Epidemiology and Animal Quarantine Management

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					   North Carolina Manual for Rabies
Prevention and Animal Bite Management




                  North Carolina Division of Public Health
                     Veterinary Public Health Program

                      Business Hours: 919-707-5900
              After Hours, Weekends, Holidays: 919-733-3419
                     Email: vetpublichealth@ncmail.net




  North Carolina Manual for Rabies Prevention and Animal Bite Management
                                 April 2007
                                                                           1
                                                                       Table of Contents



Epidemiology of Rabies in North Carolina ...............................................................................................................4

Rabies in Bats...............................................................................................................................................................4

Pre Exposure Rabies Immunization in People..........................................................................................................8

Human Exposure to Rabies ........................................................................................................................................8

Management of Rabies Exposures in Humans........................................................................................................10

Deviation from Rabies Immunization Schedule......................................................................................................10

Management of Dogs and Cats that have Bitten or Exposed a Person .................................................................12

Management of Dogs and Cats Exposed to a Potentially Rabid Animal ..............................................................13

10-day Confinement or 6-Month Quarantine? .......................................................................................................14

Animal Rabies Immunization Requirements ..........................................................................................................14

Canine and Feline hybrids; Rabies Immunization and Bite Management...........................................................15

Management of Livestock Bitten by Rabid Animals ..............................................................................................16

North Carolina General Statutes Chapter 130A: Rabies.......................................................................................17

Definitions ..................................................................................................................................................................21

References ..................................................................................................................................................................22


                                                                  State of North Carolina

                                                 Department of Health and Human Services

                                                                Division of Public Health

                                             www.ncdhhs.gov                        www.ncpublichealth.com

                                            NC DHHS is an equal opportunity employer and provider. 4/07


                       1500 copies of this public document were printed at a cost of $5,557.59, or $3.70 each.                        4/07




                  North Carolina Manual for Rabies Prevention and Animal Bite Management
                                                 April 2007
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Introduction

This manual is intended for use by veterinarians, local health departments, animal control officers, game wardens,
wildlife damage control agents and human health care providers for rabies prevention and control purposes.
Recommendations contained in this manual are largely based on the following:
    • Human Rabies Prevention-United States, 1999; Recommendations of the Advisory Committee on
         Immunization Practices (http://www.cdc.gov/MMWR/preview/mmwrhtml/00056176.htm)
    • 2007 NASPHV Compendium of Animal Rabies Prevention and Control
         (http://www.nasphv.org/documentsCompendia.html)
    • NC Statutes and Administrative Code (http://www.epi.state.nc.us/epi/vet.html)



                                      Part I – Rabies Background
Rabies is a viral zoonotic disease, which means it is a disease that is transmitted from animals to humans, as well as
being transmitted from animal to animal. Rabies virus is maintained in reservoir populations of animals. In the
United States these reservoir animals are wild carnivores (ie raccoons in the east, skunks in the midwest) and
insectivorous bats. In other parts of the world the domestic dog serves as a reservoir animal. In those countries
exposure to rabid dogs is the primary means by which people contract and die from rabies. Fortunately pet
vaccination laws in the U.S. protect us and our pets from rabies.

All mammals, including humans, are susceptible to rabies virus infection. Once an animal is exposed and becomes
ill, the disease is fatal. Prior to the death of the animal, infectious rabies virus is shed in the saliva of the sick animal.
When the infectious animal fights with or bites another animal, the virus is transmitted and the bitten animal may
develop rabies. In this way rabies can be maintained in a population of animals. In NC this cycle typically involves
raccoons; however raccoons can and do fight with other animals and cause them to become rabid. It is for this
reason that you hear about rabid foxes, skunks, coyotes, groundhogs and other animals on the news. This is also the
reason why there are rabid dogs and cats reported every year in NC. Keeping dogs and cats currently vaccinated
against rabies will protect them from the disease, and protect the people around them.

 Rabies is a single stranded RNA virus in the Lyssavirus genus. The Lyssavirus genus is divided into seven
genotypes (rabies virus and six rabies related viruses) based on the sequence of the RNA genome. Six of the seven
viruses can cause the fatal disease “rabies” in humans. However, only rabies virus itself (Genotype 1) is present in
North America. Here is a summary of these viruses...

     •    Genotype 1 – classic rabies virus, occurs worldwide but is the only Lyssavirus in North America, is the
          cause of all wildlife rabies cases in the U.S.
     •    Genotype 2 – Lagos bat virus, occurs in Africa (not known to cause “rabies” in humans)
     •    Genotype 3 – Mokola virus, occurs in Africa
     •    Genotype 4 – Duvenhage virus, occurs in Africa
     •    Genotype 5 – European bat Lyssavirus 1, occurs in Europe
     •    Genotype 6 – European bat Lyssavirus 2, occurs in Europe
     •    Genotype 7 – Australian bat Lyssavirus, occurs in Australia

Human disease (rabies) due to genotypes 3 through 7 is very rare and has only occurred in those parts of the world
where the virus exists naturally. Human disease due to genotypes 3 through 7 has not occurred in the U.S. The
reservoir animals for genotypes 3 through 7 have in all cases been identified to be insectivorous bats only. Large
bats known as flying foxes have also been identified as a reservoir for Australian Bat Lyssavirus.

Throughout this document “rabies” refers to the clinical disease rabies in humans and animals. “Rabies virus”
means genotype 1 (classic rabies virus) of the Lyssavirus genus.



             North Carolina Manual for Rabies Prevention and Animal Bite Management
                                            April 2007
                                                                                                                            3
Epidemiology of Rabies in North Carolina

Rabies was a major problem in North Carolina as well as much of the rest of the nation during the 1950s. In fact, the
last person to die from rabies in NC was in 1953, a woman from Cherokee County that was bitten by her own dog.

The rabies outbreak during the 1940s and 1950s was primarily in the dog and cat population. Through vaccination of
pets and other public health measures, it was brought under control over a period of just a few years. North Carolina
had several hundred cases of rabies each year in the early to mid-1950s; there was only a handful each year until the
1990’s (Figures 1 & 2).

Rabies is now a naturally occurring disease in terrestrial wildlife throughout the eastern seaboard and much of the
mid-West. It spreads from animal to animal over time to infect the animals of other areas. Occasionally, people
moving wildlife from an infected area to a non-infected area spread it inadvertently. Because the virus may not
cause disease in an infected raccoon for an unknown period of time, animals without signs of disease are sometimes
moved and later spread disease into uninfected populations of animals.

Three distinct epizootics (epidemics in animals) of rabies have invaded North Carolina's terrestrial wildlife
population since 1990, and the number of recorded rabid animals in the state has grown dramatically. A raccoon
rabies epizootic from the Southeast which began in Florida in the 1940s slowly spread during the intervening
decades, entered Mecklenburg and Union Counties in 1992, and spread from there.

A second epizootic of rabies in raccoons came from the Mid-Atlantic States. It spread from animal to animal from
its point of origin in West Virginia (after translocation of infected raccoons from Florida to West Virginia), and
entered Alleghany County in 1991. This epizootic moved south and east through North Carolina and joined with the
epizootic from the Southeast, creating a massive rabies epidemic from Florida to Maine.

The last epizootic of rabies spread out of the northern mid-Western states into eastern Tennessee, southwestern
Virginia, and finally into Ashe County. This epizootic has not spread as quickly as the other two epizootics.

Rabies in Bats

In contrast to terrestrial wildlife, rabies has likely always been present in the bat population in NC. There are 17
species of bats in NC, three of which are listed on the federal endangered species list. Bats are in fact theorized to be
the evolutionary source of all lyssaviruses, including rabies (genotype 1). It is suggested that rabies virus
successfully “jumped” species from the order Chiroptera to the order Carnivora approximately 1000 years ago. The
fact that lyssavirues are well established in two ecologically distinct mammal orders may be the result of successful
host switching. Through genetic adaptation members of the order Carnivora have become competent reservoirs for
rabies.1

Bats are significant in the epidemiology of rabies because, although the overall number of rabid bats in NC and the
United States is less than the number of rabid terrestrial animals, they are the primary source of human rabies in the
US. From Jan 1, 2000 through Dec 31, 2006 there have been 23 cases of human rabies in the US. In 17 of those
cases rabies was acquired from a bat. If you examine only those cases of rabies that were acquired in the US, all but
one was caused by bats (the lone US case not caused by the bat strain of rabies virus was in 2003 in Virginia where
a man died from the raccoon strain of rabies virus).

