
Regulatory Veterinary Medicine Donna M. Gatewood, DVM, MS; Animal and Plant Health
Inspection Service, USDA Carolin L. Schumacher, DVM, PhD; Animal Health Institute Charles E. Rupprecht, VMD, PhD; CDC Charles V. Trimarchi, MS; New York State Health Department
ENDORSED BY: American Veterinary Medical Association (AVMA) Council of State and Territorial Epidemiologists (CSTE)

Part II: Rabies Vaccines Licensed and Marketed in the U.S., 2002

Product Name

Produced by

A) MONOVALENT (Inactivated)

TRIMUNE

Fort Dodge Animal Health License No. 112

ANNUMUNE

Fort Dodge Animal Health License No. 112

DEFENSOR 1

Pfizer, Incorporated License No. 189

DEFENSOR 3

Pfizer, Incorporated License No. 189

Marketed by Fort Dodge Animal Health Fort Dodge Animal Health Pfizer, Incorporated Pfizer, Incorporated

RABDOMUN

Pfizer, Incorporated License No. 189

Schering-Plough

RABDOMUN 1 RABVAC 1 RABVAC 3
PRORAB-1
PRORAB-3F IMRAB 3

Pfizer, Incorporated License No. 189
Fort Dodge Animal Health License No. 112
Fort Dodge Animal Health License No. 112

Schering-Plough Fort Dodge Animal Health Fort Dodge Animal Health

Intervet, Incorporated License No. 286

Intervet, Incorporated

Intervet, Incorporated License No. 286
Merial, Incorporated License No. 298

Intervet, Incorporated Merial, Incorporated

IMRAB Bovine Plus

Merial, Incorporated License No. 298

Merial, Incorporated

IMRAB 1

Merial, Incorporated License No. 298

Merial, Incorporated

B) MONOVALENT (Rabies glycoprotein, live canary pox vector)

PUREVAX Feline Rabies

Merial, Incorporated License No. 298

Merial, Incorporated

C) COMBINATION (Inactivated rabies)

ECLIPSE 3 + FeLV/R

Fort Dodge Animal Health License No. 112

Schering-Plough

ECLIPSE 4 + FeLV/R

Fort Dodge Animal Health License No. 112

Schering-Plough

Fel-O-Guard 3 + FeLV/R

Fort Dodge Animal Health License No. 112

Fort Dodge Animal Health

Fel-O-Guard 4 + FeLV/R

Fort Dodge Animal Health License No. 112

Fort Dodge Animal Health

IMRAB 3 + Feline 3

Merial, Incorporated License No. 298

Merial, Incorporated

IMRAB 3 + Feline 4

Merial, Incorporated License No. 298

Merial, Incorporated

MYSTIQUE II POTOMAVAC+

Bayer Corporation License No. 52

Bayer Corporation

Equine POTOMAVAC + IMRAB

Merial, Incorporated License No. 298

Merial, Incorporated

D) COMBINATION (Rabies glycoprotein, live canary pox vector)

PUREVAX Feline 3/Rabies

Merial, Incorporated License No. 298

Merial, Incorporated

PUREVAX Feline 3/ Merial, Incorporated Rabies + LEUCAT License No. 298

Merial, Incorporated

PUREVAX Feline 4/ Merial, Incorporated Rabies + LEUCAT License No. 298

Merial, Incorporated

For Use In Dosage

Age at Primary Vaccination1

Booster Recommended

Dogs

1 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Sheep

2 ml

Cattle

2 ml

Dogs

1 ml

Cats

1 ml

Sheep

2 ml

Cattle

2 ml

Dogs

1 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Horses

2 ml

Dogs

1 ml

Cats

1 ml

Sheep

2 ml

Cats

1 ml

Dogs

1 ml

Cats

1 ml

Sheep

2 ml

Cattle

2 ml

Horses

2 ml

Ferrets

1 ml

Cattle

2 ml

Horses

2 ml

Sheep

2 ml

Dogs

1 ml

Cats

1 ml

3 months2 3 months
3 months 3 months
3 months 3 months
3 months 3 months 3 months 3 months
3 months 3 months 3 months 3 months
3 months 3 months
3 months 3 months
3 months 3 months 3 months
3 months 3 months 3 months
3 months
3 months 3 months 3 months 3 months 3 months 3 months
3 months 3 months 3 months
3 months 3 months

