Rabies

US Army Veterinary Corps

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 Rabies

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 Impact of Rabies
• World Health Organization reports thousands of human
deaths annually
– US - 4 deaths
– Mexico - 25 deaths
– Central America 1-2 million farm animals die due to
bites from rabid bats
– 45% of all deaths from rabies occur in southeastern
Asia*
– In India alone, estimated 18,000-20,000 cases/year
(36% of the world’s deaths)

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 Impact of Rabies

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 Rabies specific to the US
• Geography of
Rabies Variants

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 Rabies variants
• In the US, there have been spillover infections of distinct rabies
variants to other species but they “spill-overs” have not been
sustained within the population.
– Example: bats to foxes in Arizona.

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 Prevalence in the US
• The true prevalence of
Rabies in the US is
unknown.
• So what have we done to
estimate this population?

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 Rabies Transmission

1) Warm blooded 4) Incubates for

animal (to include 2-12 weeks
a human) is bitten
by a rabid animal 5) Reaches brain,
ranimata.gif multiplies rapidly,
2) Virus enters passes to
through salivary glands,
infected saliva begins to show
clinical signs
3) Virus spreads
through nerves 6) Infected animal
and spinal cord dies in 7-10 days

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 Rabies Transmission
• Virus found only in mammals
• Wildlife reservoirs maintain the virus in nature
– Skunks, raccoons, foxes, bats, monkeys
• Domesticated animals (dogs, cats, horses, cattle) and
people at risk
• Animals that pose little threat:

• Do not contract/carry rabies

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 Rabies Transmission
• Transmitted through saliva
– Animal bites
– Scratches and exposure to saliva or neural tissue
(brain, spinal cord, etc)
 Rabies is almost 100% fatal if infected, but…
 Almost 100% preventable before and after bites with
appropriate medical intervention

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 Virus Shedding
• Dogs and cats shed virus for 3-7 days prior to onset of
clinical signs
• Bats shed virus for 12 days prior to clinical signs
• Skunks shed virus 18 days prior to clinical signs
• Mice, rats, and other small rodents almost never found
infected…WHY?

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 Exposure to Clinical Signs
• The virus incubates in the animal/human
• Incubation period in humans
• Usually 3 to 8 weeks
• As short as 9 days to longer than a year
• Virus travels up peripheral nerve to brain
• Once clinical signs occur, virus is already in salivary
glands

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 Clinical Signs in Animals
• Huge misconception about what a rabid animal,
specifically a dog, looks like
• Animals may be aggressive, but they may appear
perfectly normal
• “Dumb” rabies form most common in dogs and results
in most human exposures
• “Furious” or aggressive form

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 Clinical Signs in Animals
• Clinical signs
– Non-specific illness
– Fever
– Malaise
– Headache
– Hypersalivation
– Neurologic signs
– Aggression or the “dumb” form

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 Days of death in Rabid Dogs
• 12 Jul 85 – 31 Dec 02, 957 cases
Day 1 2 3 4 5 6 7 8 9 10
# of 261 310 204 100 45 21 10 3 3 0
dogs

% dogs 27 32 21 11 5 2 1 <1 <1

# of canine deaths per day

350

300

250
# of deaths

200

150

100

50

0
1 2 3 4 5 6 7 8 9 10

Days
Mean = 2.5 days
Tepsumethanon CID, 2004; 39: 278-80)
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 Human Exposure
• A potential exposure occurs when
– Animal bite
– Animal scratch that breaks skin
– Animal saliva, blood, neural tissue contacts mucosal
tissue or abraded/open skin
– Presence of bats when sleeping or unconscious
• Anatomic location of bite matters
– Bite to face is worse than finger

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 Clinical Signs in Humans
• Often misdiagnosed in the early period
– Fever
– Headache
– General malaise
– Tingling/numbness at bite site
– Anorexia
Other signs
– “Furious” form: spasms, hyperactivity, arrhythmias
– “Dumb”/paralytic form: weakness, bladder
dysfunction, coma

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 Progression in Humans
• Incubation – 3 to 8 weeks (short as 9 days; long as 7
years)
• Course - typically 2 to10 days
• Progression to neurological signs culminating in
respiratory paralysis and death

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 Diagnosing Rabies
• If an animal bite/scratch has
occurred
– Try to apprehend & humanely
euthanize animal
– Don’t shoot it in the head – need
brain for testing!
– Animal’s head should be sent to
lab for testing
– If positive: victim & all personnel
in contact with animal will
receive PEP treatment
• If not apprehended
– Send victim to hospital for
possible PEP treatment
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 Sending a Specimen to the Lab

• Bats and small animals

– ship the entire animal
• Medium sized animals, dog, cat
– ship only the head
• Large animals, horse, cattle
– ship only the brain.
• (Brain removal under direct
supervision of a veterinarian)

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 Sending a Specimen to the Lab

• USE CAUTION
• Animal is a rabies suspect!
• Wear Personal Protective
Equipment
– Eye Protection
– Gloves
– Mask
• When removing the head or brain
– Add surgical gown
– Full face shield best, if available
– Pre-exposure vaccination series
required!
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 Sending a Specimen to the Lab

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 Preventing Rabies
• Rabies vaccines
– Dog (3-4 months of age / 1 year later)
– Cats (3-4 months of age / 1 year later)
– Ferrets (annually)
– Horses (annually)
– Other livestock (cattle/sheep only)
– Wild animals…?