The exact reason why bats pose such a risk is unclear but may be due to several factors.
    •    Bat bites are not dramatic and may not be appreciated when they occur or when the patient is examined
    •    Some may recognize the bite but not comprehend its implications
    •    Others, such as young persons or those with disabilities may be unable to provide an accurate history of a
         bite

             North Carolina Manual for Rabies Prevention and Animal Bite Management
                                            April 2007
                                                                                                                       4
                                                                   The image to the left demonstrates minor
                                                                   puncture wounds from a bat bite (arrows point
                                                                   to wounds).

                                                                   Reprinted with permission from Massachusetts
                                                                   Medical Society:
                                                                   N Engl J Med 2004;351:2626-35.




Since 1980 71% of human rabies cases have been identified as due to a rare variant associated with silver haired
bats. Yet this species of bat represents less than 8% of the number of rabid bats identified in US, which leads to the
question…Is the silver haired bat variant of rabies virus unique? This variant of rabies virus appears to replicate at
lower temperatures (34C), and thus only a small superficially administered quantity of virus could cause infection.2
Whatever the reasons, care must be taken when dealing with any exposure to bats.

It should be noted that most bats in NC are not rabid and do serve a valuable ecological function. Bats should not be
destroyed as a matter of course; all bat species in NC are protected under state wildlife laws. A review of bats
submitted to the NC SLPH for rabies testing for the years 2002 – 2005 demonstrates most do not carry the disease
(Table 1). This can be contrasted with data demonstrating the positivity rate in other species (Table 2).

As with most species there is a distinct seasonality with regards to when rabid bats are identified. This is accentuated
with bats due to the fact that many either hibernate or migrate out of NC during the winter months. Most positive
bats are identified in the summer (Figure 3).

Bat Proofing your Home or Building (the following is an excerpt from the Minnesota Department of
Natural Resources which has an excellent website detailing how to bat proof a home).3

    •    A number of methods have been tried to evict colonies of bats from buildings. Whether you do the work
         yourself, or call a pest control company, the ONLY CONSISTENTLY SUCCESSFUL METHOD IS
         PERMANENT PHYSICAL EXCLUSION.
    •    Timing is critical for excluding bats. In the spring and summer, if a maternity colony has taken up
         residence, you will need to delay excluding the bats until August when the young are able to fly. If you
         exclude the adult bats while the young are flightless, the young bats will needlessly starve to death and may
         create an odor problem. Frantic mother bats, excluded from their young may mistakenly get into your
         living area when trying to find a way back to the roost to care for the pups.
    •    Whether or not you decide to delay excluding the bats for the above reasons, concentrate your efforts first
         on bat-proofing the living areas of your home. Make sure doors to attics and basements are sealed with
         draft guards and holes in any interior walls and ceilings are repaired so that a bat can't mistakenly enter the
         main parts of your house.




            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
                                                                                                                         5
Figure 1. Positive animal rabies cases in NC by year

                                                                         879
         900
                                                                 740                                                  769
         800                                                                                                   706
         700                                                                                                                 582
                                                                                 560                    571
         600                                                                                                                               521
                                                         468                             442 459                                    458
         500
         400
         300
                                                 175
         200                             106
                      50
         100    10 24
           0
                1990

                         1991
                                 1992
                                         1993

                                                 1994
                                                         1995
                                                                 1996

                                                                         1997
                                                                                 1998
                                                                                         1999

                                                                                                 2000
                                                                                                        2001
                                                                                                               2002

                                                                                                                      2003
                                                                                                                             2004
                                                                                                                                    2005

                                                                                                                                           2006
Figure 2. Positive cases of dog and cat rabies in NC by year


           45
           40
           35
           30                      Dog
           25                      Cat
           20
           15
           10
            5
            0
                  1990
                          1991
                                  1992
                                          1993
                                                  1994
                                                          1995
                                                                  1996
                                                                          1997
                                                                                  1998
                                                                                          1999
                                                                                                 2000
                                                                                                        2001
                                                                                                               2002
                                                                                                                      2003
                                                                                                                             2004
                                                                                                                                    2005
                                                                                                                                           2006




          North Carolina Manual for Rabies Prevention and Animal Bite Management
                                         April 2007
                                                                                                                                                  6
Table 1. Percentage of bat species testing positive for rabies, NC, 2002 – 2006


                       Submission by Species                  # Submitted   # POS   % POS
                                    E. fuscus                    4118        93        2%
                                    L. borealis                  369         51     14%
                            L. noctivigans                       155          3        2%
                            T. brasiliensis                      143          8        6%
                              N. humeralis                       143          2        1%
                              P. subflavus                        30          6     20%
                              L. seminolus                        15          1        7%
                                L. cinereus                       4           1     25%
                             C. rafinesquii                       2           0        0%
                            Not Speciated                        372          6        2%
                                      Totals                     5351        171       3%



Table 2. Percentage of various species testing positive for rabies, NC, 2003 – 2004




      100                                                                   Based on NC SLPH data
                                                                            # Specimens Tested are:
        80
                                                  % Positive                Skunk:          263
        60
                                                                            Raccoon:        1563
        40                                                                  Fox:            304
                                                                            Bat:            1645
        20                                                                  Cat:            2103
                                                                            Dog:            1390
          0
               Skunk




                                         Fox
                          Raccoon




                                                  Bat

                                                        Cat

                                                                   Dog




          North Carolina Manual for Rabies Prevention and Animal Bite Management
                                         April 2007
                                                                                                      7
Figure 3. Seasonality of positive bats in NC, 2002 – 2006 (n=171)

          60

          50
                           # Pos
          40

          30

          20

          10

            0
                   J      F      M       A       M       J       J      A       S      O       N       D


                              Part II – Human Rabies Prevention

Pre Exposure Rabies Immunization in People

Pre exposure rabies vaccination is recommended for people at high risk of exposure to rabies 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.

Pre exposure vaccination consists of three 1.0-mL injections of RabAvert or Imovax administered intramuscularly
(deltoid area) -- one injection per day on days 0, 7, and 21 or 28.

Nonetheless, in the event of an exposure to rabies, persons who have received pre-exposure rabies immunization
still require post-exposure immunization. Pre-exposure immunization will allow for a rapid anamnestic response
when rabies vaccine booster doses (only two doses are required for persons who have been previously vaccinated
against rabies) are administered after an exposure and obviate the need for administration of HRIG.

The CDC recommends that, in persons who have received rabies pre exposure immunization, a serum sample be
collected every two years to measure serum neutralizing antibodies. If the person’s titer is below a level defined as
adequate by the laboratory performing the test, a single booster dose of rabies vaccine should be administered.4

Human Exposure to Rabies

Definition: Any bite, scratch or other situation in which saliva or central nervous system (CNS) tissue of a
potentially rabid animal enters an open wound, fresh wound, or comes in contact with a mucous membrane by
entering the eye, mouth or nose.
    • Bite: wound from a tooth that penetrates the skin
    • Non-bite: getting saliva or CNS tissue from a potentially rabid animal into an open wound or in the eyes,
         nose, or mouth



            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
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Petting or handling a potentially rabid animal or another animal or inanimate object that has had contact with a rabid
animal does not constitute an exposure unless wet saliva or CNS tissue entered a fresh, open wound or contacted a
mucous membrane. Being close to or in contact with the blood, urine, or feces (or spray from a skunk) of an animal
does not constitute an exposure.

Generally, bites from animals can be categorized as provoked or unprovoked. A provoked incident occurs when a
person creates a situation such that an expected reaction from the animal may be to bite (grabbing, taunting, entering
an animals territory, or even feeding). An unprovoked incident occurs when an animal bites or attacks for no
apparent reason. Unprovoked bites are more serious and may be an indication that the animal is ill, perhaps with
rabies. A provoked bite from a dog or cat that is currently vaccinated poses very little risk or rabies transmission.
Nonetheless, those animals must still be confined in accordance with law.