1 year later & triennially 1 year later & triennially
Annually Annually
Annually Annually
1 year later & triennially 1 year later & triennially Annually Annually
1 year later & triennially 1 year later & triennially Annually Annually
Annually Annually
Annually Annually
1 year later & triennially 1 year later & triennially Annually
Annually Annually Annually
1 year later & triennially
1 year later & triennially 1 year later & triennially 1 year later & triennially Annually Annually Annually
Annually Annually 1 year later & triennially
Annually Annually

Cats

1ml

8 weeks

Annually

Cats

1 ml

Cats

1 ml

Cats

1 ml

Cats

1 ml

Cats

1 ml

Cats

1 ml

Horses

1 ml

Horses

1 ml

3 months 3 months 3 months 3 months 3 months 3 months 3 months 3 months

Annually Annually Annually Annually 1 year later & triennially 1 year later & triennially Annually Annually

Cats

1ml

8 weeks

Cats

1ml

8 weeks

Cats

1ml

8 weeks

Annually Annually Annually

Route of Inoculation
IM3 IM IM IM IM or SC4 SC IM or SC SC IM IM IM or SC SC IM IM IM or SC SC IM or SC IM or SC IM or SC IM or SC IM IM or SC IM or SC IM IM or SC
IM or SC IM or SC IM or SC IM or SC IM or SC SC IM or SC IM or SC IM or SC SC SC
SC
IM or SC
IM or SC
IM or SC
IM or SC
SC
SC
IM
IM
SC
SC
SC

Product Name

Produced by

Marketed by

D) COMBINATION (Rabies glycoprotein, live canary pox vector) continued

For Use In Dosage

Age at Primary Vaccination1

Booster Recommended

PUREVAX Feline/ Rabies + LEUCAT

Merial, Incorporated License No. 298

Merial, Incorporated

Cats

1ml

8 weeks

Annually

E) ORAL (Rabies glycoprotein, live vaccinia vector) - RESTRICTED TO USE IN STATE AND FEDERAL RABIES CONTROL PROGRAMS

RABORAL V-RG

Merial, Incorporated License No. 298

Merial, Incorporated

Raccoons N/A

N/A

As determined by local authorities

Route of Inoculation SC
Oral

1 Minimum age (or older) and revaccinated one year later. 2 A month = 28 days 3 Intramuscularly 4 Subcutaneously

Part III: Rabies Control

A. PRINCIPLES OF RABIES CONTROL

1. RABIES EXPOSURE: Rabies is transmitted only when the virus is introduced into bite wounds, open cuts in skin, or onto mucous membranes.

2. HUMAN RABIES PREVENTION: Rabies in humans can be prevented either by eliminating exposures to rabid animals or by providing exposed persons with prompt local treatment of wounds combined with human rabies immune globulin and vaccine. The rationale for recommending preexposure and postexposure rabies prophylaxis and details of their administration can be found in the current recommendations of the Advisory Committee on Immunization Practices (ACIP)2. These recommendations, along with information concerning the current local and regional status of animal rabies and the availability of human rabies biologics, are available from state health departments.

3. DOMESTIC ANIMALS: Local governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove strays and unwanted animals. Such procedures in the United States have reduced laboratory-confirmed cases of rabies in dogs from 6,949 in 1947 to 114 in 2000. Because more rabies cases are reported annually involving cats (249 in 2000) than dogs, vaccination of cats should be required. The recommended vaccination procedures and the licensed animal vaccines are specified in Parts I and II of the Compendium.

4. RABIES IN WILDLIFE: The control of rabies among wildlife reservoirs is difficult. Vaccination of free-ranging wildlife or selective population reduction might be useful in some situations, but the success of such procedures depends on the circumstances surrounding each rabies outbreak. (See Part C. Control Methods in Wildlife.) Because of the risk of rabies in wild animals (especially raccoons, skunks, coyotes, foxes, and bats), the AVMA, the NASPHV, and the CSTE strongly recommend the enactment of state laws prohibiting their importation, distribution, and relocation.

5. RABIES SEROLOGY: Evidence of circulating rabies virus neutralizing antibodies should not be used as a substitute for current vaccination in managing rabies exposures or determining the need for booster vaccinations.

B. CONTROL METHODS IN DOMESTIC AND CONFINED ANIMALS

1. PREEXPOSURE VACCINATION AND MANAGEMENT Parenteral animal rabies vaccines should be administered only by, or under the direct supervision of, a veterinarian. This ensures that a qualified and responsible person can be held accountable to assure the public that the animal has been properly vaccinated. Within twenty-eight (28) days after primary vaccination, a peak rabies antibody titer is reached and the animal can be considered immunized. An animal is currently vaccinated and is considered immunized if the primary vaccination was administered at least 28 days previously and vaccinations have been administered in accordance with this Compendium. Regardless of the age of the animal at initial vaccination, a booster vaccination should be administered 1 year later. (See Parts I and II for vaccines and procedures) Because a rapid anamnestic response is expected, an animal is considered currently vaccinated immediately after a booster vaccination.

