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Epidemiology of Rabies
John R. Dunn, DVM, PhD Communicable and Environmental Diseases Tennessee Department of Health Centers for Disease Control and Prevention
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Overview Rabies virus Rabies epidemiology in the US and Tennessee
Skunk rabies Raccoon rabies and ORV Guidance documents ACIP: Pre-exposure vaccination Compendium
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Rabies virus- Lyssavirus
Rhabdoviridae- “bullet” shaped RNA virus Neurotropic, fatal encephalitis Variants- host adapted
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Transmission Transmission: BITE of a RABID animal
Virus-laden saliva contacts nerves Saliva in fresh cut or abrasion, mucous membranes (scratch?-- no) Person to person: theoretical risk, never documented in health care worker
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Rabies Epidemiology in the United States
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Human rabies in US: 2 – 5 cases / year
Tennessee case 2002 PEP: 100% effective ~ 40,000 treatments/ year $2000 – 6,000 / treatment ~ 75% unnecessary based on rabies risk Animal rabies: 7,000 – 8,000 cases / year (wildlife) 4 variants: raccoon, skunk, bat, fox Canine variant no longer enzootic in US
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Terrestrial Wildlife Rabies
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Bat Rabies
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Bat-associated Rabies
U.S.- majority of human rabies caused by bats From , 26/35 (74%) cases Silver-haired/Eastern pipistrelle bat Minor wound from bat bite Difficult to detect Persons may not recognize exposure Most human rabies diagnosed post-mortem Not on differential Healthcare workers exposed
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Rabies Epidemiology in Tennessee
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Rabies Testing by the Tennessee Department of Health (TDH)
Three testing centers Nashville Knoxville Jackson Rabies Diagnosis: Direct Fluorescent Antibody testing (DFA) of brain tissue Testing performed free of charge Not much attention paid to number and characteristics of negative results
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Results from 2005 Review of laboratory slips from 3 testing centers in 2005 2017 animal submissions 2010 submitted to testing centers in TN 92 (96%) of 95 counties 362 different localities 18 out-of-state 7 additional specimens from USDA-WS surveillance program (submitted to CDC)
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* *N=4: Cat 2001 (1), 2003 (1); Cow 2002 (1); Opossum 2004 (1)
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TN Rabies Positives (n=48) by County, 2005
Pickett Hancock Sullivan Stewart Montgomery Robertson Sumner S - 1 Macon Clay Claiborne Johnson S - 1 Scott Hawkins Fentress Campbell B - 1 Washington R-1, S-1 Lake Trousdale Obion Weakley Henry Jackson Carter R - 2 Overton Houston Union Grainger Cheatham Smith Hamblen Greene S – 1 D - 1 Unicoi F – 1 R-1 Dickson Davidson B - 2 Wilson S - 1 Putnam B - 1 Morgan Knox B – 4 F-1 Dyer Jefferson Gibson Carroll Humphreys Dekalb Cumberland Cocke S - 2 Benton Williamson S - 4 Rutherford S – 5 H - 1 White Crockett Roane Hickman Sevier Lauderdale Cannon B - 1 Van Buren Henderson Loudon Blount Perry Warren Haywood Madison Maury B - 1 Tipton Decatur Lewis F - 1 Rhea Bedford S - 2 Coffee S-1 Bledsoe Chester Monroe B - 1 Marshall Meigs Grundy McMinn Sequatchie Moore Shelby B - 2 Fayette Hardeman Giles S - 1 Hamilton B– 2 S - 1 McNairy Hardin Wayne Lawrence Lincoln S - 2 Franklin Marion B - 1 Bradley Polk Bat Horse---- 1 Skunk Fox Raccoon Dog
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TN Rabies Positives (n=26) by County, 15 April 2006
Pickett Hancock Sullivan Stewart Montgomery Robertson Sumner Macon Clay Claiborne Johnson Scott Hawkins Fentress Campbell Washington Lake Trousdale Obion Weakley Henry Jackson Carter Overton Houston Union Grainger Cheatham Smith Hamblen Greene Unicoi C – 1 Dickson Davidson S - 2 Wilson Putnam Morgan Dyer Jefferson S-1 Gibson Carroll Humphreys Knox Dekalb Cumberland Cocke Benton Williamson S - 4 White Crockett Rutherford S – 10 Roane Hickman Sevier Lauderdale Cannon Van Buren Henderson Loudon Blount Perry Warren S-1 Haywood Madison Maury Tipton Decatur Lewis Rhea Bedford D - 1 Coffee Bledsoe Chester Monroe Marshall Meigs Grundy McMinn Sequatchie Moore S-3 Shelby Fayette Hardeman Giles Hamilton McNairy Hardin Wayne Lawrence Lincoln S - 1 Franklin Marion Bradley F-1 Polk Skunk Fox (Racc Var) Cat (Racc Var) Dog - 1 (Sk Var)
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Raccoon variant
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East TN counties with raccoon variant rabies, 2002-Apr 15, 2006
Pickett Hancock Sullivan Claiborne Scott Hawkins Johnson Fentress Campbell Washington Carter Overton Union Grainger Greene Hamblen Putnam Morgan Anderson Unicoi Jefferson Knox Dekalb Cumberland Cocke White Roane Sevier Van Buren Loudon Blount Warren Rhea Bledsoe Monroe Sequatchie McMinn Grundy Meigs Marion Hamilton Bradley Polk
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Why is raccoon rabies problematic?
Raccoons thrive in suburban settings Aggressive and swift Increase in dog and cat (2X) rabies Increase in other rabid species (foxes, groundhogs, livestock, etc.) Increase in human exposures and need for PEP risk assessment Increased animal control calls & anxiety
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Tennessee response to raccoon rabies
Education Reducing risk Protecting pets through vaccination Increase surveillance USDA-Wildlife Services (> 20 East TN counties) Oral rabies vaccination (ORV) campaign Appalachian Ridge baiting GAT baiting
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Anticipated ORV Barrier Zone for Raccoon Rabies in the United States
2004 cases Proposed ORV
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ORV in Tennessee, 2005 Appalachain Ridge GAT
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Guidance documents
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Imovax® (Sanofi Pasteur)
Previously used off-label, 0.1ml intradermal for pre-exposure vaccination TDH no longer advocating use of Imovax off-label consistent with new ACIP recommendations Important for state, regional and local HD to promote rabies vaccination for at-risk persons
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Questions? John Dunn Tennessee Department of Health Communicable and Environmental Diseases 4th Floor, Cordell Hull Building 425 5th Avenue North Nashville, TN
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