Any bite from a wild carnivore, bat, or large rodent (beaver, groundhog) is serious. The animal should be collected
for rabies diagnostic testing and the bite victim should be evaluated for rabies PEP immediately. Bites from small
rodents, lagomorphs and opossums pose much less risk. Bites from rabbits, squirrels, chipmunks, rats and mice
seldom, if ever, call for rabies prophylaxis. Only an unprovoked attack by a small rodent or rabbit should be
considered for rabies prophylaxis. Domesticated rodents purchased from pet shops, raised in controlled
environments, and never exposed to carnivorous animals or bats pose no risk of rabies by biting. Public health
should be consulted for any bite from other wild or exotic animals. The simple guide below can be helpful in
determining the need for administration of rabies PEP.

Regarding bat exposures and the need for rabies PEP. The following is an excerpt from the 1999 ACIP guidance on
Human Rabies Prevention

         Postexposure prophylaxis should be considered when direct contact between a human and a bat has
         occurred, unless the exposed person can be certain a bite, scratch, or mucous membrane exposure did not
         occur. In instances in which a bat is found indoors and there is no history of bat-human contact, the likely
         effectiveness of postexposure prophylaxis must be balanced against the low risk such exposures appear to
         present. In this setting, postexposure prophylaxis can be considered for persons who were in the same room
         as the bat and who might be unaware that a bite or direct contact had occurred (e.g., a sleeping person
         awakens to find a bat in the room or an adult witnesses a bat in the room with a previously unattended
         child, mentally disabled person, or intoxicated person) and rabies cannot be ruled out by testing the bat.
         Postexposure prophylaxis would not be warranted for other household members.4


      Animal Type Causing             Evaluation and Disposition of Animal         Recommended Prophylaxis in
          Exposure                                                                           Bite Victim
                                           Healthy & available for 10 day          Begin PEP IF symptoms develop
          Dog/Cat/Ferret
                                                    observation                       during 10 day observation
                                                                                     Administer PEP, submit for
          Dog/Cat/Ferret                      Rabid or suspected rabid
                                                                                               testing
         Dog/Cat/Ferret                          Lost to follow up                           Consult PH
    Wild Carnivore, Bat, Large         Regard as rabid unless proven negative      Administer PEP, discontinue IF
             Rodent                                  by lab test                        animal tests negative
    Livestock, Small Rodents,
                                                Consider Individually                         Consult PH
          Lagomorphs




            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
                                                                                                                      9
Management of Rabies Exposures in Humans

Local Treatment of Wounds

         Animal bite wounds should be washed thoroughly with soap and water for 10-15 minutes. Medical advice
         should be sought as soon as possible after the bite so the need for antibiotic therapy, rabies prophylaxis, and
         tetanus prophylaxis can be evaluated.5

Administering rabies PEP to persons previously vaccinated against rabies

         Administer one 1-ml dose of RabAvert or Imovax IM in the deltoid on day zero. Administer a second 1-ml
         dose on day three in the deltoid, IM. Do not administer HRIG.

Administering rabies PEP to persons NOT previously vaccinated against rabies

         Deliver a total of five 1-mL doses of RabAvert or Imovax IM in the deltoid, one each on day 0, 3, 7, 14,
         and 28. Additionally, on day 0 (at the latest, day 7 after the first dose of vaccine) give 20 IU/kg body
         weight of HRIG. Inject as much of the full dose as is anatomically feasible into and around the wound site.
         Inject any remaining HRIG IM at a site distal to vaccine administration.

Physician Duty to Report
         Per NC Statute 130A-196; A physician who attends a person bitten by an animal known to be a potential
         carrier of rabies shall report within 24 hours to the local health director the name, age and sex of that
         person.

Deviation from Rabies Immunization Schedule

Pre Exposure: The recommended or standard pre exposure vaccination schedule is to administer one dose on days 0,
7, 21 or 28. This schedule provides rapid and sustained rabies virus neutralizing antibody (RVNA) titers for most
individuals. An alternate study reported results from a more widely spaced dosing schedule of days 0, 28, and 56.6
With this regimen there was a slower increase in RVNA; the maximum RVNA titer achieved three weeks after the
third dose was higher than with the standard regimen; and the longevity of RVNA (measured at two years) appeared
similar to the standard schedule. Although this alternate regimen is effective, adhere to the recommended schedule
(as appears in the package insert) whenever possible. Although minor deviations in the recommended dosing
regimen theoretically will not affect the efficacy of vaccination, each case should be considered individually.

Post Exposure: The recommended dosing schedule (if the patient has not been previously vaccinated against rabies)
is day 0, 3, 7, 14, and 28 (remember rabies immune globulin is to be administered on day 0). It is important, if
possible, that the first four doses be administered in the first 14 days with the doses of vaccine separated by a
minimum of three days. If a dose is missed, it should be administered as soon as possible with the aim of completing
the post exposure schedule per the approved regimen. If that is not possible, please consult the VPH program.
Clinicians should adhere to the recommended prophylaxis schedule. Deviations of a few days are unimportant, but
the effects of lapses lasting weeks or months is unknown.7

In conclusion deviations and delays in either the recommended pre or post exposure rabies vaccination schedule
should not occur. Discuss the importance of maintaining the approved schedule with your patients so that they are
unlikely to forget an appointment or try to reschedule an appointment for a later date. Inevitably this will occur, and
the guidance above should be helpful, but strive to avoid deviations and delays whenever possible. Understand that
whenever a deviation occurs, the product is now being used in a manner for which it is not labeled. This is unlikely
to affect efficacy in most cases, but when in doubt the patient’s immune status may be monitored by serologic


            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
                                                                                                                     10
testing 14 to 28 days after the final dose is given. Specimens collected should completely neutralize challenge virus
at a 1:5 serum dilution by the rapid fluorescent focus inhibition test (RFFIT).4

Serologic Testing

         Routine postvaccination serologic testing is not necessary due to the excellent antibody response following
         the recommended regimen. However it may be indicated in some situations, such as assessing the immune
         response in persons who have received pre exposure immunization or deviation from the approved
         schedule. Currently there are two laboratories that provide this service. Contact information:
                  Kansas State University: http://www.vet.k-state.edu/rabies
                  Atlanta Health Associates: http://www.atlantahealth.net/

Availability of rabies vaccine from SLPH

         If needed rabies vaccine (RabAvert by Novartis) and Rabies Immune Globulin (HyperRAB S/D by
         Talecris) can be ordered from the SLPH by calling Veterinary Public Health at 919-707-5900. The cost of
         the vaccine is approximately $150.00/dose and the cost of the RIG is approximately $600.00/10 ml vial
         (1500 IU). In the event that a patient is not able to afford vaccine the SLPH will supply vaccine and RIG
         free of cost IF the following criteria are met:

         1.   the individual's family income is at or below the federal poverty level in effect on July 1 of each fiscal
              year as determined by the local health department;

         2.   the individual meets the residency and other requirements set forth in 15A NCAC 24A .0200, except
              that the individual shall not be eligible for Medicaid or health insurance reimbursement for rabies
              post-exposure treatment as determined by the local health department; and

         3.   the treatment is recommended by a physician licensed to practice medicine.

         This ONLY applies to vaccine and RIG ordered from the SLPH. You may not request a reimbursement for
         vaccine and RIG that have been ordered elsewhere. In order to receive free vaccine an affidavit (see last
         page of this document) must be completed, notarized, and submitted to the SLPH. The cost for the vaccine
         and RIG will then be waived. Sale of rabies vaccine from the SLPH is available only to human health care
         providers and local health departments.

Availability of rabies vaccine from RxHope (http://www.rxhope.com/)
         RxHope.com is a privately owned, Pharmaceutical Research and Manufacturers of America (PhRMA)
         supported, web portal for physicians to submit applications for patient assistance over the Internet.

         RxHope.com is a patient assistance program. Patient Assistance Programs (PAP) are designed to support
         low income US residents with free or low cost prescriptions. The programs usually cover brand name drugs
         only and are administered individually by the pharmaceutical companies that manufacture the drugs.

         Physicians or other clinicians may visit RxHope.com to seek assistance for patients that may need rabies
         post-exposure prophylaxis but cannot afford the medication costs.

