HomeMy WebLinkAboutAgenda - 05-14-1996 - X-B 4
' ORANGE COUNTY 1
Board of Commissioners
Action Agenda
Item No.-X---.5
Action Agenda Item Abstract
Meeting Date: May 14. 1996
Subject: Rabies Control Report
Department: Health Public Hearing Yes_ No X
Budget Amendment Yes_ No X
Attachments(s) Information Contact
Health Director's Office X2411
1. Rabies Epidemics in North Carolina, Telephone Number
1995, Lee Hunter, DVM, MPH.
State Public Health Veterinarian Hillsborough 732-8181
Chapel Hill 968-4501
Mebane 227-2031
Durham 688-7331
Purpose:
To review current information regarding rabies in North Carolina and our response to the
epidemic. To review what has been done to implement the Rabies Prevention Program, what we
are working on now, and to assess our state of readiness for rabies in Orange County.
Background:
The Rabies Prevention Program was approved by the Board of County Commissioners effective
November 1, 1995. Included in the program is an educational component for elementary and
secondary school classroom instruction by Animal Control Officers using a program developed by
the State of New Jersey. Features include:
• A 10 minute video.
• Teacher's guide and instruction booklets.
• Reproducible exercises and handouts.
• Separate programs for elementary and secondary levels.
• 1-2 hour programs for elementary and secondary levels.
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Four Animal Control Officers have made 51 presentations to 94 fourth and or seventh grade
classes in both county and city public school systems as well as a few private schools reaching
approximately 2500 students directly. Commercially prepared age appropriate Rabies pamphlets
were made available to both school systems for distribution to all children grades K through 8.
The Orange County School system distributed 4,000 booklets to the children to take home. City
school administrators used the booklets in the classroom but did not send them home with the
students. We are now exploring other ways to distribute the booklets to city school children.
Another objective is to increase the number and percentage of vaccinated pets. Since September
1, 1995, Animal Control and the animal shelter have sponsored 11 clinic dates at 22 total
locations vaccinating a total of 1,890 cats and dogs. In Orange County, September through
March, 8,547 rabies vaccinations have been recorded. Currently, Animal Control can document
24,535 cats and dogs with valid rabies vaccinations in Orange County. Vaccination figures for
the past three fiscal years are:
• 94-95 13,507
• 93-94 11,002
• 92-93 11,468
On April 16, 1996, a rabid raccoon was found 2 miles North of the Orange County line in Person
County. Animal Control is preparing a Rapid Response Plan to rabies cases in Orange County.
Elements of the plan include:
• A letter to primary care, emergency and internal medicine physicians alerting them and
providing information regarding post exposure prophylaxis
• A letter to veterinarians.
• A plan by which to notify county officials of rabies cases.
• A plan by which to inform the media.
• Disposition and handling of animals in the shelter
Recommendation: To receive as information.
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P U B L I C H E A L T H
Rabies Epidemics in
North Carolina, 1995
Information for the Medical Practitioner
.Lee Hunter, DVM, MPH
Rabies—long absent as a major health threat to the land-based wide to ensure that vaccination of dogs was affordable and
animals of North Carolina--has now entered the state in three accessible close to home.2)Since rabies vaccination efforts did
separate epidemics.As these epidemics spread from their entry not reach the population of stray dogs,these animals were(and
points, the number of cases of rabies diagnosed by the State still are) unlikely to be vaccinated. They form a potential
Laboratory of Public Health has increased dramatically,nearly reservoir for the disease.In order to significantly interrupt the
doubling each year since 1990. dog-to-dog cycle of rabies(and thereby reduce the total number
The relative absence of rabies among land-based animals of rabies cases), the carrying population(the population that
(that is,mammals other than bats)in North Carolina has made allows the continuing transmission of disease in a population)
many people complacent.We have forgotten thelessonslearned must be reduced.Therefore,local animal control departments
during the major rabies epidemic of the 1950s.As a result,chil- undertook a(successful)program to reduce the population of
dren are allowed to approach unknown animals,even animals stray animals.
that appear to be ill,and people bitten by animals do not always These two efforts—mandatory mass vaccination with ef-
seek medical assistance.Many dogs and cats are not vaccinated festive vaccines and a reduction in the numbers of stray ani-
against rabies. People have forgotten that, once signs and mall—rapidly reduced the carrying population andbrought the
symptoms appear,human rabies is almost invariably fatal. epidemic under controL For example, 174 animals in North
Carolina were diagnosed as rabid during 1954,butby 1960only
11 were.Controlling the disease in the pet population reduced
The Rabies Epidemic of the 1950s the spillover of the disease into the wild animal population.
