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STATE OF WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES Rabies Surveillance, Management and Control Manual Division of Infectious Disease Epidemiology and Environmental Health Procedures Manual MEMORANDUM DISEASE CONTROL-FOUR June, 2010 WV DEPARTMENT OF HEALTH AND HUMAN RESOURCES Division of Infectious Disease Epidemiology and Environmental Health Services Program Manual MEMORANDUM DISEASE CONTROL-FOUR June, 2010 RABIES SURVEILLANCE MANAGEMENT and CONTROL MANUAL I. Table of Contents Background ......................................................................................................... 1 II. Definitions / Explanations .................................................................................. 3 III. Management of Human Exposures ................................................................... 6 A. B. C. D. E. F. G. H. I. Legal Citations………...…………………………………....…..……..6 Owned Companion Animals (dogs, cats or ferrets)…………….7 Stray Dogs, Cats, or Ferrets…………………………………….…..7 Other Mammals Owned and Kept as Pets………………………..8 Exotic Pets……………………………………………………………...8 Monkeys………………………………………………………………...8 Livestock…………………………………………………………….….9 Mammalian Wildlife……………………………………………….......9 Bats………………………………………………………………….….10 IV. Human Exposure Records………………………………………………………………...12 A. Reporting by Physicians……………………………………...........12 B. Use of WVEDSS for Reporting Potential Rabies Exposures...12 C. Case Definition………………………………………………..……...12 D. Cases that Should Not be Reported in WVEDSS………....…...13 E. Reporting Requirements in WVEDSS…………………………....13 V. Management of Animal Exposures………………………………….………………….15 A. Legal Citation………………………………………………….…......15 B. Vaccinated Dogs, Cats and Ferrets……………..…………….…15 C. Unvaccinated Dogs, Cats and Ferrets…………………………..15 D. Dogs, Cats or Ferrets with Expired Vaccinations………….….15 E. Livestock………………………………………………………….…..16 Vaccinated Livestock……………………………..………….….16 Unvaccinated Livestock………………………..…………….…16 F. Wild or Exotic Animals………………………………………….….17 VI. Animal Exposure Records………………………………………………………………..18 VII. Laboratory Analysis of Rabies Specimens………………………………..………….19 VIII. Appendices……………………………………………………………………..…………..20 WV DEPARTMENT OF HEALTH AND HUMAN RESOURCES Division of Infectious Disease Epidemiology and Environmental Health Services Program Manual MEMORANDUM DISEASE CONTROL-FOUR June, 2010 RABIES SURVEILLANCE MANAGEMENT and CONTROL GUIDE West Virginia Department of Health & Human Resources/Bureau for Public Health/Office of Epidemiology and Prevention Services/Division of Infectious Disease Epidemiology West Virginia Department of Health & Human Resources/Bureau for Public Health/Office of Environmental Health Services West Virginia Department of Health & Human Resources/Bureau for Public Health/Office of Laboratory Services United States Department of Agriculture/Animal & Plant Health Inspection Service/Wildlife Services West Virginia Division of Natural Resources West Virginia Department of Agriculture Greenbrier County Health Department/Environmental Health Lewis County Health Department Cabell-Huntington Health Department I. Background Rabies in humans in the U.S. is a rare disease. Of 37 individuals dying of rabies in the United States between 1995 and 2006; 28 (75.7%) had bat-strain rabies, 8 (21.6%) had dog-strain, and 1 (2.7%) had eastern raccoon strain rabies. Of the 28 persons with bat-strain rabies, 4 (14%) individuals reported a bite, 4 (14%) individuals were infected as a result of organ transplant, and the mode of transmission was unknown in 20 (71%). All individuals with dog-strain rabies were exposed overseas. The source of exposure was unknown for the individual with raccoon strain rabies. Rabies virus is widely distributed throughout every continent in the world. It is estimated that more than 55,000 people in the world die of rabies every year, usually after the bite of an infected dog. Ninety-five percent of rabies deaths occur in Africa or Asia. Rabies is a viral disease that affects the nerve pathways of the central nervous system and produces encephalitis in warm blooded animals. All mammals are susceptible hosts for this virus. It is most frequently encountered among 1 carnivorous (meat-eating) animals because of their biting habits. The virus is ordinarily transmitted from a bite, e.g. animal to animal, or animal to humans. In the continental boundaries of the U.S., the chief vectors of this disease, in order of incidence, include raccoon, skunk, bat, fox, cat, and dog. In West Virginia, raccoons represent the major wildlife reservoir of rabies virus with spillover into other wildlife and domestic animals. Each year cats are found positive for rabies in West Virginia and, more uncommonly, dogs. Livestock including horses, cows and goats are on occasion also found to be rabies positive, particularly in areas of the state that are endemic for raccoon-strain rabies. In addition to these terrestrial reservoirs, several species of insectivorous bats are reservoirs for rabies. Unvaccinated dogs and cats create serious problems by carrying rabies from wildlife into proximity with human populations. Even though rabies is relatively rare among dogs and cats, the control of stray, ownerless dogs and cats should be a major consideration in any rabies control and management program. Cats are the most commonly diagnosed companion or livestock species diagnosed with rabies in West Virginia. Between 2000 and 2007, 33 cats were detected with rabies. An additional important preventive measure is a county or regional rabies immunization clinic for dogs and cats. It is required by law in the State of West Virginia to have every owned, kept or harbored dog and cat immunized against rabies at least every three years with an approved rabies virus vaccine (WVC1920A-2; see Appendix I-3). For puppies and kittens the first vaccination must be completed by six months of age, with a booster dose administered within one year following the first dose. The rabies virus is transmitted in the saliva of an infected animal. Rabies virus is transmitted from an infected animal to another animal by a bite or contamination of an open cut, wound or mucous membranes with saliva or CNS tissue containing rabies virus. The virus invades the mucous membranes or central nervous system by way of nerve pathways. After local proliferation of the virus, the infection progresses along peripheral nerves to the brain. The incubation period is the time from exposure to onset of clinical disease. The incubation period may vary from a few days to several years, but is typically one to three months. The virus can infect and remain localized at the inoculation (bite) site for several months. Once the virus reaches the brain it multiplies rapidly and invades the salivary glands. During this period of cerebral infection, the classic behavioral changes associated with rabies develop. The virus can be found in saliva and neural tissues but not blood, nor feces nor the spray of a skunk. Not all brain infections are caused by the rabies virus. Therefore, it takes careful observation and diagnostic procedures by physicians and veterinarians to make accurate clinical diagnosis. A final diagnosis of rabies is based on laboratory examinations. 