Use of Rabies Vaccine in International Travelers

Rabies remains a worldwide public health problem even though means to control the disease are known. The World
Health Organization estimates as many as 50,000 to 70,000 human rabies deaths annually. Worldwide most human
deaths due to rabies occur in countries where canine rabies is endemic and uncontrolled. Visitors to these countries


              North Carolina Manual for Rabies Prevention and Animal Bite Management
                                             April 2007
                                                                                                                      11
must assume that most dogs have not been vaccinated against rabies8 and therefore an exposure to these animals
represents a much greater risk than a similar exposure in NC. Safe and highly immunogenic rabies vaccines are
available for vaccinating at risk individuals prior to travel.

Which travelers are at risk?

Pre-exposure vaccination against rabies can be considered for travelers in the following categories8:
    • Those going to countries where rabies is present and who intend to have regular contact with animals (e.g.
        veterinarians or zoologists)
    • Those going to countries where rabies is endemic and who will be more than 24 hours away from a reliable
        source of post-exposure vaccine and rabies immunoglobulin.
    • Health and laboratory workers who in the course of their travels may come into contact with specimens or
        patients infected with the virus.

Additionally current tissue cell rabies vaccines and specific immunoglobulins are used against all genotypes of
lyssavirus genus. Rabies researchers generally agree that current vaccines confer a protective immune response
against the seven characterized genotypes of lyssaviruses.9

In the event of any potential exposure to rabies or rabies related viruses, rabies post exposure prophylaxis is
indicted. However, pre-exposure immunization against rabies will afford some degree of protection for
unrecognized exposures and for exposures where immediate post-exposure care may be delayed due to geography or
lack of medical infrastructure in the host country.

                   Part III – Animal Rabies Prevention and Control
Management of Dogs and Cats that have Bitten or Exposed a Person

Any dog or cat (regardless of rabies vaccination status) that bites a person must be confined and observed for a 10-
day period of time per NC Statute 130A-196. The local health director designates the location and conditions of the
10-day confinement. At home confinement is NOT guaranteed but may be allowed at the discretion of the local
health director.

If the dog/cat does die or develop clinical symptoms suggestive of rabies during the 10-day confinement period
submit the head for rabies diagnostic testing. If the dog or cat does not die or develop clinical signs suggestive of
rabies during the 10-day confinement period then it can be concluded that the dog/cat was not shedding rabies virus
in its saliva at the time of the bite. Rabies PEP would not be warranted for the bite victim.

Euthanasia of dogs and cats that bite a person is not permissible unless
    • signs or symptoms of rabies develop during the 10 day confinement period or
    • extenuating circumstances exist and the approval of the health director is granted. An example may be a
        dog or cat that has been hit by a car and subsequently bites a person. If it would be inhumane to keep the
        dog/cat alive solely for purposes of rabies confinement the animal may be humanely euthanized and
        submitted for rabies diagnostic testing following consultation with the local agency responsible for animal
        control.

Any dog or cat that dies, for any reason, during the 10-day confinement period following a bite must be submitted to
the NC SLPH for rabies diagnostic testing per NC Statute 130A-199. If the dog/cat is stray or running at large
consult with animal control and arrange for capture of the animal as soon as possible. Administration of rabies
vaccine to the dog/cat is not recommended during the confinement period to avoid confusing signs of rabies with
possible side effects of vaccine administration.




            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
                                                                                                                  12
     Management of Dogs and Cats Exposed to a Potentially Rabid Animal


                       Dog / Cat Exposed1 to Wild Mammal that can
                       be Reasonably Suspected of Having Rabies



  Exposed Dog / Cat has a                            Exposed Dog / Cat does NOT have
 Current2 Rabies Vaccination                           a Current2 Rabies Vaccination



 Revaccinate against Rabies                                         Test Mammal4 that
 within 72 Hours of Exposure3                                      Exposed the Dog / Cat


 In North Carolina Animals
 Reasonably Suspected of
  Having Rabies Include:
                                     Results are Positive                  Results are
                                         for Rabies                     Negative for Rabies
         Raccoons
      Bats (all species)
    Red and Gray Foxes
Striped and Spotted Skunks           Euthanize Exposed                  Vaccinate Dog / Cat
          Bobcats                        Dog / Cat5                       against Rabies
          Coyotes
          Beavers
Groundhogs (woodchucks)

If there is any question as to        At the Discretion of the Local Health Director, a
   whether or not an animal             6 Month Quarantine may be an Acceptable
   poses a risk, call VPH at                     Alternative to Euthanasia5
        919-707-5900



1. Dog or cat bites, is bitten by, or is otherwise exposed to an animal reasonably suspected of
   being rabid.
2. Current rabies vaccination means the dog or cat was vaccinated within the previous 12 months
   (by a licensed veterinarian or certified rabies vaccinator) if it was the animal’s initial rabies
   vaccination. For subsequent rabies vaccinations current means administered by a veterinarian
   within one, three or four years from the previous vaccination, depending on the vaccine used.
3. If dog or cat is not revaccinated within 72 hours, treat as not currently vaccinated.
4. If mammal is unavailable for testing, proceed as if the mammal was rabid.
5. In accordance with NC General Statute 130A-197.




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10-day Confinement or 6-Month Quarantine?

A common question posed is which “quarantine” period is used for a given situation. In short…
    • The 10-day confinement period is used when a dog or cat bites a person
    • The 6-month quarantine is used when a dog or cat, that is not currently vaccinated against rabies, is bitten
      by an animal that may have rabies
    • These time periods apply for domestic dogs, cats and ferrets ONLY

Figure 4 is a generalized representation of when a dog or cat is incubating rabies (and not infectious) versus when
the dog or cat is shedding rabies in their saliva (and is infectious).

Figure 4: quarantine or confinement?


  1. virus           2. variable           3.virus enters        4. virus        5. virus              6. animal
  enters body        latency period        PNS travels           enters          spreads to            shows signs
                                           toward brain          brain           salivary gland        of rabies




                                       Incubation                                    Shedding


     Exposure:                     Animal NOT                            Animal IS                      DEATH
    bite, scratch,                   infectious,                         infectious,
   saliva touches                 appears healthy,                       may appear
     eyes, nose,                 average 60-90 day                      healthy or ill,
       mouth                          duration                        1-10 day duration


Animal Rabies Immunization Requirements

All dogs and cats in NC are required to be vaccinated against rabies by four months of age per NC General Statute
130A-185. Although rabies vaccination of ferrets is not required by law it is strongly encouraged. Dogs and cats
should be re-immunized 12 months after the initial vaccination and vaccinated every 1, 3, or 4 years thereafter
depending on the vaccine used. The current Compendium of Animal Rabies Control published by NASPHV should
be consulted for rabies vaccine recommendations.10 However, it must be noted that in cases where state law and the
compendium differ, state law is the appropriate guidance to adhere to.

Vaccination requirements for dogs and cats entering North Carolina
         Per NC General Statute 130A-193 all dogs and cats entering the state must have a health certificate issued
         within 30 days and, for animals three months old and older, rabies vaccination within 12 months of entry. If


            North Carolina Manual for Rabies Prevention and Animal Bite Management
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         the animal was vaccinated within 12 months of entering NC, the vaccine will be recognized for the full
         duration of immunity. If the animal was vaccinated more than 12 months prior to entering NC the animal
         should be securely confined and revaccinated within one week of entry.

Lapses in rabies vaccination
         Because a rapid anamnestic response is expected, an animal is considered currently vaccinated immediately
         after a booster vaccination, regardless of any lapse in vaccination.

Evaluating serology in lieu of rabies vaccination
         The existence of a measurable antibody titer against rabies virus glycoprotein is not synonymous with
         protection against rabies. It IS indicative of exposure to rabies virus glycoprotein, which is the major
         feature against which virus neutralizing antibodies are directed. The efficacy of rabies vaccines for animals
         is founded on viral challenge of immunity studies, not serologic evaluation.11 All animal rabies vaccines are
         licensed for a specific duration of immunity by the USDA, typically 1 or 3 years though the package insert
         should always be consulted. Beyond that time frame there is no guarantee of efficacy, even if a measurable
         serum titer in the animal exists. For these reasons rabies vaccine titers may not be used in place of actual
         vaccination against rabies. The appropriate use of rabies titers is to document rabies immunization prior to
         export of a dog or cat from NC to a state or country that requires proof of exposure to rabies vaccine.