The reason that the disease has been absent from land-based
animals is the effectiveness of the public health programs Rabies Epidemics Today
launched to control rabies during the 1950s.In the mid-1950s, -
several hundred animals per year were diagnosed as rabid and Now,the disease is threatening us once again.But not because
there were some resulting human deaths.The main reservoir of of a failure of our established public health programs to deal
rabies 40 years ago was the population of owned and stray dogs with domestic animals.This time the threat comes from a new
and cats.Efforts at the state and local level to control the spread direction. The rabies epidemics in North Carolina predomi-
of the disease within those populations efforts consisted of two nately affect the wild animal population.Thatmakes thecontrol
main programs:l)The North Carolina General Assembly made of the disease much more difficult,if not impossible,given the
it mandatory that all dogs be vaccinated against rabies. The tools we now possess. These epidemics are part of a larger
Commission for Health Services permitted the use only of regional problem affecting the Southeast, Mid-Atlantic, and
animal rabies vaccines that could be proven effective.County- Midwest United States.The reasons for the epidemic outbreaks
sponsored rabies vaccination clinics were made available state- are varied and complex.The epidemic in the northwestern part
of the state affects mainly skunks,while that in the northeastern,
southeastern, and south-central regions of the state affects
Dr.Hunter is with the Medical Evaluation and Risk Assessment
Branch, Occupational and Environmental Epidemiology Sec- primarily raccoons.The difference is due to the origins of the
tion,Division of Epidemiology.NC Department of Environment, epidemics affecting each area.
Health,and Natural Resources, Raleigh 27611. Figures 1-3,next page,show the counties affected and the
14 NC:vt1/January 1906,Volume 57 Number I
4
timesequenceof thespread of the epidemics depict-
ing 1990, 1993,and 1995,respectively.The con-
tinuing and rapid spread of the disease across the
state is noticeable.The maps do not depict counties
that have experienced isolated cases of rabies not
due to a natural extension of the epidemics.
Three distinct epidemics of wild animal rabies L
have entered the state,and two have shown a strong
tendency to spreadquickly from theirpointof entry. '
The Southeastern Raccoon Rabies Epidemic origi-
nated in Florida during the 1950s.The reasons for
its movement are not completely clear,but we do
know that the epidemic spread from Florida into =_rabies epidemic: 1990
Alabama, Georgia,and South Carolina. It moved
into two separate regions figure 2)of southeastern
and south-central North Carolina over a two-year
period Those two regions have now converged into
a rough triangle including Gaston County (south-
west), Harnett County (north), and Brunswick
County (southeast) (Figure 3). Northern Georgia i
has experienced rabies in its raccoon population as
part of the same epidemic, and extension from
northern Georgia into western North Carolina is
very possible.
A second epidemic(the Mid-Atlantic Raccoon
Epidemic) originated in Virginia as a result of
human action: the translocation of wild raccoons
from the Southeast into West Virginia and Virginia y rabies epidemic: 1993
during the late 19 70s. The infection has spread
south into North Carolina,west into Ohio,and north
and east into Pennsylvania,New Jersey,New York,
and New England. In North Carolina, rabid rac-
coons are now found in a roughly rectangularregion ____
from Granville County(northwest),northern Harnett _
County(southwest),Beaufort County(southeast),
and Currituck County(northeast)(Figure 3)•
A third epidemic of rabies originated in skunks
in Canada and spread through the midwestern states ----
into Tennessee,southwestern Virginia,and north-
western North Carolina. This Midwestern Skunk
Epidemic rmwaffects WataugaandAlleghanycoun-
ties(Figure 3).
-:hies _tide-nic: 1995
Rabies Control Measures
As more counties experience epidemic rabies,the Figs 1-3 (top to bottom): North Carolina counties affected by rabies
-- risks to citizens increase and the costs of trying to epidemics during 1990(top), 1993(middle), and 1995 (bottom).
control the disease and treat people exposed to the
virus increase. Financial aspects include medical costs for increased approximately 60%in two counties that experienced
people or pets exposed to the disease; pre-exposure rabies a rabies epidemic.Most of the increased costs were borne by the
vaccination of animal control officers,veterinarians and wild- private sector,primarily in the form of rabies vaccination for
life rehabilitators;vaccination of dogs and cats to prevent the pets.'
disease;and county government funds for animal control.The Controlling the spreadof rabies inawildanima!population
state of New Jersey estimated that the cost of rabies control is a complex problem, and few have been successful. The
NCS11/lan"ary 1996,Volwne S7 Nwnber 1 15
f
5
experiment of trapping and vaccinating wildlife across the base of Animal Bites, is available for free from the Division of
of a peninsula has been tried to stop the advance of the disease Epidemiology (P.O. Box 27687, Raleigh, NC 27611-7687).