2 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 II. Definitions/Explanations Vector Species Vector species include bats or terrestrial mammals, especially carnivores. Wild species known to be reservoirs of rabies include, but are not limited to: raccoons, skunks, foxes, coyotes, bobcats, wolves or any hybrids between these wild species and domestic dogs and cats. Domestic species include, but are not limited to dogs, cats and ferrets. Small rodents such as mice, rats, gerbils, hamsters, squirrels, chipmunks, etc. are almost never found to be rabid. Groundhogs are occasionally found to be rabid in areas where raccoon strain rabies is enzootic. Human Exposure Any bite or scratch from a vector species or the introduction of saliva or central nervous system (CNS) tissue from a vector species into an open, fresh wound or mucous membrane (eye, mouth, or nose) of a human being. The touching or handling of a vector species or another animal or inanimate object that had contact with a vector species does not constitute an exposure unless wet saliva or CNS material from the animal entered a fresh, open wound or had contact with a mucous membrane. A fresh wound is defined as a break in the skin that has bled within the last 24 hours. Animal Exposure A bite or scratch from a vector species, or the introduction of saliva or CNS tissue from a vector species into a break in the skin or mucous membranes of a domestic animal. The actual witnessing of a bite or attack by a vector species is not required in order for an exposure to have occurred. Any vector species which has exposed a domestic animal and is not available for laboratory testing should be presumed to be rabid. Domestic animals that bite other domestic animals are not usually considered as rabies suspects unless showing signs compatible with the disease. When a female dog, cat or ferret or any of her litter of offspring are exposed to a rabid animal the entire family group should be treated as the exposed unit. Disposition, either confinement or euthanasia, should be recommended for the entire group. 3 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Surveillance Surveillance has been defined as “the continued watchfulness over the distribution and trends of incidence [of a disease] through the systematic collection, consolidation, and evaluation of morbidity and mortality reports and other relevant data.” [Alexander Langmuir] Passive surveillance for rabies includes any animals that have exposed a human or domestic animal. Active surveillance includes both passive surveillance and testing of road kills, sick acting animals, and animals with other clinical signs of rabies. Active surveillance activities may occur when new cases of rabies are detected in an area that has not had previous detected cases. In West Virginia, active surveillance has been performed in counties on either side of the leading edge of the raccoon strain rabies epizootic for the purposes of correct placement of the oral rabies vaccine barrier. Confinement The animal is housed in a building, pen or by some other suitable escape-proof method or enclosure. Tying the animal in an open yard is not adequate confinement. The animal cannot be removed from confinement unless on a leash and under the immediate control of a responsible adult. The animal may not be moved from the premises unless permission is obtained from the local health department. Under no circumstances should the animal be permitted to run at large during the confinement. At the first indication the animal is becoming ill it is the responsibility of the owner or custodian to notify the local health department and take the animal to a veterinarian for an examination. If rabies is suspected, the animal should be immediately euthanized and the brain submitted for rabies testing. To avoid misunderstanding, such instructions should be provided to the owner or custodian in writing. There are no established observation and confinement periods for any animals other than dogs, cats or ferrets. Strict Isolation A kennel in a veterinary hospital, animal control facility, commercial boarding establishment, or a pen at home (see Appendix A) that prevents direct contact between the animal and any human or other animal, but allows for observation, feeding, watering and sanitation. The local Sanitarian is responsible for approving the adequacy of the isolation unit. Currently Immunized Against Rabies A domestic animal is currently immunized against rabies if a certificate of vaccination is available that describes the animal adequately and documents that the animal received rabies vaccine approved by the United States Department of Agriculture (USDA) from a licensed veterinarian. The duration of immunity must 4 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 be adequate for the animal species and age as described on the USDA‟s approved vaccine label. In lieu of a vaccination certificate, the records of the attending veterinarian may suffice. A current list of licensed rabies vaccines marketed in the U.S. including recommended booster intervals are available in the national Association of State Public Health Veterinarians (NASPV)‟s Compendium of Animal Rabies Prevention and Control. (http://www.nasphv.org/Documents/RabiesCompendium.pdf). Signs of Rabies in Domestic Animals Signs of rabies in domesticated animals are varied. Two characteristic clinical conditions are noted when domestic animals are infected with rabies virus. These are usually evident as a change in “expected” behavior. In the dumb form of rabies, the animal may become unusually shy or hide and become very approachable. This may be followed by sluggishness, confusion and depression. In the furious form of rabies, the animal may become excitable, irritable and aggressive. At times it may seem confused and calm, then suddenly attack when approached. It may lose all caution for natural enemies. Other signs may include: staggering, weakness and paralysis, a change in the sound of the animal‟s voice, inability to eat or drink, drooling, convulsions (seizures), paralysis, coma and frothing at the mouth. The virus is lethal and animals with these signs usually die within a matter of days. Signs of Rabies in Wildlife An animal may be infected with the rabies virus for a long time before it shows clinical signs. This period may range from weeks to years; most commonly weeks to months, depending on the location of the bite, severity of bite, amount and strain of virus introduced from a rabid animal and other variables. Wild animals may show signs which include: aggression, unusual friendliness, disorientation, paralysis, whining, drooling, choking and frothing at the mouth. On occasion rabid wildlife will attack inanimate objects (e.g. a ground hog attacking a shovel left outside). 5 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 III. Management of Human Exposures (See Definitions and Explanations) A. Legal Citations: §19-20-9a. Dogs, cats, etc.; rabies observation. (West Virginia State Code, WV Department of Agriculture) (a) Any person who owns or harbors any dog, cat or other domesticated animal, whether licensed or unlicensed, which bites any person, shall forthwith confine and quarantine the animal for a period of ten days for rabies observation. (c) If the animal is not confined and quarantined as directed in subsections (a) … of this section, the humane officer, dog warden or sheriff may cause the animal to be placed in the custody and care of a licensed veterinarian for that purpose at the owner's expense. The penalty for any violation of this section is a fine of fifty dollars or confinement in the county or regional jail for a period of no less than two nor more than three days. 64 CSR7-5.3. (Legislative rule, WVDHHR) If the animal is a domestic dog, cat or ferret, the local health officer shall make a reasonable attempt to determine the animal's owner, and, if successful, shall direct the owner to confine the animal for a period of ten days. The owner of the dog cat or ferret, county humane officer, dog warden or sheriff shall notify the local health officer immediately if the animal shows symptoms compatible with rabies or dies, and the local health officer, county humane officer, dog