         Pet owners that are concerned about adverse reactions or over-vaccination should be informed of this. In
         the event a dog or cat that is not currently vaccinated against rabies (for ANY reason) is exposed to rabies it
         will be subject to immediate euthanasia or six month quarantine at the discretion of the local health director
         (even if the animal has a documented rabies titer).

Canine and Feline hybrids; Rabies Immunization and Bite Management

Offspring resulting from a cross between a wild animal and domestic animal are regarded as wild animals and
should be managed as wild animals in the event that a person is bitten. There is no rabies vaccine licensed for use in
hybrid animals. The efficacies of currently available rabies vaccines have not been determined in these animals.
Additionally the viral shedding period for rabies has not been characterized in hybrid animals as it has been in
domestic dogs and cats. It is the reason why a raccoon or tiger or wolf hybrid cannot be held for a 10-day
confinement period if they bite a person. It is unknown how long these animals may survive while shedding rabies
virus because the rigorous scientific studies required for public health protection have not been accomplished.
Therefore if a canine or feline hybrid bites a person, the animal should be humanely euthanized and the head
submitted for rabies diagnostic testing at the SLPH.

Also if a canine or feline hybrid animal is exposed to a possibly rabid animal, the possibly rabid animal should be
submitted for rabies diagnostic testing, even if the hybrid was vaccinated against rabies. Because there is no licensed
rabies vaccine for use in hybrids, they will always be considered not vaccinated against rabies. Placing a hybrid
animal into a 6-month quarantine is NOT permissible because the incubation period for rabies has not been
characterized in these animals as it has been for domestic dogs and cats. If it is concluded that the hybrid animal has
been exposed to rabies it should be humanely euthanized.

Special Note to Veterinarians: The AVMA professional liability insurance trust has issued the following statement
regarding vaccination of wolf hybrids12:

         The vaccinating of wolf-hybrids has become a topic of concern for veterinarians as a result of their
         increasing popularity as companion animals. The Trust office is frequently asked whether the AVMA
         policy will provide coverage if a veterinarian vaccinates a wolf-hybrid. The answer hinges on the state or
         local regulations regarding the harboring of these animals as pets.



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         The Trust office advises veterinarians to check with state authorities to determine the hybrid’s legal status
         as a pet. If the state or local government has no law against keeping a wolf-hybrid as a pet, the Trust would
         consider the vaccination of this animal as a discretionary use of a biologic by the veterinarian, an act which
         the policy does not specifically exclude.

         Prior to any such vaccination, however, the owner must be informed that the vaccine is not approved for
         use in wolf-hybrids and that there have been no studies to provide efficacy of the vaccine in these animals.
         Make a notation of this discussion in the record and have the owner initial it. This allows the owner to
         make an informed decision regarding the use of the vaccine.

         If the veterinarian practices in a state where it is illegal to keep these animals as pets, any treatment of a
         wolf-hybrid may be considered an illegal act. Illegal acts are excluded under the AVMA professional
         liability policy.

There is no state ban on owning canine or feline hybrids in North Carolina. However some municipalities,
recognizing the danger posed by exotic, or hybrid, animals have adopted local ordinances that restrict or outlaw
ownership of animals like this. Please be sure to check with the municipality in which you practice prior to engaging
in any activities with these animals.

Management of Livestock Bitten by Rabid Animals

Investigation of livestock bitten by rabid animals is important to protection of public health as well as animal
agriculture. While such protection may be accomplished by a quarantine of the affected animal, a quarantine may
not always be indicated. Depending on the circumstances, a quarantine may not affect all animals on the farm.

Livestock currently vaccinated against rabies
    Consult the NASPHV rabies prevention and control compendium to determine if a USDA licensed rabies
    vaccine is available for use in that species.

    Three options exist for livestock that are currently vaccinated against rabies and exposed to a rabid animal:
    1. The animal should be re-vaccinated against rabies within 72 hours of exposure and quarantined for 45 days.
    2. If the animal is not revaccinated it should be quarantined for eight months from the date of exposure.
    3. Euthanize the animal.

Livestock not currently vaccinated against rabies
    Two options exist for livestock that are not currently vaccinated against rabies and exposed to a rabid animal:
    1. The animal should be quarantined for eight months from the date of exposure.
    2. Euthanize the animal.

The conditions of any quarantine will be determined by the attending NCDA&CS field veterinarian. If at any time
during either quarantine period the animal shows signs suggestive of rabies the owner must notify the attending field
veterinarian. The animal will be euthanized and submitted for rabies diagnostic testing.

The animal may be sent to slaughter if the following two criteria are met, regardless of rabies vaccination status:
    1. At least eight months have elapsed since the exposure incident
    2. The animal is not displaying clinical signs or symptoms suggestive of rabies

Vaccinating livestock against rabies
Vaccination of livestock is not required by NC state law. Only dogs and cats are required to be vaccinated. The
decision to vaccinate livestock is left to the producer based on economic factors and the prevalence of rabies in the


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area. Producers are encouraged to vaccinate livestock against rabies if the animals are particularly valuable or will
have frequent contact with people. Animals placed in public settings (ie petting zoos) should be vaccinated against
rabies if a vaccine licensed for use in that species is available.


                              Part IV – Statutes and Other Material

North Carolina General Statutes Chapter 130A: Rabies

§ 130A-184. Definitions.
The following definitions shall apply throughout this Part:
(1) “Animal Control Officer” means a city or county employee designated as dog warden, animal control officer,
animal control official or other designations that may be used whose responsibility includes animal control.
(2) “Cat” means a domestic feline.
(3) “Certified rabies vaccinator” means a person appointed and certified to administer rabies vaccine to animals in
accordance with this Part.
(4) “Dog” means a domestic canine.
(5) “Rabies vaccine” means an animal rabies vaccine licensed by the United States Department of Agriculture and
approved for use in this State by the Commission.
(6) “State Public Health Veterinarian” means a person appointed by the Secretary to direct the State public health
veterinary program.
(7) “Vaccination” means the administration of rabies vaccine by a licensed veterinarian or by a certified rabies
vaccinator. (1935, c. 122, s. 1; 1949, c. 645, s. 1; 1953, c. 876, s. 1; 1957, c. 1357, s. 3; 1973, c. 476, s. 128; 1983, c.
891, s. 2.)

§ 130A-185. Vaccination of all dogs and cats.
(a) The owner of every dog and cat over four months of age shall have the animal vaccinated against rabies. The
time or times of vaccination shall be established by the Commission. Rabies vaccine shall be administered only by a
licensed veterinarian or by a certified rabies vaccinator.
(b) Only animal rabies vaccine licensed by the United States Department of Agriculture and approved by the
Commission shall be used on animals in this State. (1935, c. 122, s. 1; 1941, c. 259, s. 2; 1953, c. 876, s. 2; 1973, c.
476, s. 128; 1983, c. 891, s. 2.)

§ 130A-186. Appointment and certification of certified rabies vaccinator.
In those counties where licensed veterinarians are not available to participate in all scheduled county rabies control
clinics, the local health director shall appoint one or more persons for the purpose of administering rabies vaccine to
animals in that county. Whether or not licensed veterinarians are available, the local health director may appoint one
or more persons for the purpose of administering rabies vaccine to animals in their county and these persons will
make themselves available to participate in the county rabies control program. The State Public Health Veterinarian
shall provide at least four hours of training to those persons appointed by the local health director to administer
rabies vaccine. Upon satisfactory completion of the training, the State Public Health Veterinarian shall certify in
writing that the appointee has demonstrated a knowledge and procedure acceptable for the administration of rabies
vaccine to animals. A certified rabies vaccinator shall be authorized to administer rabies vaccine to animals in the
county until the appointment by the local health director has been terminated. (1935, c. 122, s. 3; 1941, c. 259, s. 3;
1953, c. 876, s. 3; 1957, c. 1357, s. 4; 1983, c. 891, s. 2.)

§ 130A-187. County rabies vaccination clinics.
The local health director shall organize or assist other county departments to organize at least one countywide rabies
vaccination clinic per year for the purpose of vaccinating dogs and cats. Public notice of the time and place of rabies
vaccination clinics shall be published in a newspaper having general circulation within the area. (1983, c. 891, s. 2;
1987, c. 219.)