(a) DOGS, CATS, AND FERRETS All dogs, cats, and ferrets should be vaccinated against rabies and revaccinated in accordance with Part II of this Compendium. If a previously vaccinated animal is overdue for a booster, it should be revaccinated with a single dose of vaccine. Immediately following the booster, the animal is considered currently vaccinated and should be placed on an annual or triennial schedule depending on the type of vaccine used.

(b) LIVESTOCK Consideration should be given to vaccinating livestock that are particularly valuable or that might have frequent contact with humans. Horses traveling interstate should be currently vaccinated against rabies.

(c) CONFINED ANIMALS (1) WILD No parenteral rabies vaccine is licensed for use in wild animals. Wild animals or hybrids should not be kept as pets.

(2) MAINTAINED IN EXHIBITS AND IN ZOOLOGICAL PARKS Captive animals that are not completely excluded from all contact with rabies vectors can become infected. Moreover, wild animals might be incubating rabies when initially captured; therefore, wild-caught animals susceptible to rabies should be quarantined for a minimum of 6 months before being exhibited. Employees who work with animals at such facilities should receive preexposure rabies vaccination. The use of pre- or postexposure rabies vaccinations for employees who work with animals at such facilities might reduce the need for euthanasia of captive animals. Carnivores and bats should be housed in a manner that precludes direct contact with the public.
2. STRAY ANIMALS Stray dogs, cats, and ferrets should be removed from the community. Local health departments and animal control officials can enforce the removal of strays more effectively if owned animals are confined or kept on leash. Strays should be impounded for at least 3 days to determine if human exposure has occurred and to give owners sufficient time to reclaim animals.
3. IMPORTATION AND INTERSTATE MOVEMENT OF ANIMALS (a) INTERNATIONAL CDC regulates the importation of dogs and cats into the United States. Imported dogs must satisfy rabies vaccination requirements (42 CFR, Part 71.51[c], www.cdc.gov/ncidod/dq/lawsand/htm). The appropriate health official of the state of destination should be notified within 72 hours of the arrival into his or her jurisdiction of any imported dog required to be placed in confinement under the CDC regulation. Failure to comply with these requirements should be promptly reported to the Division of Quarantine, CDC, (404) 639-8107.
CDC regulations alone are insufficient to prevent the introduction of rabid animals into the country. All imported dogs and cats are subject to state and local laws governing rabies and should be currently vaccinated against rabies in accordance with the Compendium. Failure to comply with state or local requirements should be referred to the appropriate state or local official.
(b) INTERSTATE Before interstate movement, dogs, cats, and ferrets should be currently vaccinated against rabies in accordance with the Compendium's recommendations (See Part III, B.1. Preexposure Vaccination and Management). Animals in transit should be accompanied by a currently valid NASPHV Form #51, Rabies Vaccination Certificate. When an interstate health certificate or certificate of veterinary inspection is required, it should contain the same rabies vaccination information as Form #51.
4. ADJUNCT PROCEDURES Methods or procedures which enhance rabies control include the following: (a) IDENTIFICATION. Dogs, cats and ferrets should be identified (e.g., metal or plastic tags, microchips, etc.) to allow for verification of rabies vaccination status.
(b) LICENSURE. Registration or licensure of all dogs, cats, and ferrets may be used to aid in rabies control. A fee is frequently charged for such licensure and revenues collected are used to maintain rabies- or animal-control programs. Vaccination is an essential prerequisite to licensure.
(c) CANVASSING OF AREA. House-to-house canvassing by animal control personnel facilitates enforcement of vaccination and licensure requirements.
(d) CITATIONS. Citations are legal summonses issued to owners for violations, including the failure to vaccinate or license their animals. The authority for officers to issue citations should be an integral part of each animal-control program.
(e) ANIMAL CONTROL. All communities should incorporate stray animal control, leash laws, and training of personnel in their programs.
5. POSTEXPOSURE MANAGEMENT ANY ANIMAL POTENTIALLY EXPOSED TO RABIES VIRUS (See Part III, A. 1. Rabies Exposure) BY A WILD, CARNIVOROUS MAMMAL OR A BAT THAT IS NOT AVAILABLE FOR TESTING SHOULD BE REGARDED AS HAVING BEEN EXPOSED TO RABIES.
(a) DOGS, CATS, AND FERRETS Unvaccinated dogs, cats, and ferrets exposed to a rabid animal should be euthanized immediately. If the owner is unwilling to have this done, the animal should be placed in strict isolation for 6 months and vaccinated 1 month before being released. Animals with expired vaccinations need to be evaluated on a case-by-case basis. Dogs, cats, and ferrets that are currently vaccinated should be revaccinated immediately, kept under the owner's control, and observed for 45 days.
(b) LIVESTOCK All species of livestock are susceptible to rabies; cattle and horses are among the most frequently infected. Livestock exposed to a rabid animal and currently vaccinated with a vaccine approved by USDA for that species should be revaccinated immediately and observed for 45 days. Unvaccinated livestock should be slaughtered immediately. If the owner is unwilling to have this done, the animal should be kept under close observation for 6 months.