warden or sheriff shall arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 64 CSR7-5.4. If the local health officer cannot determine the owner of the domestic dog cat or ferret, he or she shall direct the county humane officer, dog warden or sheriff to pick up the suspect dog cat or ferret, that has bitten a person and confine it in isolation for a period of ten days. If the animal shows symptoms compatible with rabies, including if the animal bit someone without provocation, or if the animal demonstrates aggressive behavior toward human beings such that the animal may pose a continuing risk to other people, the local health officer shall direct the county humane officer, dog warden, sheriff, or other designee to humanely destroy the animal and arrange for appropriate examination of the animal‟s brain. If the animal dies, the local health officer shall arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 65 CSR-7-5.5. If a person is reported bitten by any animal having or suspected of having rabies other than a domestic dog cat or ferret, especially a wild mammal or hybrid, the local health officer may direct the county humane officer, dog warden, sheriff, or other designee to have the animal humanely destroyed immediately and to arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 6 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 B. Owned Companion Animals (dogs, cats or ferrets): Any person who owns or harbors any dog, cat or ferret, whether licensed or unlicensed, which bites any person, shall … confine … the animal for a period of 10 days for rabies observation (West Virginia code 19-20-9a). A Notice of Animal Quarantine, Form SG-59 (see Appendix H) shall be issued by the local health officer or his designee (64CSR7). In some situations, immediate euthanasia and testing of the animal(s) may be preferable including when: a) there is a severe bite on the head, face, neck or hands, b) there are severe bites resulting in hospitalization or death, or c) the animal has a past history of biting. The animal shall not be killed, sold, released or given away during the quarantine period. Administration of the rabies vaccine is not recommended during the observation period. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be euthanized and its head submitted for rabies examination to the Office of Laboratory Services (OLS). If the suspect animal is not confined as directed, the humane officer, dog warden or sheriff may cause the animal to be placed in the custody and care of a licensed veterinarian for that purpose at the owner(s) expense and can fine/imprison the owner (19-20-9c). C. Stray Dogs, Cats or Ferrets: If the dog, cat or ferret responsible for the bite and/or exposure has no known owner (i.e., no one in the community who harbors or maintains the animal), the local health officer shall direct the county humane officer, dog warden or sheriff to confine the suspect animal for a period of 10 days for rabies observation. A Notice of Animal Quarantine, Form SG-59 (Appendix H) shall be issued by the local health officer or his designee. If symptoms of rabies develop, the animal shall be humanely euthanized and tested. If the animal dies its head should be immediately submitted for testing at OLS. (64CSR7-5.4). In some situations, immediate euthanasia and testing of the animal may be preferable, especially when: a) there is a severe bite on the head, face, neck or hands; b) there are severe bites resulting in hospitalization or death; c) the animal has a past history of biting; or d) the animal will not have an owner at the end of the 10-day quarantine period. If the animal is not available for either quarantine or laboratory testing, the attending physician (as necessary, with the assistance from the local or state health departments) should evaluate the level and type of animal exposure in 7 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 determining the need for rabies post exposure prophylaxis (PEP). The decision to start any immunization regimen rests between the physician and the patient. D. Other Mammals Owned and Kept as Pets (e.g., hamsters, gerbils, rats, mice, rabbits, guinea pigs, etc.): An approved rabies vaccine is not available for small rodents and they are generally considered low risk for rabies transmission. These animals are not considered a risk unless acting abnormally and/or housed in a manner allowing potential contact with mammalian wildlife; especially established wildlife rabies vectors. Ordinarily, persons bitten by small rodents should be counseled that risk is low. If the bite victim is anxious about the risk, testing is available through the Office of Laboratory Services, but it is not necessary. There is no observation period for small rodents. Other classes of owned animals kept as pets (e.g., birds, reptiles, amphibians, fish and invertebrates) present no risk for rabies transmission. E. Exotic Pets There is no established rabies observation period for any animal other than a dog, cat or ferret. When a person is bitten by an exotic pet, many factors should be considered. These include: apparent health status of animal, type of pet, whether it is a rare or zoological collection mammal, whether its behavior is normal, history of exposure and whether the area is endemic or not for rabies. These circumstances should be handled on a case-by-case situation and DIDE should be consulted for guidance. F. Monkeys Monkeys by nature are dangerous and even seasoned handlers and menagerie owners are often bitten by animals that have been maintained in captivity for years. Monkeys which have been housed indoors for long periods and have no known exposure to rabies vector species are unlikely to have the rabies virus. Animals housed outdoors or otherwise have intermittent access to the outside have increased likelihood of exposure to rabies vector species. Hence, consideration for rabies post exposure treatment and/or testing of captive monkeys should take into account historical husbandry conditions. If rabies is a concern the monkey should be euthanized and tested. There is no rabies observation period for monkeys. If the owner declines testing and rabies is a concern, PEP should be recommended. A separate danger of monkey bites is B virus (Cercopithecine herpesvirus 1) infection. B virus may result in encephalomyelitis in humans with a case fatality rate approaching 80 percent. This is a relatively rare infection in humans and is 8 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 commonly found among more than 19 species of macaque monkeys. A confirmed bite or scratch or exposure to saliva or genital secretions of a macaque monkey should prompt an immediate consult to DIDE. See appendix K for the management algorithm. Keeping monkeys as pets, including macaques, should be discouraged. Only experienced and trained caretakers with proper personal protective equipment and training should care for monkeys for research and other medical settings. G. Livestock Livestock such as cattle, horses, sheep, goats and pigs, are not high risk for transmitting rabies. When a person is bitten by livestock, many factors should be considered. If the animal is healthy, its behavior is normal, there is no history of exposure, and the area is not endemic for rabies, it may be reasonable to keep the animal under 10 – 14 days observation (although the shedding period of virus in the saliva is unknown in livestock). Otherwise, euthanasia and testing of the animal or PEP of the person should be considered. West Virginia Agriculture Law 19-9-30 states the commissioner or his agent shall act as appraiser and appraise each infected or directly exposed animal within five days prior to the date of slaughter provided, however, that where indemnities are claimed