Part I: Recommendations for Immunization Procedures

The purpose of these recommendations is to provide information on rabies vaccines to practicing veterinarians, public health officials, and others concerned with rabies control. This document will serve as the basis for animal rabies vaccination programs throughout the United States. Its adoption will result in standardization of procedures among jurisdictions which is necessary for an effective national rabies control program. These recommendations are reviewed and revised as necessary prior to the beginning of each calendar year. All animal rabies vaccines licensed by the U.S. Department of Agriculture and marketed in the United States are listed in Part II of the Compendium, and Part III describes the principles of rabies control.

1. VACCINE ADMINISTRATION It is recommended that all animal rabies vaccines be restricted to use by or under the supervision of a veterinarian.

2. VACCINE SELECTION In comprehensive rabies control programs, it is recommended that only vaccines with 3-year duration of immunity be used. This eliminates the need for annual vaccination and constitutes the most effective method of increasing the proportion of immunized dogs and cats. (See Part II)

3. ROUTE OF INOCULATION Unless otherwise specified by the product label or package insert, all vaccines must be administered intramuscularly at one site in the thigh.

4. WILDLIFE VACCINATION Vaccination is not recommended since no rabies vaccine is licensed for use in wild animals and since there is no evidence that any vaccine will protect wild animals against rabies. It is recommended that neither wild nor exotic animals be kept as pets. Offspring borne to wild animals bred with domestic dogs or cats will be considered as wild animals.

5. ACCIDENTAL HUMAN EXPOSURE TO VACCINE Accidental inoculation may occur in individuals during administration of animal rabies vaccine. Such exposure to inactivated vaccines constitutes no known rabies hazard. There have been no cases of rabies resulting from needle or other exposure to a licensed modified live virus vaccine in the United States.

6. IDENTIFICATION OF VACCINATED DOGS It is recommended that all agencies and veterinarians adopt the standard tag system. This will aid the administration of local, state, national, and international procedures. Dog license tags should not conflict in shape and color with rabies tags. It is recommended that anodized aluminum rabies tags should not be less than 0.064 inches in thickness.

1. Rabies Tags.

2. Rabies Certificate. All agencies and veterinarians should use the National Association of State Public Health Veterinarians (NASPHV) form #50 Rabies Vaccination Certificate, which can be obtained from vaccine manufacturers.

   ***********************************

   Part II: Vaccines Marketed in the United States

   and NASPHV Recommendations

   LARGE TABLE

   ***********************************

   Part III: Principles of Rabies Control

   These guidelines have been prepared by the NASPHV for use by government

officials, practicing veterinarians, and others who may become involved in certain aspects of rabies control. It is intended that the NASPHV will annually review and revise these recommendations as necessary. Standardized control procedures are needed to deal effectively with the public health aspects of rabies.

7. PRINCIPLES OF RABIES CONTROL

1. Human Rabies Prevention. Rabies in humans can be prevented either by eliminating exposures to rabid animals or in exposed persons by prompt local wound treatment combined with appropriate passive and active immunization. The rationale for recommending pre-exposure and post-exposure rabies prophylaxis and details of their adminis- tration can be found in the current recommendations of the Immuni- zation Practices Advisory Committee (ACIP), of the U.S. Public Health Service (USPHS) (1,2). These recommendations, along with information concerning the current local and regional status of animal rabies and the availability of human rabies biologics, are available from state health departments.

2. Domestic Animals. Local governments should initiate and maintain effective programs to remove stray and unwanted animals and ensure vaccination of all dogs and cats. Since cat rabies cases now exceed the annually reported cases in dogs, immunization of cats should be required. Such procedures in the United States have reduced labor- atory confirmed rabies cases in dogs from 6,949 in 1947 to 113 in 1985. The recommended vaccination procedures and the licensed animal vaccines are specified in Parts I and II of the NASPHV's annually released compendium.

3. Rabies in Wildlife. The control of rabies in foxes, skunks, raccoons, and other terrestrial animals is very difficult. Selective reduction of these populations when indicated may be useful, but the utility of this procedure depends heavily upon the circumstances surrounding each rabies outbreak. (See C. Control Methods in Wild Animals.)

8. CONTROL METHODS IN DOMESTIC AND CONFINED ANIMALS

1. Pre-exposure Vaccination and Management. Animal rabies vaccines should be administered only by or under the direct supervision of a veterinarian. This is the only way to assure the public that the animal has been properly immunized. Within 1 month after vaccin- ation, a peak rabies antibody titer is reached and the animal can be considered to be immunized. (See Parts I and II of the compendium for recommended vaccines and procedures.)