The following are recommendations for owners of unvaccinated livestock exposed to rabid animals:
(1) If the animal is slaughtered within 7 days of being bitten, its tissues may be eaten without risk of infection, provided that liberal portions of the exposed area are discarded. Federal meat inspectors must reject for slaughter any animal known to have been exposed to rabies within 8 months.
(2) Neither tissues nor milk from a rabid animal should be used for human or animal consumption. Pasteurization temperatures will inactivate rabies virus, therefore, drinking pasteurized milk or eating cooked meat does not constitute a rabies exposure.
(3) Having more than one rabid animal in a herd or having herbivore-to-herbivore transmission is uncommon; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies might not be necessary.
(c) OTHER ANIMALS Other mammals bitten by a rabid animal should be euthanized immediately. Animals maintained in USDA licensed research facilities or accredited zoological parks should be evaluated on a case-by-case basis.
6. MANAGEMENT OF ANIMALS THAT BITE HUMANS (a) A healthy dog, cat, or ferret that bites a person should be confined and observed daily for 10 days; administration of rabies vaccine is not recommended during the observation period. Such animals should be evaluated by a veterinarian at the first sign of illness during confinement. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be euthanized and the head shipped for testing as described in (c) below. Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately and the head submitted for rabies examination.
(b) Other biting animals which might have exposed a person to rabies should be reported immediately to the local health department. Prior vaccination of an animal may not preclude the necessity for euthanasia and testing if the period of virus shedding is unknown for that species. Management of animals other than dogs, cats, and ferrets depends on the species, the circumstances of the bite, the epidemiology of rabies in the area, and the biting animal's history, current health status, and potential for exposure to rabies.
(c) Rabies testing should be done by a qualified laboratory, designated by the local or state health department. Euthanasia 3 should be accomplished in such a way as to maintain the integrity of the brain so that the laboratory can recognize the anatomical parts. Except in the case of very small animals, such as bats, only the head or brain (including brain stem) should be submitted to the laboratory. Any animal or animal part being submitted for testing should be kept under refrigeration (not frozen or chemically fixed) during storage and shipping.
C. CONTROL METHODS IN WILDLIFE The public should be warned not to handle wildlife. Wild mammals and hybrids that bite or otherwise expose persons, pets or livestock should be considered for euthanasia and rabies examination. A person bitten by any wild mammal should immediately report the incident to a physician who can evaluate the need for antirabies treatment (See current rabies prophylaxis recommendations of the ACIP2). State regulated wildlife rehabilitators may play a role in a comprehensive rabies control program. Minimum standards for persons who rehabilitate wild mammals should include rabies vaccination, appropriate training and continuing education. Translocation of infected wildlife has contributed to the spread of rabies; therefore, the translocation of known terrestrial rabies reservoir species should be prohibited.
1. TERRESTRIAL MAMMALS The use of licensed oral vaccines for the mass vaccination of free-ranging wildlife should be considered in selected situations, with the approval of the state agency responsible for animal rabies control. The distribution of oral rabies vaccine should be based on scientific assessments of the target species and followed by timely and appropriate analysis of surveillance data; such results should be provided to all stakeholders. Continuous and persistent government-funded programs for trapping or poisoning wildlife are not cost effective in reducing wildlife rabies reservoirs on a statewide basis. However, limited control in high-contact areas (e.g., picnic grounds, camps, suburban areas) may be indicated for the removal of selected high-risk species of wildlife. State agriculture, public health and wildlife agencies should be consulted for planning, coordination and evaluation of vaccination or population-reduction programs.
2. BATS Indigenous rabid bats have been reported from every state except Hawaii, and have caused rabies in at least 33 humans in the United States. Bats should be excluded from houses and adjacent structures to prevent direct association with humans. Such structures should then be made bat-proof by sealing entrances used by bats. Controlling rabies in bats by programs designed to reduce bat populations is neither feasible nor desirable.
REFERENCE
1. Rupprecht CE, et. al. Brief Report: Human Infection Due to Recombinant Vaccinia-Rabies Glycoprotein virus. N Engl J Med 2001; 345:8,582-586.
2. Centers for Disease Control and Prevention: Human rabies prevention--United States, 1999. recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-1).
3. 2000 Report of the AVMA Panel on Euthanasia. JAVMA 2001; 218:5,669-696.