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§ 130A-188. Fee for vaccination at county rabies vaccination clinics.
The county board of commissioners is authorized to establish a fee to be charged at the county rabies vaccination
clinics. The fee shall include an administrative charge not to exceed four dollars ($4.00) per vaccination, and a
charge for the actual cost of the vaccine, the vaccination certificate, and the rabies vaccination tag. (1935, c. 122, s.
9; 1941, c. 259, s. 7; 1949, c. 645, s. 5; 1953, c. 876, s. 5; 1959, c. 139; 1983, c. 891, s. 2.)

§ 130A-189. Rabies vaccination certificates.
A licensed veterinarian or a certified rabies vaccinator who administers rabies vaccine to a dog or cat shall complete
a three-copy rabies vaccination certificate. The original rabies vaccination certificate shall be given to the owner of
each dog or cat that receives rabies vaccine. One copy of the rabies vaccination certificate shall be retained by the
licensed veterinarian or the certified rabies vaccinator. The other copy shall be given to the county agency
responsible for animal control, provided the information given to the county agency shall not be used for
commercial purposes. (1935, c. 122, s. 6; 1941, c. 259, s. 5; 1959, c. 352; 1983, c. 891, s. 2; 1993, c. 245.)

§ 130A-190. Rabies vaccination tags.
(a) A licensed veterinarian or a certified rabies vaccinator who administers rabies vaccine to a dog or cat shall issue
a rabies vaccination tag to the owner of the animal. The rabies vaccination tag shall show the year issued, a
vaccination number, the words “North Carolina” or the initials “N.C.” and the words “rabies vaccine.” Dogs and
cats shall wear rabies vaccination tags at all times. However, cats may be exempted from wearing the tags by local
ordinance.
(b) Rabies vaccination tags, links and rivets may be obtained from the Department. The Secretary is authorized to
establish by rule a fee for the rabies tags, links and rivets. Except as otherwise authorized in this section, the fee
shall not exceed the actual cost of the rabies tags, links and rivets, plus transportation costs. The Secretary may
increase the fee beyond the actual cost plus transportation, by an amount not to exceed five cents ($.05) per tag, to
fund rabies education and prevention programs.
I The Department shall make available a special edition rabies tag to be known as the “I Care” tag. This tag shall be
different in shape from the standard tag and shall carry the inscription “I Care” in addition to the information
required by subsection (a) of this section. The Secretary is authorized to establish a fee for the “I Care” rabies tag
equal to the amount set forth in subsection (b) of this section plus an additional fifty cents ($.50). The additional
fifty cents ($.50) shall be credited to the Spay/Neuter Account established in G.S. 19A-62. (1935, c. 122, s. 6; 1941,
c. 259, s. 5; 1959, c. 352; 1983, c. 891, s. 2; 1997-69, s. 1; 2000-163, s. 2.)

§ 130A-191. Possession and distribution of rabies vaccine.
It shall be unlawful for persons other than licensed veterinarians, certified rabies vaccinators and persons engaged in
the distribution of rabies vaccine to possess rabies vaccine. Persons engaged in the distribution of vaccines may
distribute, sell and offer to sell rabies vaccine only to licensed veterinarians and certified rabies vaccinators. (1987,
c. 218.)

§ 130A-192. Dogs and cats not wearing required rabies vaccination tags.
The Animal Control Officer shall canvass the county to determine if there are any dogs or cats not wearing the
required rabies vaccination tag. If a dog or cat is found not wearing the required tag, the Animal Control Officer
shall check to see if the owner’s identification can be found on the animal. If the animal is wearing an owner
identification tag, or if the Animal Control Officer otherwise knows who the owner is, the Animal Control Officer
shall notify the owner in writing to have the animal vaccinated against rabies and to produce the required rabies
vaccination certificate to the Animal Control Officer within three days of the notification. If the animal is not
wearing an owner identification tag and the Animal Control Officer does not otherwise know who the owner is, the
Animal Control Officer may impound the animal. The duration of the impoundment of these animals shall be
established by the county board of commissioners, but the duration shall not be less than 72 hours. During the
impoundment period, the Animal Control Officer shall make a reasonable effort to locate the owner of the animal. If
the animal is not reclaimed by its owner during the impoundment period, the animal shall be disposed of in one of
the following manners: returned to the owner; adopted as a pet by a new owner; sold to institutions within this State
registered by the United States Department of Agriculture pursuant to the Federal Animal Welfare Act, as amended;
or put to death by a procedure approved by the American Veterinary Medical Association, the Humane Society of
the United States or of the American Humane Association. The Animal Control Officer shall maintain a record of all


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animals impounded under this section which shall include the date of impoundment, the length of impoundment, the
method of disposal of the animal and the name of the person or institution to whom any animal has been released.
(1935, c. 122, s. 8; 1983, c. 891, s. 2.)

§ 130A-193. Vaccination and confinement of dogs and cats brought into this State.
(a) A dog or cat brought into this State shall immediately be securely confined and shall be vaccinated against rabies
within one week after entry. The animal shall remain confined for two weeks after vaccination.
(b) The provisions of subsection (a) shall not apply to:
(1) A dog or cat brought into this State for exhibition purposes if the animal is confined and not permitted to run at
large; or
(2) A dog or cat brought into this State accompanied by a certificate issued by a licensed veterinarian showing that
the dog or cat is apparently free from and has not been exposed to rabies and that the dog or cat has received rabies
vaccine within the past year. (1935, c. 122, s. 11; 1983, c. 891, s. 2.)

§ 130A-194. Quarantine of districts infected with rabies.
An area may be declared under quarantine against rabies by the local health director when the disease exists to the
extent that the lives of persons are endangered. When quarantine is declared, each dog and cat in the area shall be
confined on the premises of the owner or in a veterinary hospital. However, dogs or cats on a leash or under the
control and in the sight of a responsible adult may be permitted to leave the premises of the owner or the veterinary
hospital. (1935, c. 122, s. 12; 1941, c. 259, s. 9; 1949, c. 645, s. 3; 1953, c. 876, s. 8; 1957, c. 1357, s. 8; 1983, c.
891, s. 2.)

§ 130A-195. Destroying stray dogs and cats in quarantine districts.
When quarantine has been declared and dogs and cats continue to run uncontrolled in the area, any peace officer or
Animal Control Officer shall have the right, after reasonable effort has been made to apprehend the animals, to
destroy the uncontrolled dogs and cats and properly dispose of their bodies. (1935, c. 122, s. 13; 1953, c. 876, s. 9;
1983, c. 891, s. 2.)

§ 130A-196. Confinement of all biting dogs and cats; notice to local health director; reports by physicians;
certain dogs exempt.
When a person has been bitten by a dog or cat, the person or parent, guardian or person standing in loco parentis of
the person, and the person owning the animal or in control or possession of the animal shall notify the local health
director immediately and give the name and address of the person bitten and the owner of the animal. All dogs and
cats that bite a person shall be immediately confined for 10 days in a place designated by the local health director.
However, the local health director may authorize a dog trained and used by a law enforcement agency to be released
from confinement to perform official duties upon submission of proof that the dog has been vaccinated for rabies in
compliance with this Part. After reviewing the circumstances of the particular case, the local health director may
allow the owner to confine the animal on the owner’s property. An owner who fails to confine his animal in
accordance with the instructions of the local health director shall be guilty of a Class 2 misdemeanor. If the owner or
the person who controls or possesses a dog or cat that has bitten a person refuses to confine the animal as required
by this section, the local health director may order seizure of the animal and its confinement for 10 days at the
expense of the owner. A physician who attends a person bitten by an animal known to be a potential carrier of rabies
shall report within 24 hours to the local health director the name, age and sex of that person. (1935, c. 122, s. 17;
1941, c. 259, s. 11; 1953, c. 876, s. 13; 1957, c. 1357, s. 9; 1977, c. 628; 1983, c. 891, s. 2; 1985, c. 674; 1989, c.
298; 1993, c. 539, s. 950; 1994, Ex. Sess., c. 24, s. 14(c).)