for directly exposed animals slaughtered on account of being infected with rabies, appraisement shall be based on the value of the animal before it became infected. West Virginia Agriculture law 19-9-2(h) states it shall be the duty of the commissioner, and he shall have authority to cause the destruction of diseased animals, when such animals are deemed diseased as a result of physical examination or an approved test, and of infected personal property, and to regulate and prohibit the moving or transportation of such animals or property from one place to another in this State. H. Mammalian Wildlife (e.g., raccoons, foxes, skunks, coyotes, bobcats, bats and other) If a human is exposed (see definition above) to a wild mammal or hybrid offspring of wild animals crossbred to domestic animals or exotic animals, the local health department shall be notified as soon as possible. Animals in these categories should be euthanized immediately and the head should be submitted to the Office of Laboratory Services for rabies examination (64CSR7-5.5). Because of the risk of rabies among wild animals, such as raccoons, skunks, bobcats, foxes and coyotes, the American Veterinary Medical Association (AVMA), National Association of State Public Health Veterinarians (NASPHV), and the Council of State and Territorial Epidemiologist (CSTE) strongly recommend enactment of state laws prohibiting the importation, distribution, relocation, or keeping of wild animals or hybrids as pets. The incubation period and number of days rabies virus is shed in the saliva, prior to onset of clinical 9 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 signs, are unknown for wild and exotic animals. Infected animals can transmit the rabies virus not only while clinically sick but also for an indeterminate number of days before clinical signs become apparent. It is never appropriate to confine and observe wild or exotic animals that are involved in a human bite and/or exposure incident. When responding to citizen inquiries or situations regarding wild animals, the sanitarian, law enforcement officer or wildlife biologist should determine, to the extent possible, if there has been human, pet or livestock exposure. Road kills or wild animals having no known contact with humans, pets or livestock should be buried or incinerated, except within counties participating in active rabies surveillance. In these counties brainstems should be submitted for testing. Note: Persons involved with the head removal should follow the self- protection guidelines in Appendix B; which includes pre-exposure rabies vaccination. I. Bats A bat that is active by day, is found in a place where bats are not usually seen (for example, in a room in your home or on the lawn) or is unable to fly is far more likely than others to be rabid. Such bats are often easily approached. Therefore, it is best never to handle any bat. If you are bitten or scratched by a bat or if infectious material (saliva) from a bat contacts your eyes, nose, mouth or a fresh wound; wash the affected area thoroughly and get medical advice immediately. Whenever possible, the bat should be captured without further risk of human exposure and submitted for rabies testing. Rabies can only be confirmed in a laboratory. Most bats are not rabid and they fill an important part of the ecosystem through consumption of mosquitoes and other insects. People usually know when they have been bitten or scratched by a bat. However, since bats have small teeth which may leave marks that are not easily seen, there are situations in which medical advice should be sought even in the absence of an obvious wound. Examples may include awakening and finding a bat in your room, seeing a bat in the room with an unattended child or seeing a bat near a mentally impaired or intoxicated person. People cannot get rabies just from seeing a bat in an attic, in a cave or at a distance. In addition, persons cannot get rabies from having contact with bat guano (feces), blood or urine or from touching a bat on its fur. More than 11 million people enjoy camping each year in the U.S. and few individuals will ever be exposed to a rabies-suspect animal, including bats or need medical intervention due to a potential exposure while camping. To date, no human rabies cases due to bats in the U.S. have implicated camping as a risk factor for an unrecognized exposure. In many camp situations, the mere presence or sighting of bats is common and normal. If bats were present while 10 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 campers were sleeping, careful assessment by local or state public health professionals of the potential for rabies exposure on a case-by-case basis should occur. Campers who may have been bitten by a bat or had direct contact with a bat need to be identified for appropriate evaluation, and if needed, vaccinated to prevent rabies. 11 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 IV. Human Exposure Records A. Reporting by Physicians Every person bitten or scratched by any animal (including bats) should consult a physician and be guided by their advice. If indicated, the physician may treat the patient to prevent: 1. wound infection, 2. septicemia (blood infection), 3. tetanus (lock jaw) or 4. rabies (hydrophobia). The physician or staff attending the victim of an animal bite or exposure must contact the local health officer within 24 hours in accordance with 64CSR7-5., and submit an Animal Encounter Report (see Appendix G) so that the local health department (LHD) may take proper measures to protect others in the community. Alternatively, the physician may submit the provider (yellow) section of the WVEDSS form. B. Use of WVEDSS for Reporting Potential Rabies The local health department should use the West Virginia Electronic Disease Surveillance System (WVEDSS) to keep an individual case record of each potential human rabies exposure. If resident of another state – do not enter WVEDSS, contact resident state of victim to report the case or contact DIDE for interstate notification. C. Case Definition: Before entering a potential rabies exposure in WVEDSS, determine if the case definition for exposure is met: Human Exposure A bite or scratch from a vector species or the introduction of saliva or central nervous system (CNS) tissue from a vector species into an open, fresh wound or mucous membrane ( eye, mouth, or nose) of a human being. Vector Species Species include bats or terrestrial mammals, especially carnivores. Wild species known to be reservoirs of rabies include, but are not limited to, raccoons, skunks, foxes, coyotes, bobcats, wolves, or any hybrids between these wild species and domestic dogs and cats. Domestic species include, but are not limited to, dogs, cats, and ferrets. 12 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Case Classification Confirmed: Human exposure from a vector species as defined above. Comment Touching or handling a potentially rabid animal or another animal or inanimate object that had contact with a rabid animal does not constitute an exposure unless wet saliva or CNS material from the rabid animal was introduced into a fresh, open wound or had contact with a mucous membrane of a human being. Bats have small teeth which may leave marks that are not easily seen; so any contact with a bat in which a bite cannot be ruled out, is considered a potential exposure to rabies. A person sleeping in a room with a bat or finding a bat in the room with an unattended child, mentally impaired or intoxicated person, are examples of possible exposures. D. Cases that Should Not be Reported in WVEDSS: The following types of cases should not be reported in WVEDSS: 1. Exposure of a human being to non-mammalian species (reptile, bird, amphibian, etc.). 