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Animal Rabies -- South Dakota, 1995

On July 28, 1995, the South Dakota Public Health Laboratory diagnosed rabies in an 8-week-old puppy; on July 23, the puppy had had onset of neurologic signs (e.g., head tilt, ataxia, and somnolence) that culminated in seizures, and the puppy was euthanized. A clinically normal littermate owned by a neighboring family was euthanized on July 31 and tested positive for rabies. This report summarizes the epidemiologic investigation and follow-up management by the South Dakota Department of Health (SDDH), with assistance from CDC, of persons and domestic animals potentially exposed to rabies.

On July 8, the neighboring families acquired the two puppies from a private owner near Summit, South Dakota. The puppies were from a litter of nine born on May 29. On June 13 or 14, a skunk attacked the litter in a garage where they were kept. The skunk was killed by the owner of the puppies but was not tested for rabies. All the puppies were free of clinical signs consistent with rabies when given away between July 8 and July 27. However, the original owner of the puppies was uncertain of the identity of all the persons who had adopted them. Through announcements in the local news media and distribution of flyers door-to-door by the Aberdeen Area Indian Health Service in Sisseton, by August 4 the remaining seven puppies were identified to be in private residences located throughout eastern South Dakota. Six of the puppies tested negative for rabies at the South Dakota Public Health Laboratory; the seventh puppy had been killed by the owner because it was part of the exposed litter, and it was unavailable for testing. The dam of the litter and another contact dog -- neither of which were currently vaccinated against rabies -- were euthanized and tested negative for rabies. Two other potentially exposed pet dogs, past due for rabies vaccination, were identified; they were managed by home quarantine and booster vaccination according to the 1995 animal rabies compendium (1) and remained symptom-free.

The SDDH initiated efforts to identify persons with potential exposure to the two puppies and determine their risk for rabies infection. In response to the alert, the state health department and four major health-care facilities screened by phone or personal interview approximately 150 persons possibly exposed during July 13-31 (the established period of potential rabies transmission). In addition, SDDH conducted town meetings and provided briefings to health-care providers, the news media, and animal-control authorities. Of the 150 persons, 22 (15%) (including nine persons from the veterinary clinic in which the ill puppy had been treated and euthanized and seven persons who had had contact with the puppy that had been destroyed and was unavailable for rabies testing) met the criteria used to determine the need for rabies postexposure treatment (PET) for either a bite or nonbite exposure as defined by the Immunization Practices Advisory Committee (2). Specific antirabies treatment was initiated for 31 persons; the other nine persons requested and received PET despite reassurance they were at low risk for rabies infection.

Reported by: K Peterson, DVM, Milbank Veterinary Clinic, K Vanadurongvan, MD, Milbank Medical Clinic, Milbank; H Burrish, DVM, Sisseton Veterinary Clinic, Sisseton; F Zambrana, MD, J Leith, Aberdeen Area Indian Health Service, Sisseton; S DeCoteau, Sisseton-Wahpeton Sioux Tribe, Sisseton; G Larson, MD, H Nipe, MD, K Peterson, MD, C Gerrish, MD, R Peshek, MD, M Preys, MD, L Danforth, Brown Clinic, Watertown; J Ostby, MD, C Breske, MD, M Jergenson, Bartron Clinic, Watertown; L Volmer, L Schaefer, G Welch, S Lance, DVM, State Epidemiologist, South Dakota Dept of Health; R Steece, PhD, South Dakota Public Health Laboratory. Viral and Rickettsial Zoonoses Br, and Special Pathogens Br, Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: In the United States, the most frequently reported rabid wild animals are raccoons, skunks, bats, and foxes (3). Although the exposure for the two rabid puppies in this report was not confirmed, the skunk that attacked the litter in mid-June was probably the source of infection. Measures for preventing pets from contacting wild animals include keeping them indoors, on leashes, or in fenced outdoor areas. If pets are wounded by wild animals, wounds should be washed immediately with soap and water, and the pet should be evaluated by a veterinarian. Wildlife that attacks persons or pets should be apprehended by trained personnel, euthanized, and tested for rabies. Wild and stray domestic animals exhibiting signs of neurologic illness or of abnormal behavior (signs of rabies among wild animals cannot be interpreted reliably) should be reported to appropriate local health authorities, especially if the animal bites or scratches a person. Only trained personnel should attempt to trap or capture these animals and submit them for rabies testing.

The economic burden of the exposures in South Dakota was minimized because of the small number of persons requiring PET and as a result of efforts to inform and reassure persons who unnecessarily were seeking medical services for exposures not associated with true risk (e.g., petting a rabid puppy, handling a noninfected littermate, or having contact with a human who had been exposed to a rabid puppy). Nonetheless, substantial resources were required to educate potentially exposed persons about rabid animals and to conduct the prompt and standardized assessment of persons who received PET (4). The estimated cost associated with the public health response, assessment, and PET was $115,000: $97,900 for chemoprophylaxis and provider services, $16,500 for the investigation by public health officials, and $600 for laboratory testing of animals. In South Dakota, from 1990 through 1995, an estimated $1.4 million was spent for PET for 632 persons exposed to approximately 704 rabies-positive animals. Although this estimate is for a 5-year period, it is similar to the cost ($1.5 million) associated with the single-point source exposure to a rabid kitten in New Hampshire, in which PET was initiated for 665 persons (5). To facilitate efforts to investigate rabies exposures such as those described in this report, persons involved in the private sale or adoption of pets are encouraged to maintain records of buyers' or adoptees' names and addresses.

References

  1. CDC. Compendium of animal rabies control, 1995: National Association of State Public Health Veterinarians, Inc. MMWR 1995;44(no. RR-2).

  2. CDC. Rabies prevention -- United States, 1991: recommendation of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no. RR-3).

  3. Krebs JW, Strine TW, Smith JS, Rupprecht CE, Childs JE. Rabies surveillance in the United States during 1993. J Am Vet Assoc 1994:205:1695-709.

  4. Childs JE, Noah DL, Rupprecht CE. Rabies. In: Gorbach SL, Bartlett JG, Blacklow NR, eds. Infectious diseases. 2nd ed. Philadelphia, Pennsylvania: Saunders (in press).

  5. CDC. Mass treatment of humans exposed to rabies -- New Hampshire, 1994. MMWR 1995; 44:484-6.




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