animal and currently vaccinated with a vaccine approved by USDA for that species should be revaccinated immediately and observed for 45 days. Unvaccinated livestock should be slaughtered immediately. If the owner is unwilling to have this done, the animal should be kept under close observation for 6 months. The following are recommendations for owners of unvaccinated livestock exposed to rabid animals:
(1) If the animal is slaughtered within 7 days of being bitten, its tissues may be eaten without risk of infection, provided that liberal portions of the exposed area are discarded. Federal meat inspectors must reject for slaughter any animal known to have been exposed to rabies within 8 months.
(2) Neither tissues nor milk from a rabid animal should be used for human or animal consumption. Pasteurization temperatures will inactivate rabies virus, therefore, drinking pasteurized milk or eating cooked meat does not constitute a rabies exposure.
(3) Having more than one rabid animal in a herd or having herbivore-to-herbivore transmission is rare; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies might not be necessary.
(c) OTHER ANIMALS Other mammals bitten by a rabid animal should be euthanized immediately. Animals maintained in USDA licensed research facilities or accredited zoological parks should be evaluated on a case-by-case basis.
6. MANAGEMENT OF ANIMALS THAT BITE HUMANS (a) A healthy dog, cat, or ferret that bites a person should be confined and observed daily for 10 days; administration of rabies vaccine is not recommended during the observation period. Such animals should be evaluated by a veterinarian at the first sign of illness during confinement. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be euthanized, its head removed, and the head shipped under refrigeration (not frozen) for examination of the brain by a qualified laboratory designated by the local or state health department. Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately and the head submitted as described above for rabies examination.
(b) Other biting animals which might have exposed a person to rabies should be reported immediately to the local health department. Prior vaccination of an animal may not preclude the necessity for euthanasia and testing if the period of virus shedding is unknown for that species. Management of animals other than dogs, cats, and ferrets depends on the species, the circumstances of the bite, the epidemiology of rabies in the area, and the biting animal's history, current health status, and potential for exposure to rabies.
C. CONTROL METHODS IN WILDLIFE The public should be warned not to handle wildlife. Wild mammals and hybrids that bite or otherwise expose persons, pets or livestock should be considered for euthanasia and rabies examination. A person bitten by any wild mammal should immediately report the incident to a physician who can evaluate the need for antirabies treatment (See current rabies prophylaxis recommendations of the ACIPo). State regulated wildlife rehabilitators may play a role in a comprehensive rabies control program. Minimum standards for persons who rehabilitate wild mammals should include rabies vaccination, appropriate training and continuing education. Translocation of infected wildlife has contributed to the spread of rabies; therefore, the translocation of known terrestrial rabies reservoir species should be prohibited.
1. TERRESTRIAL MAMMALS The use of licensed oral vaccines for the mass vaccination of free-ranging wildlife should be considered in selected situations, with the approval of the state agency responsible for animal rabies control. Continuous and persistent government-funded programs for trapping or poisoning wildlife are not cost effective in reducing wildlife rabies reservoirs on a statewide basis. However, limited control in high-contact areas (e.g., picnic grounds, camps, suburban areas) may be indicated for the removal of selected high-risk species of wildlife. State agriculture, public health and wildlife agencies should be consulted for planning, coordination and evaluation of vaccination or population-reduction programs.
2. BATS Indigenous rabid bats have been reported from every state except Hawaii, and have caused rabies in at least 33 humans in the United States. Bats should be excluded from houses and adjacent structures to prevent direct association with humans. Such structures should then be made bat-proof by sealing entrances used by bats. Controlling rabies in bats by programs designed to reduce bat populations is neither feasible nor desirable.
REFERENCE
1. Centers for Disease Control and Prevention: Human rabies prevention--United States, 1999. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999;48(No. RR-1).
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