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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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Presentation on theme: "Epidemiology of Rabies John R. Dunn, DVM, PhD Communicable and Environmental Diseases Tennessee Department of Health Centers for Disease Control and Prevention."— Presentation transcript:

1 Epidemiology of Rabies John R. Dunn, DVM, PhD Communicable and Environmental Diseases Tennessee Department of Health Centers for Disease Control and Prevention

2 Overview Rabies virus Rabies epidemiology in the US and Tennessee –Skunk rabies –Raccoon rabies and ORV Guidance documents –ACIP: Pre-exposure vaccination –Compendium

3 Rabies virus- Lyssavirus Rhabdoviridae- bullet shaped RNA virus Neurotropic, fatal encephalitis Variants- host adapted

4 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

5 Rabies Epidemiology in the United States

6 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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11 Terrestrial Wildlife Rabies

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15 Bat Rabies

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17 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

18 Rabies Epidemiology in Tennessee

19 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

20 Results from 2005 Review of laboratory slips from 3 testing centers in 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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23 * *N=4: Cat 2001 (1), 2003 (1); Cow 2002 (1); Opossum 2004 (1)

24 Unicoi F – 1 R-1 Lake Obion Dyer Lauderdale Tipton Shelby B - 2 Fayette Haywood Crockett Gibson Weakley Carroll Henry Madison Hardeman McNairy Chester Henderson Hardin Wayne Lawrence Giles S - 1 Lincoln S - 2 Franklin Marion B - 1 Hamilton B– 2 S - 1 Bradley Polk Perry Lewis F - 1 Decatur Hickman Maury B - 1 Marshall Bedford S - 2 Moore Coffee S-1 Grundy Sequatchie Bledsoe Rhea Meigs McMinn Monroe B - 1 LoudonBlount Roane Sevier Knox B – 4 F-1 Morgan Scott Campbell B - 1 Claiborne Grainger Union Hamblen Jefferson Cocke S - 2 Stewart Houston Humphreys Montgomery Dickson Williamson S - 4 Davidson B - 2 Cheatham Robertson Sumner S - 1 Macon Trousdale Wilson S - 1 Rutherford S – 5 H - 1 Clay Pickett Jackson Overton Fentress Smith Dekalb Cannon Warren B - 1 Van Buren White Putnam B - 1 Cumberland Hancock Hawkins Greene S – 1 D - 1 Washington R-1, S-1 Sullivan Carter R - 2 Johnson S - 1 Benton TN Rabies Positives (n=48) by County, 2005 Bat Horse Skunk Fox Raccoon Dog

25 Unicoi C – 1 Lake Obion Dyer Lauderdale Tipton Shelby Fayette Haywood Crockett Gibson Weakley Carroll Henry Madison Hardeman McNairy Chester Henderson Hardin Wayne Lawrence Giles Lincoln S - 1 Franklin Marion Hamilton Bradley F-1 Polk Perry Lewis Decatur Hickman Maury Marshall Bedford D - 1 Moore S-3 Coffee Grundy Sequatchie Bledsoe Rhea Meigs McMinn Monroe LoudonBlount Roane Sevier Knox Morgan Scott Campbell Claiborne Grainger Union Hamblen Jefferson S-1 Cocke Stewart Houston Humphreys Montgomery Dickson Williamson S - 4 Davidson S - 2 Cheatham Robertson Sumner Macon Trousdale Wilson Rutherford S – 10 Clay Pickett Jackson Overton Fentress Smith Dekalb Cannon Warren S-1 Van Buren White Putnam Cumberland Hancock Hawkins Greene Washington Sullivan Carter Johnson Benton TN Rabies Positives (n=26) by County, 15 April 2006 Skunk Fox (Racc Var) Cat (Racc Var) Dog - 1 (Sk Var)

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27 Raccoon variant

28 Unicoi Marion Hamilton Bradley Polk Grundy Sequatchie Bledsoe Rhea Meigs McMinn Monroe LoudonBlount Roane Sevier Knox Morgan Anderson Scott Campbell Claiborne Grainger Union Hamblen Jefferson Cocke Pickett Overton Fentress Dekalb Warren Van Buren White Putnam Cumberland Hancock Hawkins Greene Washington Sullivan Carter Johnson East TN counties with raccoon variant rabies, 2002-Apr 15, 2006

29 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

30 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

31 Anticipated ORV Barrier Zone for Raccoon Rabies in the United States 2004 casesProposed ORV

32 ORV in Tennessee, 2005 GAT Appalachain Ridge

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34 Guidance documents

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36 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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38 Questions? John Dunn Tennessee Department of Health Communicable and Environmental Diseases 4 th Floor, Cordell Hull Building th Avenue North Nashville, TN


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