§ 130A-197. Infected dogs and cats to be destroyed; protection of vaccinated dogs and cats.
When the local health director reasonably suspects that a dog or cat has been exposed to the saliva or nervous tissue
of a proven rabid animal or animal reasonably suspected of having rabies that is not available for laboratory
diagnosis, the dog or cat shall be considered to have been exposed to rabies. A dog or cat exposed to rabies shall be
destroyed immediately by its owner, the county Animal Control Officer or a peace officer unless the dog or cat has
been vaccinated against rabies in accordance with this Part and the rules of the Commission more than three weeks
prior to being exposed, and is given a booster dose of rabies vaccine within three days of the exposure. As an
alternative to destruction, the dog or cat may be quarantined at a facility approved by the local health director for a


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period up to six months, and under reasonable conditions imposed by the local health director. (1935, c. 122, s. 14;
1953, c. 876, s. 10; 1983, c. 891, s. 2; 2000-163, s. 4.)

§ 130A-198. Confinement.
A person who owns or has possession of an animal which is suspected of having rabies shall immediately notify the
local health director or county Animal Control Officer and shall securely confine the animal in a place designated by
the local health director. Dogs and cats shall be confined for a period of 10 days. Other animals may be destroyed at
the discretion of the State Public Health Veterinarian. (1935, c. 122, s. 15; c. 344; 1941, c. 259, s. 10; 1953, c. 876,
s. 11; 1983, c. 891, s. 2.)

§ 130A-199. Rabid animals to be destroyed; heads to be sent to State Laboratory of Public Health.
An animal diagnosed as having rabies by a licensed veterinarian shall be destroyed and its head sent to the State
Laboratory of Public Health. The heads of all dogs and cats that die during the 10-day confinement period required
by G.S. 130A-196, shall be immediately sent to the State Laboratory of Public Health for rabies diagnosis. (1935, c.
122, s. 16; 1953, c. 876, s. 12; 1973, c. 476, s. 128; 1983, c. 891, s. 2.)

§ 130A-200. Confinement or leashing of vicious animals.
A local health director may declare an animal to be vicious and a menace to the public health when the animal has
attacked a person causing bodily harm without being teased, molested, provoked, beaten, tortured or otherwise
harmed. When an animal has been declared to be vicious and a menace to the public health, the local health director
shall order the animal to be confined to its owner’s property. However, the animal may be permitted to leave its
owner’s property when accompanied by a responsible adult and restrained on a leash. (1935, c. 122, s. 18; 1953, c.
876, s. 14; 1983, c. 891, s. 2.)

§ 130A-201. Rabies emergency.
A local health director in whose county or district rabies is found in the wild animal population as evidenced by a
positive diagnosis of rabies in the past year in any wild animal, except a bat, may petition the State Health Director
to declare a rabies emergency in the county or district. In determining whether a rabies emergency exists, the State
Health Director shall consult with the Public Health Veterinarian and the State Agriculture Veterinarian and may
consult with any other source of veterinary expertise the State Health Director deems advisable. Upon finding that a
rabies emergency exists in a county or district, the State Health Director shall petition the Executive Director of the
Wildlife Resources Commission to develop a plan pursuant to G.S. 113-291.2(a1) to reduce the threat of rabies
exposure to humans and domestic animals by foxes, raccoons, skunks, or bobcats in the county or district. Upon
determination by the State Health Director that the rabies emergency no longer exists for a county or district, the
State Health Director shall immediately notify the Executive Director of the Wildlife Resources Commission. (1997-
402, s. 1.)




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Definitions

Euthanasia: Humane killing of an animal

Exposure (to rabies): Any bite, scratch or other situation in which saliva or central nervous system (CNS) tissue of a
potentially rabid animal enters an open wound, fresh wound, or comes in contact with a mucous membrane by
entering the eye, mouth or nose.
    • Bite: wound from a tooth that penetrates the skin
    • Non bite: getting saliva or CNS tissue from a potentially rabid animal into an open wound or in the eyes
         nose or mouth

HRIG: Human Rabies Immune Globulin is anti-rabies immunoglobulins (antibodies) concentrated from the plasma
of persons who have been previously immunized against rabies. It is used in persons who have not previously been
vaccinated against rabies but have been exposed to rabies through an animal bite or other means. It functions to
effectively bind rabies virus at the site of inoculation prior to the virus entering nerve cells.

Incubation period (for rabies): The time between exposure to disease and the development of clinical signs or
symptoms of disease. This time period in domestic dogs and cats is not known to exceed 180 days, though is most
commonly 1 to 3 months in duration.

NASPHV: National Association of State Public Health Veterinarians

Post exposure prophylaxis, for persons not previously immunized against rabies: Deliver a total of five 1-mL doses
of RabAvert or Imovax IM in the deltoid, one each on day 0, 3, 7, 14, and 28. Additionally, on day 0 (at the latest,
day 7 after the first dose of vaccine) give 20 IU/kg body weight of HRIG. Inject as much of the full dose as is
anatomically feasible into and around the wound site. Inject any remaining HRIG IM at a site distal to vaccine
administration.

Post exposure prophylaxis, for persons previously immunized against rabies: Administer one 1-ml dose of
RabAvert or Imovax IM in the deltoid on day zero. Administer a second 1-ml dose on day three in the deltoid, IM.
Do not administer HRIG.

Pre Exposure vaccination for rabies: Three 1.0-mL injections of RabAvert or Imovax administered intramuscularly
(deltoid area) – one injection per day on days 0, 7, and 21 or 28. Per ACIP preexposure 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.

Previously vaccinated against rabies: A person who has completed either the rabies pre exposure vaccination series
or the post exposure prophylaxis series.

Shedding period (infectious stage): The time during which an animal excretes rabies in its saliva. During this time an
animal can transmit rabies to another animal or person. Viral shedding only occurs during the late stages of disease,
after the virus has affected the brain and shortly preceding death. In the domestic dog and cat the shedding period
has been established to not be longer than 10 days.

SLPH: State Laboratory of Public Health
   • Bath Building, 306 North Wilmington Street, Raleigh, North Carolina 27601
   • Phone Number: 919-733-7834

USDA: United States Department of Agriculture




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References
1. Badrane, Tordo. Host Switching in Lyssavirus History from the Chiroptera to the Carnivora Orders, Journal of
Virology, 2001;75(17)8096–8104

2. Characterization of a Unique Variant of Bat Rabies Virus Responsible for Newly Emerging Human Cases in
North America. Proc Natl Acad Sci USA, 1996;93:5653-5658

3. Bat Exclusion Guidelines from MN DNR. Accessed online 26 January 2007
http://www.dnr.state.mn.us/livingwith_wildlife/bats/exclusion.html

4. Human Rabies Prevention – United States, 1999: Recommendations of the Advisory Committee on Immunization
Practices. MMWR 1999; 48 (RR-1):1-21

5. Presutti. Prevention and Treatment of Dog Bites. American Family Physician 2001; 63:1567-72

6. Nicholson, et al. Pre exposure studies with purified chick embryo cell culture rabies vaccine and human diploid
cell vaccine: serologic and clinical responses in man. Vaccine, 1987;5:208-210

7. Rupprecht. Prophylaxis Against Rabies. NEJM, 2004;351:2626-2635

8. Wilde, et. al. Rabies Update for Travel Medicine Advisors. Clinical Infectious Diseases, 2003;37:96-100

9. Stantic-Pavlinic. Public Health Concerns in Bat Rabies Across Europe. Eurosurveillance, 2005;10(11)217-220

10. Compendium of Animal Rabies Prevention and Control, 2007. NASPHV. http://www.nasphv.org/

11. USDA requirements for rabies vaccine licensing; 9 CFR Ch. 1 Section 113.209

12. AVMA position statement. Accessed online 21 January 2007
http://www.avma.org/issues/policy/vaccination_wolf_hybrids.asp




            North Carolina Manual for Rabies Prevention and Animal Bite Management
                                           April 2007
                                                                                                                  22
                                                                                                      NC State Public Health Lab Number:
N.C. Department of Health and Human Services
State Laboratory of Public Health
Leslie Wolf, PhD, Director
306 N. Wilmington Street, P.O. Box 28047                                                              Date Received:
Raleigh, North Carolina 27611-8047                  Rabies Examination                                Date Reported:
Phone: (919) 733-7544 • Fax: (919) 715-7700
After Hours Beeper: (919) 310-5620                                                                             Condition Upon Receipt:

*See Reverse Side of Form for Instructions.                                                                 Š cold Š ambient Š frozen