1. Dogs and Cats. All dogs and cats should be vaccinated against rabies commencing at 3 months of age and revaccinated in accordance with Part II of this Compendium.

2. Livestock. It is not economically feasible, nor is it justified from a public health standpoint, to vaccinate all livestock against rabies. Owners of valuable animals and veterinary clinicians may consider immunizing certain livestock located in areas where wildlife rabies is epizootic and where colonies of bats exist.

3. Other Animals. (1) Animals Maintained in Exhibits and in Zoological Parks.

   Captive animals not completely excluded from all contact with local vectors of rabies can become infected with rabies. Moreover, such animals may be incubating rabies when captured. Exhibit animals, especially those carnivores and omnivores having contact with the viewing public, should be quarantined for a minimum of 180 days. Since there is no rabies vaccine licensed for use in wild animals, vaccination even with inactivated vaccine is not recommended. Pre-exposure rabies immunization of animal workers at such facilities is recommended. This may reduce the need for euthanasia of valuable animals for rabies testing after they have bitten a handler. (2) Wild Animals. Because of the existing risk of rabies in

   wild animals (especially raccoons, skunks, and foxes), the American Veterinary Medical Association, the NASPHV, and the Conference of State and Territorial Epidemiologists strongly recommend the enactment of state laws prohibiting the importation, distribution, and relocation of wild animals and wild animals crossbred to domestic dogs and cats. These same organizations continue to recommend the enactment of laws prohibiting the distribution or keeping of wild animals as pets. Moreover, the NASPHV recommends that ferrets not be kept at pets, since they have severely bitten many people, especially inflicting mutilating bites to infants. Ferrets are susceptible to and could transmit rabies. There is no licensed rabies vaccine for use in ferrets.

2. Stray-Animal Control. Stray dogs or cats should be removed from the community, especially in rabies epizootic areas. Local health department and animal control officials can enforce the pick-up of strays more efficiently if owned animals are confined or kept on leash. Strays should be impounded for at least 3 days to give owners sufficient time to reclaim animals apprehended as strays and to determine if human exposure has occurred.

3. Quarantine.

1. International. Present USPHS regulations (42 CFR No. 71.51) governing the importation of domestic felines and canines are minimal for preventing the introduction of rabid animals into the United States. All dogs and cats imported from countries with endemic rabies should be vaccinated against rabies at least 30 days prior to entry into the United States. ** The Centers for Disease Control (CDC) is responsible for these animals imported into the United States. Their requirements should be coordinated with interstate shipment requirements. The health authority of the state of destination should be notified within 72 hours of any animal conditionally admitted into its jurisdiction.

   The conditional admission into the United States of such animals must be subject to state and local laws governing rabies. Failure to comply with these requirements should be promptly reported to the director of the CDC.

2. Interstate. Prior to interstate shipment, dogs and cats should be vaccinated against rabies according to the compendium's recommendations and preferably shall be vaccinated at least 30 days prior to shipment. While in shipment, they should be accompanied by a currently valid NASPHV Form #50 Rabies Vaccination Certificate. One copy of the certificate should be mailed to the appropriate Public Health Veterinarian or State Veterinarian of the state of destination.

3. Health Certificates. If a certificate is required for dogs and cats in transit, it must not replace the NASPHV rabies vaccin- ation certificate.

4. Adjunct Procedures. Methods or procedures which enhance rabies control include:

1. Licensure. Registration or licensure of all dogs and cats may be used as a means of rabies control by controlling the stray animal population. Frequently a fee is charged for such licensure and revenues collected are used to maintain a rabies or animal control program. Vaccination is usually recommended as a prerequisite to licensure.

2. Canvassing of Area. This includes house-to-house calls by members of the animal control program to enforce vaccination and licensure requirements.

3. Citations. These are legal summonses issued to owners for violations including the failure to vaccinate or license their animals.

4. Leash Laws. All communities should adopt leash laws which can be incorporated in their animal control ordinances.

5. Post-exposure Management. ANY DOMESTIC ANIMAL THAT IS BITTEN OR SCRATCHED BY A BAT OR BY A WILD, CARNIVOROUS MAMMAL WHICH IS NOT AVAILABLE FOR TESTING SHOULD BE REGARDED AS HAVING BEEN EXPOSED TO A RABID ANIMAL.