*Kole AK et al. Human rabies in India: a problem needing more attention. Bulletin of the World Health Organization 2014;92:230.
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 Rabies Free Countries

http://www.cdc.gov/importation/rabies-free-countries.html

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 Rabies Control Programs

*Kole AK et al. Human rabies in India: a problem needing more attention. Bulletin of the World Health Organization 2014;92:230.

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 Rabies Control Programs
• Considerations
– Magnitude of rabies problem in the area
– Reservoirs of rabies in the area
– Transmitters of rabies in the area
– Magnitude of stray animal problem in area
– Existing control measures – are they effective?
– Availability of treatment for humans exposed to
rabies
– Feasibility and sustainability of any control program
suggestions

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 Control Program Basics
• It has been proven that simply eliminating the animals with
rabies does not prevent the spread of disease.
• What needs to be done is a Trap/Vaccinate/Release program.
Ideally this would also include sterilization (Spay or neuter).
• Must be able to estimate population
• Dedicated rabies catch and release teams ideal
• Minimize stress to animals (ideally 60 secs or less).
• Track dog bites to track effect in human population

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 To begin
• Population estimation is
most important.
• The best way to do this is go
into a community and simply
count
• The area you are working in
should be segmented and
teams should be sent to each
segment.
• Then sweep the streets for
animals making sure to cover
all ground.

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 Population estimate
• Once the population has been roughly estimated, you will know
what you are working with. Very rough estimate.
• Once we have that, dedicated teams must return to their
segments with supplies i.e. vaccines, nets, and trained people to
administer
• There is some art to this. You want to be able to catch the dog
with the net (or other items), restrain them, and vaccinate (IM or
intradog) as quickly as possible. Ideally, you would then mark
the dogs whether that be with a collar or some sort of tag to
follow up next year.
• Each segment completes their respective area and ideally getting
as many dogs as possible.

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 Goals
• In a respective area, you want to be able to vaccinate 70-80% of
the dog population.
• Research shows that this level of vaccination will prevent the
rabies cycle from continuing.
• This vaccination scheme must be completed for several years in
order to stop the cycle.

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 Other important considerations
• Dog bite reporting
– Teach your children to also report being bitten by dogs.
– If bitten, wash wound well with soap and water. Then seek
medical care!! This can greatly help prevent rabies and helps
track it in the area.
• Work with Human Medical teams – must be a collaboration

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 Rabies Control Programs
• Vaccination – most effective method
– Parenteral injections – 75% for herd immunity
– Oral baits
– Stray population & wild reservoir population
• Foxes in Middle East

• Surveillance
– Basis for any rabies control program
– Laboratory confirmation
– Effective reporting of human & animal cases

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 Rabies Control Programs
• Stray animal population management
– Habitat control
– Reproductive control
– Movement control
– Must be part of any management program
– Mandatory registration of dogs & owners
– Dog warden

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 Rabies Control Programs
• Note: Killing stray/wild animals alone is NOT an effective
method of controlling rabies!
• Any rabies or stray animal program based on this
concept alone has been unsuccessful on a global scale

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 The WHO recommends
• Establish a national rabies control program including a 5 year
strategic plan
• Improve rabies surveillance and data collection
• Phase out the NTV vaccines
• Promote rational use of TCVs for PEP and encourage the use of
cost effective intradermal human rabies vaccines
• Strengthen collaboration between ministries and sectors of the
government to start dog population management, and rabies
control programs. Work with an NGO!!!
• Develop a program to regulate animal movement in and out of
the country
• Community participation and “buy-in”

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 Mission Rabies
• A charity that works with countries to start an effective
eradication strategy and elimination program.
– If additional questions, please contact Fred Lohr, a Mission
Rabies representative at: fred@missionrabies.com

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 Conclusion
• Human rabies can be reduced or eliminated by
– Preventing animal bites
– Reducing rabies in animals
– Controlling animal populations
– Cleaning wounds
– Vaccinating (people and animals)
– Post exposure prophylaxis – proper techniques!
• Which is easiest?

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 Questions?

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 References
• Kaplan MM, Cohen D, Koprowski H, et al Studies on the local
treatment of wounds for the prevention of rabies. Bull WHO
1962;26:765-75.
• Kole AK et al. Human rabies in India: a problem needing more
attention. Bulletin of the World Health Organization
2014;92:230.
• WHO. Expert Committee on Rabies, Technical Report Series
824. Geneva 1992

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