  1    Send Report to:              EIN Number: __________________                2   Where was the animal found:

 Name: ___________________________________________________ County: __________________________________

 Street: ___________________________________________________ City: ______________State: ____ZIP:__________

 City: ________________________ State: ______ ZIP: _____________ Address: ________________________________

  3    Species of Animal: _____________________________________                   4   Date of Death: _________________________

       Breed/Color: _________________ Specimen ID#: ____________                      Date Shipped: _________________________


  5                                                        Signs of Disease:
 Š Animal was not known to have exhibited signs of disease
 Š Animal exhibited signs of rabies: Š convulsions Š unusually vicious Š unable to eat or drink Š excessive salivation
   Š Other _________________________________________________________________________________

 Š Wild animal showing abnormal behavior
 Š Bat found in home or occupied dwelling
 Š Other ___________________________________________________________________________________________

  6        Persons Exposed to This Animal & Nature of Exposure / Owner of Domestic Animals Exposed to this Animal
                      Name                                        Date of Exposure                    Type of Exposure

                                                                                         Š bite Š scratch Š handling
                                                                                         Š other _____________________________

                                                                                         Š bite Š scratch Š handling
                                                                                         Š other _____________________________

                                                                                         Š bite Š scratch Š handling
                                                                                         Š other _____________________________
       All positive and unsatisfactory results will be reported by telephone to the person listed below. Please list the name of the
       individual who will be responsible for arranging treatment of this/these patient(s) if this should be necessary. You MUST include
       telephone numbers with area code where this individual can be reached during working hours, after working hours and on weekends.
                                                                        Telephone # from 8 AM until 4 PM)         (       )
                                                                                                                 ______________________
  7                                                                                                               (       )
       Name __________________________________________________ Telephone # after 4 PM and on weekends ______________________
                                                                               (       )
                                                                        Fax # _______________________
       All negative results will be sent via courier or US mail to submitter

FLUORESCENT ANTIBODY TEST RESULTS                                          For State Laboratory Use Only

 Š Negative         Š Positive      Š Unsatisfactory     Š Decomposed Š Brain destroyed Š Test Not Performed
 Results telephoned: ______________________    _____________    _______________________________________         ________________________
                            date                   time                      reported to                                reported by

DHHS 1614 (Revised 1/07)
Laboratory Services (Review 7/09)
            Instructions for the Submission of Animal Heads and Bats for Rabies Testing

SUBMISSION OF SPECIMENS
   Domestic animals exhibiting signs of rabies and wild animals that have potentially exposed a person, household pet or
   livestock to rabies should be submitted. Dogs, cats and ferrets that do not exhibit signs of rabies and which bite people, pets
   or livestock should be confined and observed for 10 days unless circumstances demand otherwise. Dogs, cats and ferrets that
   survive the 10-day quarantine period should not be submitted to the rabies laboratory for testing. Surveillance animals will be
   tested with prior approval. Low risk animals (i.e., rabbits, opossums, squirrels and small rodents) rarely require testing and
   should not be submitted without prior approval. Prior approval of submission or risk management questions should be directed
   to Dr. Carl Williams, Occupational and Environmental Epidemiology Branch at (919) 707-5900. The beeper number for
   emergency questions after 5 PM weekdays or during holidays or weekends is (919) 733-3419. Questions or comments regarding
   rabies testing at the State Laboratory of Public Health (SLPH) should be directed to Virology/Serology Unit at (919) 733-7544.

     Brain tissue is examined in the diagnosis of rabies; therefore, only the animal’s head should be submitted for diagnostic
     purposes. Small animals no larger than a squirrel may be submitted whole. For bats, the entire dead animal must be submitted.
     Animals should be euthanized in a manner that will not destroy the brain. The animal’s neck should then be severed at the
     mid-point between the base of the skull and the shoulders. Immediately submit the specimen to SLPH by the most rapid means
     possible. If shipment will be delayed, refrigerate specimen prior to shipment.

COMPLETION OF FORM
   Fully complete Sections 1 through 7 of the submission form, DHHS 1614. Seal the form in a separate plastic bag and enclose
   with the specimen. Complete one form per specimen that is submitted. The form is available from the Laboratory Mailroom,
   (919) 733-7656, or on the Internet at http://slph.state.nc.us/Forms.asp

PACKAGING OF SPECIMENS
   Treat any specimens for fleas, ticks, maggots, &/or ants prior to packing. Place each specimen in a separate leak-proof bag
   (ziplock bag, secured plastic bag, etc.) with absorbent material. Place specimen into a secondary container (ziplock bag,
   secured plastic bag, etc.) and securely seal. Place Biohazard sticker on secondary container. Place the secondary container into a
   thick-walled Styrofoam container with or without an exterior fiberboard liner and enclose refrigerants to keep the specimen cold
   then tightly seal. Specimens should be kept cold but NOT FROZEN. Do not use loose wet ice or dry ice. Specimens that are
   inadvertently frozen are suitable for testing; however, testing may be delayed due to thawing. Specimens fixed in formalin
   cannot be tested and will be reported as unsatisfactory.

SHIPMENT OF SPECIMENS
    Shipment via State Courier Service is usually the most rapid mode of transport. Bus transportation may be used when courier
    service is unavailable however, this service has been found to be unreliable at times. Shipment via FedEx or UPS is possible
    but not recommended due to laboratory hours of operation. Address all shipping containers using the special label (white
    with red lettering) available from the Laboratory mailing room. This label instructs the transporting service to call the
    Laboratory upon arrival and will assure proper handling of the specimen.

PERSONAL DELIVERY OF SPECIMENS
   Specimens may be brought to the Bath Building, 306 N. Wilmington Street, Raleigh, during working hours (8 AM until 5 PM)
   Monday through Friday. At all other times, specimens should be placed in the specimen drop chute at the back of the building.

LABORATORY TESTING
   Testing is available Monday through Friday (7:30 AM to 4 PM) and Saturday (8 AM to noon) under some circumstances. In
   the event of a three-day weekend, testing may be performed on Sunday rather than Saturday. The testing schedule may be
   adjusted for other holidays as well. Contact the Laboratory for schedule if interested.

INTERPRETATION OF RESULTS
    The laboratory staff will telephone test results for any animal positive for rabies or any unsatisfactory test result automatically to
    the appropriate parties at the numbers listed on the completed form. Negative results will be reported via US Mail or the State
    Courier System. It should be noted that although the fluorescent antibody test is very reliable, a negative test does not
    completely exclude the possibility of the animal being rabid.

EMERGENCY PHONE NUMBERS
   Laboratory Results: (919) 733-7544 Virology/Serology Branch
   Ordering forms or labels: (919) 733-7656 SLPH Mail Room
   Ordering rabies vaccine for people: (919) 707-5900 Dr. Carl Williams
   Prior approval or patient management: (919) 707-5900 Dr. Carl Williams
   Patient management (after hours): (919) 733-3419 nights, weekends & holidays
   Night, weekend, holiday laboratory contact: (919) 310-5620 (Beeper)
                            Request for Free Rabies Vaccine
                                               CONDITIONS
In accordance with 15A NCAC .0006 rabies vaccine may be provided without charge for an
individual who meets ALL of the following criteria:

(1)     the individual's family income is at or below the federal poverty level in effect on July 1 of
        each fiscal year as determined by the local health department;

(2)     the individual meets the residency and other requirements set forth in 15A NCAC 24A
        .0200, except that the individual shall not be eligible for Medicaid or health insurance
        reimbursement for rabies post-exposure treatment as determined by the local health
        department; and

(3)     the treatment is recommended by a physician licensed to practice medicine.

                                               AFFIDAVIT

On behalf of                          (patient name), who meets ALL OF THE ABOVE
CRITERIA, I am requesting post-exposure rabies vaccine to be provided without charge.

Date of Treatment

County of Residence

Health Director or Attending Physician

NOTARY PUBLIC CERTIFICATION: State of                            County of

I, as a Notary Public of the said State and County, do hereby certify that

                  personally appeared before me and executed the foregoing instrument.

Witness my hand and seal this         day of                            , 200

Signature of Notary

My commission expires




                                       Please complete and return to:

                             State Laboratory of Public Health
                        N C Department of Health and Human Services
                                 1918 Mail Service Center
                            Raleigh, North Carolina 27699-1918

				
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