2. Exposure of an animal (e.g., dog or cat) to a potentially rabid animal (e.g., raccoon). 3. Non-exposures, such as touching an animal‟s fur, picking up an animal, or contact with blood or feces of an animal. E. Reporting Requirements in WVEDSS: If the case is reported in WVEDSS, record at a minimum: 1. Identification data for the victim: a. Name b. Date of birth c. Sex d. Address e. Phone number 2. Provider with Further Patient Information: a. Name of provider b. Contact information for the provider 3. Circumstances of Bite / Exposure. a. Date of Bite / Exposure b. Type of Exposure. Indicate bite, scratch, mucous membrane exposure, etc. Animal encounters that are not exposures (e.g., touching the fur of an animal) should not be reported in WVEDSS. c. Location of Bite / Exposure d. Was Rabies Post-Exposure Prophylaxis (PEP) initiated? e. Species of animal. Indicate the species such as dog, cat, bat, raccoon, etc. Exposures to non-mammalian species should 13 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 not be reported in WVEDSS. f. Pet, stray or wild g. These variables are important for judging the risk of rabies from the animal encounter: 1. Was the bite? (provoked or unprovoked) 2. Was the animal behaving? (normally, abnormally) 3. Was the patient hospitalized for the bite? 4. How long before wound(s) cleansed with soap and water? 4. Public Health Investigation and Public Health Action Taken: In these sections, document public health management of the animal and counseling and recommendation offered to the victim: a. If the animal is confined, document: 1. Final status of animal after 10 day confinement 2. Date completed and checked. 3. If the animal escapes or is lost to follow-up or is not healthy 10 days after the exposure, document action taken, including counseling offered to the bite victim and recommendations regarding post-exposure vaccination, if appropriate. b. If the animal is tested, document: 1. Test results and date 2. If the test result is positive, unsatisfactory or nondiagnostic, document action taken, including counseling offered to the victim and recommendations regarding post-exposure vaccination, if appropriate. c. If the animal encounter is considered low risk, and neither testing nor confinement is performed, document: 1. Reasons animal encounter is considered low risk, and 2. Counseling / education offered to the victim d. Patient‟s Post-Exposure Vaccination e. All attempts to contact the bite victim should be recorded. 5. Review Process: Once the case is completed in WVEDSS, it must be forwarded to the Regional Epidemiologist for review prior to sending to the Division of Infectious Disease Epidemiology (DIDE) for evaluation and closure. 14 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 V. Management of Animal Exposures (See Definitions) Any animal bitten or scratched by a wild, carnivorous mammal (or a bat) which is not available for testing should be regarded as having been exposed to rabies. A. Legal Citation: §19-20-9a. Dogs, cats, etc.; rabies observation…. (b) If any unvaccinated domesticated animal is bitten by a rabid animal, the owner shall confine the bitten animal for a period of six months. The animal shall be vaccinated or revaccinated after five months. (c) If the animal is not confined and quarantined as directed in subsections … (b) of this section, the humane officer, dog warden or sheriff may cause the animal to be placed in the custody and care of a licensed veterinarian for that purpose at the owner's expense. The penalty for any violation of this section is a fine of fifty dollars or confinement in the county or regional jail for a period of no less than two nor more than three days. B. Vaccinated Dogs, Cats and Ferrets Any healthy, vaccinated dog, cat or ferret that is exposed to a proven or suspected rabid animal should be re-vaccinated immediately by a licensed veterinarian, confined, and observed for 45 days. Any sign of illness should be immediately evaluated by a veterinarian. If signs of rabies develop, the animal should be humanely euthanized and tested. If the animal dies, its head should be immediately submitted for testing at OLS. NOTE: The most important postexposure action is insuring that a booster vaccination is obtained immediately. C. Unvaccinated Dogs, Cats or Ferrets Any unvaccinated dog, cat or ferret that is exposed to a proven or suspected rabid animal should be euthanized immediately, unless the exposing animal tests negative for rabies. If the owner of an exposed dog, cat or ferret is unwilling to euthanize it, the animal shall be placed in strict isolation (see definitions) for six months and vaccinated upon entry or one month prior to release. Any sign of illness should be immediately evaluated by a veterinarian. If symptoms of rabies develop, the animal should be humanely euthanized and tested, or if the animal dies, its head should be immediately submitted for testing at OLS. D. Dogs, Cats or Ferrets with Expired Vaccinations Any dog, cat or ferret overdue for a booster vaccination needs to be evaluated on a case-by-case basis taking into account the severity of exposure, time elapsed since last vaccination, number of previous vaccinations, current health status, 15 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 and local rabies epidemiology. Questions should be discussed with the epidemiologists at the WVDHHR, Division of Infectious Disease Epidemiology. E. Livestock All species of livestock are susceptible to rabies; cattle and horses are among the most frequently infected. A legal quarantine requires coordination with the West Virginia Department of Agriculture, Division of Animal Health at (304) 5582214. West Virginia Agriculture Law 19-9-30 states the commissioner or his agent shall act as appraiser and appraise each infected or directly exposed animal within five days prior to the date of slaughter provided; however, that where indemnities are claimed for directly exposed animals slaughtered on account of being infected with rabies, appraisement shall be based on the value of the animal before it became infected. West Virginia Agriculture law states, “It shall be the duty of the Commissioner and he shall have the authority to cause destruction of diseased animals.” ref. 19-9-2 (for slaughter). Vaccinated Livestock Livestock currently vaccinated with a vaccine approved by the USDA for that species, exposed to a rabid animal, should be re-vaccinated immediately, confined (in a manner routine for that species) and observed for signs of rabies for 45 days. Multiple rabid animals in a herd or herbivore-to-herbivore transmission are uncommon; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies is usually not necessary. Unvaccinated Livestock Unvaccinated livestock should be slaughtered immediately. If the owner is unwilling to comply, the animal should be confined and kept under close observation for six months and the animal shall be vaccinated after five months. Refer 19-20-9(a) for slaughter. If an exposed animal is to be slaughtered for consumption, it should be done immediately after exposure, and all tissues should be cooked thoroughly. Persons handling exposed animals should use barrier precautions. Federal meat inspectors will reject for slaughter any animal known to have been exposed to rabies within the previous 8 months. Neither tissues nor milk from a rabid animal should be used for human or animal consumption. However, since pasteurization temperatures inactivate the rabies virus, drinking pasteurized milk or eating adequately cooked meat does not constitute a rabies exposure. 