This document summarizes a rabies forum held in Jefferson County, Colorado on October 9, 2014. It discusses rabies concerns in Colorado and Jefferson County, including recent case data showing increasing cases in bats and skunks. Prevention strategies are covered, including vaccinating pets, avoiding contact with wildlife, and quarantining or observing animals after exposures. Quarantine requirements differ based on the animal's vaccination status and type of exposure. The forum aims to educate public health practitioners and veterinarians on rabies transmission and prevention.

1. October 9, 2014
6:30 – 8:00 pm
Jefferson County Public Health
Mount Bierstadt Room

2.  Rabies in Colorado
◦ Public Health Concerns for Practitioners
◦ Colorado Rabies data
 Rabies in Jefferson County
◦ Jefferson County Data
 Prevention and Public Education
◦ Protecting Clinic Staff
 Cat Vaccination Proposal
 Veterinarian Electronic Vaccination Reporting
proposal

3. October 9, 2014
Jennifer House, DVM, MPH, DACVPM
State Public Health Veterinarian
Colorado Department of Public Health
and Environment
303-692-2628
jennifer.house@state.co.us

4.  An infectious disease (virus) of the central
nervous system that may affect any mammal.

7.  ~ 1% of bats carry rabies virus
 May or may NOT show symptoms
 Bites don’t always leave visible marks
 Most exposure occur when bats enter
human living quarters

8.  Bites from bats might not be noticed
 Examining a person for a bite is not reliable
 Any direct contact between a bat and a
human or domestic pet should be
considered a possible rabies exposure

9. courtesy of Nebraska
Department of Health and
Human Services

11.  Bite to a human
 Direct contact with human or pet
◦ Do NOT tell pet owner to release bat
 Proximity exposures

12. Low risk animals
 Not usually considered
rabies exposures
 Treatment or testing is
not normally necessary
 Evaluate for unusual
circumstances that may
indicate possible rabies

13. 0
20
40
60
80
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
CaseCount
Year
Bats
Skunks
Other Wildlife
Domestic

14. 2007-2008 2009
2010 2011

19. Rabies Forum
October 9, 2014
Jefferson County Public Health
David Volkel
dvolkel@jeffco.us
303-271-5730

20. RABIES

21. Human Rabies in the US (CDC)
2011 - 4 (1 survivor, Bat, Dog Haiti,
Dog Afghanistan)
2010 - 2 (Vampire Bat/Mexico, Bat/US)
2009 - 4 (1 survivor, 3 Bats, India dog)
2008 - 2 (Bat, Mexico Fox)
2007 - 1 (Bat)
2006 - 3 (2 Bats & Philippines dog)
2005 - 1 (Bat)
2004 - 8 (1 survivor, bat bite, donor and
3 from Transplants)
2003 - 3 (Dog & Bat & Unknown)
2002 - 3 (Bats)
2001 - 1 (Philippines dog)
2000 - 5 (4 Bats, Africa dog)
1999 - 0
1998 - 1 (Bat)
Over half cases from 1980 are from bats
Rabid bats-all states except Hawaii

22. Human Exposure to Rabies
in the US
WHO
• Estimated that 40,000 people a year have
contact with potentially rabid animals and
receive rabies PEP
• Rabies PEP is a medical urgency, not a
medical emergency, but decisions must
not be delayed

23. Animal Rabies in the US (CDC 2010)
• 5,666 cases in wild animals
• 92% of all reported cases - wild animals
• 8% domestic animals
• (303 cats, 71 cattle, 69 dogs)
• Raccoons (36.5%), Bats (23.2%), Skunks (23.5%), Foxes (7%),
others including rodents and lagomorphs (2%)

24. Rabies in the USA (CDC 2008)

25. Rabies in Colorado by
Species and Year (CDPHE)
• Bats Every year (most counties)
• Skunk 2014 (Adams, Arapahoe, Boulder, Elbert,
• Larimer, Pueblo, Weld)
• Cat 2014 Yuma
• Cat 2013 (Larimer, Logan, Washington,
Weld)
• Cat 2012 (Cheyenne)
• Cat 2008 (Cheyenne) last in Co was 1985
• Dog 2003 (Morgan County) (Texas)
• Human 1931 (El Paso County)
• Due the reemergence of skunk rabies in 2008 there have been
rabies cases in
– Horse, Cow, Mountain Lion, Fox, Raccoon, Bison, & Coyote

26. 2014 Skunk Rabies (9/19/14)
1
9
3
1
1
1
6
1

27. Rabies Tests
Jefferson County (10/3/2014)
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total 69 50 70 70 133 90 60 79 107 102 141 147 137
DOMESTIC
Total 29 32 38 28 42 42 22 30 38 30 39 46 27
WILD
Bats
POS
24
5
13
1
17
2
26
3
79
17
36
1
24
5
34
2
44
5
46
9
63
11
55
7
82
11
Total 40 18 32 42 91 48 38 49 69 72 102 101 110

28. Wildlife/Pet Interaction
Bites, puncture wounds, blood, saliva, direct physical contact, in
pets mouth. Test wildlife or confine the pet
– Current vaccination: re-vaccinate now & home observation for 45
days
– Expired (with 2 in the past) re-vaccinate at 0 and in 30 days with
a 90 home quarantine
– No vaccination – High Risk: euthanasia recommended if owner
unwilling the animal must be placed in 90 day quarantine at a
secure facility and then 90 days at home with vaccinations at 0,
21, and 60 days. ~ $20.00 a night for secure facility.