in a raccoon population.Despite a large investment of time and This booklet gives dosage and schedule regimens for both pre-
money, the rabies virus jumped this human-trade barrier. exposure and post-exposure rabies vaccination.In addition,it
Trapping and shooting wildlife to lower population levels have discusses how to determine when vaccination is appropriate,
been tried and found ineffective(probably because such meth- the potential sequelae and contraindications of vaccination,and
ods would also have to preventthe in-migration ofwildlife from names and telephone numbers of Division staff who can help.
surrounding areas).Damaging an area's ecology by decimation The NC DEHNR maintains a stock of rabies vaccine and
of wildlife may have serious and unintended consequences. rabies-immune globulin for sale to physicians, pharmacies,
A potential method of controlling the spread of the rabies hospitals,and health departments at cost on a non-exchange,
virus is on the horizon.Wildlife can be given a bait containing non-return basis.Orders may be made through the Division of
an active,genetically engineered, live vaccinia vitas that in- Epidemiology. Rabies vaccine and rabies-immune globulin
eludes genetic material coding for an external rabies protein. may also be available through local and regional hospitals at
This method has been used in Europe to control rabies virus in comparable prices.Referral of patients to such hospitals may be
foxes, and it holds much promise. Briefly, genetic material indicated when treatment should be started immediately.
coding for an external protein of the rabies virus is inserted into There are many ways in which to mitigate the rabies risk in
the DNA of the vaccinia virus.This new virus,which is alive but areas experiencing an epidemic. First, we must teach our
altered from its original form,is placed into bait attractive to children not to approach unknown animals, even those not
raccoons and distributed throughout the targetarea.Thevaccinia showing signs of disease.Normal-appearing animals may have
virus enters the raccoon through its tonsils.The virus infects the saliva capable of transmitting disease.Second,we mustchange
host,producing a rabies protein in addition to more vaccinia certain habits that attract wild animals into our living space.
virus.The host,in turn,produces antibodies against the vaccinia Watching raccoons feeding in the backyard may be educational
virus and the rabies protein.The genetically engineered vaccinia to our children and ourselves,but those raccoons pose a threat
virus cannot produce rabies but can imm unite the host to rabies. to our health and the health of our pets.Dog or cat food should
Laboratory data suggest that horizontal and vertical transmis- not be left outside at night because it may attract wildlife.
sion may occur during the first few hours after immunization. Garbage cans should have tightly fitting lids or have cords
Oral baiting has limitations. It is designed to protect a across the lids to keep them securely fastened.Third--and one
specific area such as a peninsula or camp.It is too expensive and of the most important things we can do to protect our families—
labor intensive to be used to eradicate rabies in an entire state or is to have our pets vaccinated against rabies. Vaccination is
even most counties.No vaccine is 100%effective and this one required by law, but many people neglect to do it until the
is not expected to be any different.It is intended to immunize epidemic is upon them.By then it may be too late.Eight rabid
a population of animals and slow or stop the epidemic spread of cats and two rabid dogs were identified in North Carolina in
rabies.It is a public health measure,not an individual veterinary 1993.themost pets in one yearsince 1959.Noneof these 10pets
medical procedure. had been vaccinated.It has been my experience that,for every
case of rabies in a pet, six people are forced to undergo
antirabies vaccination.
Help for Health Professionals
Determining whether people need post-exposure rabies vacci- A Last Word
nation is difficult because of the large number of variables
involved:the species of animal,circumstances of the bite,the To summarize: the calm before the rabies storm has ended.
epidemiology of the disease.Help in making such decisions is Three epidemics of rabies have entered the state and spread
available from the schools of medicine throughout the state, from their point of entry.These events mean a large investment
local health departments,and the North Carolina Department of of time and money by state and local health departments to
Environment,Health,and Natural Resources(DEHNR),Divi- prevent human and pet animal cases of rabies.Since control of
sion of Epidemiology. Assistance is available during normal the disease in the wildlife population poses many challenges,
working hours from the Division of Epidemiology(919[733- the medical community will see increased demands on its time
3410),and during evening hours,weekends,and holidays by and expertise in hopes of preventing human rabies.The expe-
calling a beeper-voice mailbox(9191733-3419). rience of our neighboring states shows that problem of rabies
A booklet written for medical professionals,Management will affect all of our citizens regardless of social strata. ❑
Reference orally absorbed vaccine to control rabies in raccoons.J Amer Vet
1 Uhaa 13.Dato VM.Sorhage FE,et al.Benefits and costs of using an Med Association 1992;201:1373-82.
16 NCM3 I January 1096.Volume 57 Number 1
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