16 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Having more than one rabid animal in a herd or having herbivore to herbivore transmission of rabies is uncommon; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies is usually not necessary. For assistance, please contact the Division of Infectious Disease Epidemiology and/or the West Virginia Department of Agriculture. F. Wild or Exotic Animals The efficacy of injectable rabies vaccination of wildlife and hybrids (the offspring of wild animals‟ crossbred to domestic animals) has not been established, and no such vaccine is licensed for these animals. Wild or exotic animals bitten by a rabid animal should be euthanized immediately. Zoos or research institutions may establish vaccination programs which attempt to protect valuable animals, but these should not replace appropriate public health activities to protect humans from rabies exposures. Employees who work with animals at such facilities should receive pre-exposure rabies immunization. The use of pre- and post-exposure rabies vaccinations for employees who work with animals at such facilities might reduce the need for euthanasia of captive animals. 17 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 VI. Animal Exposure Records Local Health Departments should maintain written records of animal exposures according to local agency policies and procedures. Questions about management of animal exposures may be referred to DIDE. Rabies exposures of animals should not be reported in WVEDSS. 18 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 VII. Laboratory Analysis of Rabies Specimens Wild animal specimens should only be submitted for analysis when humans, pets or livestock have been exposed. For domesticated animals, it is recommended that head removal be accomplished by a licensed veterinarian. In the case of large animals (cows, horses, sheep, pigs. etc.) the brain must be removed by a veterinarian when the head of the animal is too large to ship. If the services of a veterinarian are not available, persons involved with the head removal should follow self-protection guidelines associated with any infectious disease and should be pre-immunized against rabies. If ectoparasites are evident (including fly larvae) on an animal head prior to the health department receiving it, it is suggested that prior to packaging the specimen, it should be sprayed with insecticide. Consult with laboratory staff for other unusual circumstances when dealing with specimens. Previously buried animals are not allowed for rabies testing. (Consult Appendix F: WVDHHR OLS Policy of Acceptance for Rabies Specimens). Care must be taken in the preparation and handling of all suspect specimens for shipping to the Office of Laboratory Services. Ideally, specimens should NOT be frozen and should be maintained at refrigerated temperatures. Freezing of a specimen does not necessarily exclude it from rabies testing. Consult Appendix D for instructions. If the only specimen available is frozen, ship the specimen without ice packs to allow thawing before arrival at OLS. It is possible that frozen samples may take an extra day for testing if not completely thawed upon arrival. NOTE: Specimens stored in automatic defrost freezers are more susceptible to degradation as a result of multiple freeze-thaw cycles. If a specimen must be frozen, store in a manual defrost freezer such as a chest freezer. Consult OLS if specimen handling and quality issues are not addressed in the appendices. 19 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendices A. B. C. D. E F. G. H I. J. K. Isolation Pen for Unvaccinated Dogs and Cats Exposed to Rabies Self-Protection Guidelines Resources for Obtaining Rabies Immune Titers WVDHHR OLS Rabies Specimen Submission Instructions OLS Rabies Laboratory Submission Form E-1 Specimen Submission Form Completed for Human Exposure E-2 Specimen Submission Form Completed for Pet/Domestic Animal Exposure E-3 Specimen Submission Form Completed for Active Surveillance WVDHHR OLS Policy for Acceptance of Rabies Specimens Animal Encounter Report (SG-58) Notice of Animal Quarantine (SG-59) Government Agency Regulations I-1 WVDHHR (Reporting of Animal Bites) I-2 WV Department of Agriculture (Chapter 19, Article 9: Diseases Among Domestic Animals) I-3 WV Department of Agriculture (Chapter 19, Article 20: Dogs and Cats) I-4 Chapter 20 Natural Resources Agency Roles and Responsibilities and Contact Information J-1 Local Health Department J-2 OEHS Public Health Sanitation Division J-3 WVDA J-4 WVDHHR J-5 USDA-APHIS-Wildlife Services J-6 County Sheriff J-7 WVDNR Assessment of Herpes B Transmission Risk from a Monkey Bite 20 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix A 21 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 22 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix B Self-Protection Guidelines Avoid direct skin or mucous membrane contact with the suspected animal and its body fluids before, during, and after removal of the head. To minimize contact use the following Universal Protection Precautions: A. Avoid splattering blood, etc.; wear a plastic apron or other suitable removable outer garment such as coveralls; wear rubber gloves and a face mask and safety goggles or face shield. B. All instruments and tools coming in contact with the suspected animal should be disinfected with bleach immediately after use. C. Protective clothing and gloves should be discarded in a plastic bag or other enclosed container or washed in a 10% bleach solution or other suitable disinfectant. D. The surface area used for the head removal should be disinfected immediately using a 10% bleach solution or other suitable disinfectant. E. If a self inflicted cut or wound occurs during the removal of the head, the wound should be cleaned with soap and water and a physician consulted as soon as possible. Sanitarians who will be removing animal heads or doing brainstem extractions should have pre-exposure vaccination. Thereafter, their rabies titers should be checked every 2 years (see Appendix D) and re-booster as necessary. 23 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix C Resources for Obtaining Rabies Immune Titers Atlantic Health Associates Services offered: Rabies Neutralizing Antibody Testing using the Rapid Fluorescent Focus Inhibition Test (RFFIT) for both human and animal specimens Contact Information: rnewhouse@atlantahealth.net Tel: (770)205-9091 Toll Free: (800)717-5612 Fax: (770)205-9021 Mailing Address: Atlanta Health Associates, Inc. 309 Pirkle Ferry Road, Suite D300 Cumming, Georgia 30040 www.atlantahealth.net Kansas State Veterinary Diagnostic Laboratory Services offered: Serologic testing of humans, serologic testing of animals for export to rabies free countries Contact Information: Diagnostic Laboratory Office Phone: 866-512-5650 Email: dlaboffice@vet.k-state.edu Fax: 785-532-4481 Mailing Address: Kansas State Veterinary Diagnostic Laboratory 1800 Denison Avenue Manhattan, KS 66506-5606 http://www.vet.ksu.edu/depts/dmp/service/rabies/index.htm 24 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix D OFFICE OF LABORATORY SERVICES MICROBIOLOGY SECTION RABIES UNIT RABIES TESTING GUIDANCE DOCUMENT TYPES OF SPECIMENS 1. BURIED ANIMALS WILL NOT BE ACCEPTED FOR TESTING. a. Small animals such as bats or small rodents can be sent whole. The sender should ensure that smaller animals are dead before shipping the specimen to the OLS Rabies Unit. b. Severed head of moderate-sized animal. c. Brain only of larger size animal such as a cow. NOTE: The services of a veterinarian should be used to sever the heads or the remove the brains of suspect animals immediately after the animal‟s death. Specimen should be submitted to the OLS Rabies Unit NO LATER THAN 48 hours after removal of head. RABIES SPECIMEN MAILING BOXES Specimen Mailing Boxes are provided to County Health Departments, Veterinarian clinics, and the West Virginia Department of Natural Resources. Each consists of the following: 2 PLASTIC BAGS: Specimen should be placed in a plastic bag and then placed in the second bag to ensure that no fluids will contaminate the box or leak out of the container. Both bags should be tied to prevent leakage. VINYL ZIPPER BAG: Double bagged specimen should be placed in the zipper bag to serve as added to protection against any leaks. 