29. Observations & Quarantines
(2010-2014)
Currently Vaccinated
45 day observation
(41)
Expired Vaccination
90 day quarantine
(31)
High Risk
180 day quarantine
(31)
Cat Dog Cat Dog Cat Dog
Bat Wild Bat Wild Bat Wild Bat Wild Bat Wild Bat Wild
2010 1 1 3
2011 1 3 1 1 2 3
2012 2 5 2 1 1 1 3 1 1 3
2013 9 4 1 1 5 2 3 1
2014 2 1 1 8 9 2 8 4 1 2 3
14 1 13 13 1 15 3 12 12 4 3 12
Total Bats 46 Cats/Bats 27 Dogs/Bats 19
Total Wild 57 Cats/Wild 20 Dogs/Wild 37

30. Wildlife/Pet Interaction (2010-2014)
• Current Vaccination
– Cats 15 (14 bats/1 wild animals)
– Dogs 26 (13 bats/13 wild animals)
• Expired Vaccination
– Cats 16 (1 bat/15 wild animals)
– Dogs 15 (3 bats/12 wild animals)
• High Risk
– Cats 16 (12 bats/4 wild animals)
– Dogs 15 (3 bats/12 wild animals)

31. State Legislation Requiring Rabies
Vaccination of Cats and Dogs (CDC, 2009)

32. Prevent Rabies In Animals
• Vet exams of pets on a regular basis
• Vaccinations up-to-date for all domestic pets and
valuable livestock
• Keep cats and ferrets indoors and keep dogs
under direct supervision
• Spay or neuter reduces unwanted pets that are
not vaccinated regularly
• Animal control will remove all stray animals as
these animals may be unvaccinated or ill

34.  10 day bite Quarantine
◦ When do you use this one?
 6 month exposure Quarantine
◦ What about this one?
 What is the difference?
 Why is there a difference?
 Does it really matter?

35. Rabies In Dogs
Exposure
Incubation
Period
7 - 125 days
Prodromal
period
1-3 days
excited
phase
1-7 days
Paralytic
phase
2-5 days
Death
More affectionate
Shy and seek seclusion
Snappy and irritable
Very agitated
Roam
Bite anything
Drooling
Paralysis of masseter
muscles
Drooling (foaming)
Dogs shed rabies virus during this time
No more than 4-7 days prior to symptoms

37.  Normal is 3-12 weeks
 Range may be 9 days to 7 years
 ***Long incubation period allows time
to wait for treatment in certain
situations

38. Rabies Prevention Guidance
• Human Rabies Prevention-United States,
2008 Recommendations of Practices
(ACIP)
– MMWR: May 23, 2008 / 57 (RR-03);1 – 28
– MMWR Update: March 19, 2010 / 59(02);1-9
• Animal : Compendium of Animal Rabies
Prevention and Control, 2011 (NASPHV)
– http://www.nasphv.org/Documents/RabiesCompendium.pdf
38

39.  3 doses of vaccine
◦ Day 0, 7, and 21 (or 28)
 Need booster doses after exposure
◦ No RIG!
◦ Day 0
◦ Day 3
~ cost is $220-260/vaccine

40.  Effective if given after exposure
 Anytime before symptoms develop
 Can be shipped to HCP overnight
(manufacturer)
 Expensive!

41.  Given once (day 0)
 Immediate, passive antibodies
 Weight based (20 IU/kg)
 Given at the site of bite
 If no known bite or bite area is too
small for full dose—give in a large
muscle group

42.  Small dose
 Given in muscle (arm)
 4 doses over 2 weeks
◦ Day 0 (with RIG)
◦ Day 3
◦ Day 7
◦ Day 14
Day 0 is the date when the 1st vaccine was given
NOT when the exposure occurred

43.  Colorado Rabies Task Force, 2012
 How to Guide
 https://www.colorado.gov/pacific/cdphe/rabies

44. Jennifer House
State Public Health Veterinarian
Colorado Department of Public Health and
Environment
303-692-2628
jennifer.house@state.co.us

46.  Jefferson County Board of Health
Support for Ordinance Changes
 Jefferson County Board of County
Commissioners Animal Control
Ordinance Change Public Hearing
 Letters of Support:
Jim Rada, Director
Jefferson County Public Health
Environmental Health Services Division
645 Parfet Street
Lakewood, CO 80215
jrada@jeffco.us

48. 0
5
10
15
20
25
30
35
40
Domestic
Wildlife, non-
skunk

49. 0
5
10
15
20
25
30
35
Other Wildlife
Domestic
Bat
Skunk