1. Dogs and Cats. When bitten by a rabid animal, unvaccinated dogs and cats should be destroyed immediately. If the owner is unwilling to have this done, the unvaccinated animal should be placed in strict isolation for 6 months and vaccinated 1 month before being released. Dogs and cats that are currently vaccinated should be revaccinated immediately and observed by the owner for 90 days.

2. Livestock. All species of livestock are susceptible to rabies infection; cattle appear to be among the most susceptible of all domestic animal species. Livestock known to have been bitten by rabid animals should be destroyed (slaughtered) immediately. If the owner is unwilling to have this done, the animal should be kept under very close observation for 6 months.

   The following are recommendations for owners of livestock exposed to rabid animals: (1) If slaughtered within 7 days of being bitten, tissues may

   be eaten without risk of infection providing liberal portions of the exposed area are discarded. Federal meat inspectors will reject for slaughter any animal that has been exposed to rabies within 8 months. (2) No tissues or secretions from a clinically rabid animal

   should be used for human or animal consumption. However, as pasteurization temperatures will inactivate rabies virus, the drinking of pasteurized milk or eating of completely cooked meat does not constitute a rabies exposure.

6. Management of Animals That Bite Humans. A healthy dog or cat that bites a person should he confined and observed for 10 days and evaluated by a veterinarian at the first sign of illness during confinement or before release. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be humanely killed and its head removed and shipped, under refrigeration, for examin- ation by a qualified laboratory designated by the local or state health department. Any stray or unwanted dog or cat that bites a person may be killed immediately and the head submitted, as described above, for rabies examination.

9. CONTROL METHODS IN WILD ANIMALS Bats and wild carnivorous mammals, as well as wild animals cross-bred with domestic dogs and cats, that bite people should be killed and appropriate tissues should be sent to the laboratory for examination for rabies. A person bitten by a bat or any wild animal should immedi- ately report the incident to a physician who can evaluate the need for anti-rabies treatment. (See current rabies prophylaxis recommendations of the ACIP {1,2}).

1. Terrestrial Mammals. Continuous and persistent government-funded programs for trapping or poisoning wildlife as a means of rabies control are not cost effective in reducing wildlife reservoirs or rabies incidence on a statewide basis. However, limited control in high-contact areas (picnic grounds, camps, suburban areas) may be indicated for the removal of selected high-risk species of wild animals. The public should be warned not to handle wild animals. The state wildlife agency should be consulted early to manage any elimination programs in coordination with the state health department.

2. Bats. Rabid bats have been reported from every state except Hawaii and have caused human rabies infections in the United States. It is neither feasible nor practical, however, to control rabies in bats by areawide bat population reduction programs. Bats should be eliminated from houses and surrounding structures to prevent direct association with people. Such structures should then be made bat proof by sealing routes of entrance with screen or other means.

References

1. ACIP. Rabies prevention -- United States, 1984. MMWR 1984;33:393-402, 407-8.

2. ACIP. Rabies prevention: supplementary statement on the preexposure use of human diploid cell rabies vaccine by the intradermal route. MMWR 1986;35:767-8.

10. THE NASPHV COMPENDIUM COMMITTEE: Melvin K. Abelseth, DVM, PhD, Chairman; Russell W. Currier, DVM, MPH; John I. Freeman, DVM, MPH; Russell J. Martin, DVM, MPH; Grayson B. Miller, Jr, MD; James M. Shuler, DVM, MPH; R. Keith Sikes, DVM, MPH. CONSULTANTS TO THE COMMITTEE: George Baer, DVM, CDC, PHS, HHS; Kenneth L. Crawford, DVM, MPH; David A. Espeseth, DVM, Veterinary Biologics Staff, APHIS, USDA; Suzanne Jenkins, VMD, MPH; Howard Koonse, Representative, Veterinary Biologics Section, Animal Health Institute; Paul Waters, Representative, Veterinary Biologics Section, Animal Health Institute. ENDORSED BY: Council of State and Territorial Epidemiologists; AVMA Council on Public Health and Regulatory Veterinary Medicine.

** In regard to cats, these recommendations do not conform to the official recommendations of CDC and the U.S. Public Health Service. Although domestic feline rabies has increased, there has been no evidence of increased risk of imported rabies in cats. U.S. Foreign Quarantine regula- tions do not require rabies vaccinations for imported cats.

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