2 REFRIGERANTS: Two refrigerants or ice packs should be placed in zipper bag near specimen. Placing the ice packs in the zipper bag will ensure that any leakage will be contained if the refrigerants were to rupture. TEST REQUEST/SUBMISSION FORM: Please provide all information requested on the Test Request/Specimen Submission form. When completed, the form should be placed on the lid of the mailing box, away from the specimen. OUTER MAILING BOX: The outer box has a white label which states: PROPERTY OF THE OFFICE OF LABORATORY SERVICES/167 11th AVENUE/SOUTH CHARLESTON, WV 25303. PRE-ADDRESSED LABEL: After the specimen is properly packaged. The box should be taped closed and the pre-addressed label should be affixed to the outside of the box. UN3373 LABEL DIAGNOSTIC: Affix UN3373 Biological Specimen label to the outside of the box. 25 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 NOTE: Newspaper or any absorbent material can be used to prevent smaller samples from shifting inside the container. DO NOT USE STYROFOAM PEANUTS OR SHREDDED PAPER TO PACK SPECIMEN. In the event of a specimen leak, the peanuts or shredded paper would pose a larger contamination threat to the technician. SPECIMEN SUBMISSION REQUIREMENTS 1. 2. 3. 4. 5. 6. Notify the OLS Rabies Unit in advance regarding submission of specimen. It is important to inform the technician what type of exposure was involved (Human or pet). The kit is designed to hold the severed head of moderate-size animals. It can also serve to hold the BRAIN ONLY of larger-size animals such as a cow, horse, etc. OLS strongly recommends using only the boxes provided. Complete all the required information LEGIBLY on the Rabies Test Request/Specimen Submission Form. No living animals will be accepted for Rabies testing. Smaller animals involved in an exposure should be euthanized HUMANELY. Specimens brought to the OLS after work hours can be placed in the dock refrigerator. The Rabies Unit must be notified prior to placing any specimen in the dock refrigerator. Call the Rabies Unit if you have any questions. SHIPPING Rabies specimens are considered „Category B‟ and are to be shipped following IATA Packing Instruction 650. All specimens packaged in the provided Rabies Mailing Box can be sent by the United State Postal Service (USPS), United Parcel Services (UPS) or any other carrier that accepts diagnostic specimens AS LONG AS the proper labeling is placed in a visible area of the shipping container. BIOHAZARD LABELS SHOULD NOT BE PLACED ON THE OUTSIDE OF THE SHIPING CONTAINER. VACCINATION RECOMMENDATIONS Any questions concerning vaccination recommendations should be addressed to: DIVISION OF INFECTIOUS DISEASE EPIDEMIOLOGY (304) 558-5358 -or- 1-800-423-1271 (In West Virginia only) RABIES UNIT CONTACT INFORMATION Work Hours | Monday through Friday from 8:00am to 4:30pm (OLS observes all State and Federal holidays.) Phone | (304) 558-3530 extension(s) 2611 / 2613 / 2602 Fax | (304) 558-6210 Pager | (304) 361-9066 (after Work Hours on weekdays, weekends, or holidays) 26 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 27 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix E 28 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix E-1 Specimen Submission Form Completed for Human Exposure 29 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix E-2 Specimen Submission Form Completed for Pet/Domestic Animal Exposure 30 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix E-3for Human Exposure Specimen Submission Form Completed Specimen Submission Form Completed for Active Surveillance 31 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix F Office of Laboratory Services Policy for Acceptance of Rabies Specimens 1.0 PURPOSE The purpose of this policy is to set forth policy updates for the acceptance of specimens (animal) to the Rabies Unit of the Microbiology Section of the OLS. 2.0 SCOPE This policy applies to all specimens (animal) received at OLS. 3.0 APPLICABLE DOCUMENTS/MATERIAL 3.1 Rabies Procedure Manual, OLS. 3.2 Protocol for Postmortem Diagnosis of Rabies in Animal, CDC. 4.0 RESPONSIBILITY/REQUIREMENTS 4.1 Acceptable Specimens 4.1.1 Severed heads of animals, so long as the head fits within the specimen collection box provided by OLS. 4.1.2 Whole animals such as bats and small rodents. 4.1.3 Brain only of large animals such as cow, horse, etc. 4.2 Unacceptable Specimens 4.2.1 Large, whole animals such as raccoon, skunks, etc. 4.2.2 Animals that have been buried. 4.2.3 Animals dead longer than 7 days. 4.2.4 Animals with extensive, severe head trauma. 4.3 Animals That Have Been Shot in the Head 4.3.1 OLS will accept animals that have been shot in the head. 4.3.2 Animals which have significant head trauma and those which are bleeding from the ears should not be submitted for testing. 4.3.3 It is at the sole discretion of the Rabies Unit technologists to determine whether or not the animal head is acceptable for testing. 32 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 4.4 Acceptance Timeline 4.4.1 Animals which have been dead for less than 5 days are suitable for testing submission. 4.4.2 Animals which have been dead for 5 to 7 days are questionable for testing submission. It is at the sole discretion of the Rabies Unit technologist to determine whether or not the animal head is acceptable for testing. 4.5 Maintaining Policies 4.5.1 OLS/Microbiology Section is responsible for posting and maintaining this policy. 4.5.2 Approved policies remain in effect and are only replaced at the issuance of a new or modified policy. 4.5.3 Any modified or temporary policy that materially effects the usage rights or responsibilities of employees will be communicated to employees by e-mail. 4.5.4 Employees must also sign an acknowledgement for which can be found at the end of this policy. 4.6 Access and Distribution 4.6.1 This policy is available in the Policy Manual located in the Microbiology Office and in the Rabies Procedure Manual. 4.6.2 This policy will be distributed to Rabies Unit employees via e-mail distribution. 5.0 DEFINITIONS 5.1 Employee: Individuals employed on a temporary or permanent basis by DHHR, BPH, OLS, as well as contractor‟s employees, volunteers, and individuals who are determined by the Bureau or Office to be subject to this policy. For the purposes of this policy, this refers to anyone working in the Rabies Unit of the Microbiology Section of the OLS. 33 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix G Animal Encounter Form 34 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix H Notice of Animal Quarantine 35 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix I-1 Reportable Disease Rule (WVDHHR) §64-7-5. Other Reportable Events: Potentially Rabid Animal Bites, Rabid Animals, Rabies PreExposure Vaccinations and Post-Exposure Prophylaxis. 5.1. If a person is bitten, scratched, or otherwise exposed (gets saliva, neural tissue, or other potentially infectious fluid into an open cut, wound, or mucous membrane) to an animal which has or is suspected of having rabies, then the incident, including the person‟s full name, date of birth, and address, shall be reported to the local health officer within twenty-four hours, by phone, or preferably by WVEDSS, by the following individuals: 5.1.a. The physician or other health care provider caring for or observing the person; 5.1.b. The veterinarian or animal health care provider; 5.1.c. The person bitten, scratched, or otherwise exposed, if no physician or other health care provider is in attendance and the person bitten, scratched or otherwise exposed is an adult; 5.1.d. Whoever is caring for the person, if no physician or other health care provider is in attendance and the person bitten, scratched, or otherwise exposed is incapacitated; or 5.1.e. The parent or guardian, if no physician or other health care provider is in attendance and the person bitten, scratched or otherwise exposed is a child. 5.2. The local health officer shall report within twenty-four hours to the commissioner the name, date of birth, address, circumstances of the exposure, and action taken for every person bitten, scratched, or otherwise exposed to an animal which has or is suspected of having rabies. 5.3. If the animal is a domestic dog, cat or ferret, the local health officer shall make a reasonable attempt to determine the animal's owner, and, if successful, shall direct the owner to confine the animal for a period of ten days. The owner of the dog cat or ferret, county humane officer, dog warden or sheriff shall notify the local health officer immediately if the animal shows symptoms compatible with rabies or dies, and the local health officer, county humane officer, dog warden or sheriff shall arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 5.4. If the local health officer cannot determine the owner of the domestic dog cat or ferret, he or she shall direct the county humane officer, dog warden or sheriff to pick up the suspect dog cat or ferret, that has bitten a person and confine it in isolation for a period of ten days. If the animal shows symptoms compatible with rabies, including if the animal bit someone without provocation, or if the animal demonstrates aggressive behavior toward human beings such that the animal may pose a continuing risk to other people, the local health officer shall direct the county humane officer, dog warden, sheriff, or other designee to humanely destroy the animal and arrange for appropriate examination of the animal‟s brain. If the animal dies, the local health officer shall arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 36 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 5.5. If a person is reported bitten by any animal having or suspected of having rabies other than a domestic dog cat or ferret, especially a wild mammal or hybrid, the local health officer may direct the county humane officer, dog warden, sheriff, or other designee to have the animal humanely destroyed immediately and to arrange for appropriate examination of the animal‟s brain at the office of laboratory services. 5.6. Any person who becomes aware of the existence of an animal apparently afflicted with rabies shall report the existence of the animal, the place where it was last seen, the owner's name, if known, and the symptoms suggesting rabies to the local health officer immediately. 5.7. Health care providers, health care facilities, local health officers and other facilities administering rabies pre-exposure vaccination or post-exposure prophylaxis shall report vaccinations and treatment administered to WVEDSS. 37 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 Appendix I-2 Chapter 19, Article 9 Excerpts Diseases Among Domestic Animals West Virginia Department of Agriculture …. §19-9-2. Duties and powers of commissioner. It shall be the duty of the commissioner, and he shall have authority: (a) To prevent, suppress, control and eradicate any communicable diseases of animals or poultry; (b) To make and enforce such rules and regulations as may be necessary to effectuate the provisions of this article; …. (d) To make or cause to be made any investigations he may deem advisable regarding the causes and methods of preventing, controlling and eradicating diseases of animals or poultry, and exercise such other powers and perform such other duties as may be proper or necessary to prevent the spread of, eradicate or control any communicable disease among animals or poultry, including the power to promulgate, issue, and enforce regulations prohibiting the feeding of garbage to swine unless said garbage has been thoroughly heated to a temperature of at least 212 degrees F for at least thirty minutes or treated in some other manner equally effective for the prevention of swine diseases and the protection of public health, such regulations not to apply to any individual who feeds only his own household garbage to swine which are raised for such individuals' own use; (e) To prohibit the importation into this state of animals and poultry, when necessary to prevent the spread of disease; (f) To cause general or special quarantine of premises and of animals and poultry to be established and maintained; (g) To cause the disinfection of any premises; (h) To cause the destruction of diseased animals, when such animals are deemed diseased as a result of physical examination or an approved test, and of infected personal property, and to regulate and prohibit the moving or transportation of such animals or property from one place to another in this state; (i) To have charge of the enforcement of the provisions of this article and the laws of the state relating to diseases of animals and poultry, and the manufacture, preparation, storage, sale and offering for sale of the food and food products derived from diseased animals and poultry. §19-9-3. Consulting veterinarians to assist commissioner. The commissioner shall have authority to appoint, subject to dismissal by him at any time, such 38 West Virginia Department of Health and Human Resources, Bureau for Public Health, June, 2010 consulting veterinarians as may be necessary from time to time to assist him in discharging the duties imposed upon him by this article. Each consulting veterinarian shall be registered as required by article ten, chapter thirty of this code, and shall receive a per diem, and actual expenses, to be determined by the commissioner, for the time actually engaged in carrying out the directions of the commissioner, which per diem and expenses shall be paid out of the current appropriation made for the enforcement of this article. Whenever any incorporated city of this state shall have in its employ any veterinary sanitary officer engaged in the inspection of meat, milk or animals, and such officer is a registered veterinarian as aforesaid, the commissioner may appoint such city veterinary sanitary officer a consulting veterinarian, but such officer shall not be entitled to compensation or expenses from both the state and city for the same service. §19-9-4. Inspectors of animals. The commissioner may appoint, at different points in the state, inspectors to examine and inspect any of the animals enumerated in this article which are to be moved to states where the sanitary laws require such examination and inspection, with authority to issue certificates of inspection in the name of the state department of agriculture in such form as the commissioner may prescribe. Such inspectors shall be registered veterinarians, and the appointment of any such inspector may, at any time, be revoked by the commissioner. The commissioner shall regulate and fix the fees to be charged by the inspector, which fees shall be paid by the owner requesting such examination and inspection, and the inspector shall receive no compensation from the state for any such service he may render. Upon the request of any owner for an examination and inspection of such animals and tender of the fees authorized to be charged therefor, it shall be the duty of the inspector to examine and inspect such animals and to issue and deliver to such owner a certificate of inspection showing the results of such examination and inspe