Given the recent confirmation of Rabies in animals in our area, now is a great time to cover this very important topic. But what is Rabies, exactly?
Rabies is an acute viral infection resulting in encephalomyelitis that is nearly always fatal to both humans and other mammals who contract it. The rabies virus proliferates in neural tissue and is found in high concentration in saliva following replication in the salivary glands.
The rabies virus may be transmitted when saliva or neural tissue of an infected animal is introduced into the body, usually through a bite or scratch. Fresh saliva and neural tissue can also be infectious if introduced onto a mucous membrane or a fresh break in the skin. Exposure to blood, urine or other bodily fluids from a known or suspected rabid animal are not considered exposures.
Post-exposure prophylaxis (PEP) for any exposed human combines wound treatment, local infiltration of rabies immune globulin (RIG), and vaccination, which has been shown to be uniformly effective when appropriately administered.
South Carolina State Law Mandates Reporting of Animal Bites. Animal (mammal) bites are a reportable condition in South Carolina. As mandated by State Code of Laws Section 47-5-90. Potential exposures from animal bites are an urgently reportable condition under the SC List of Reportable Conditions. Reports are to be made by phone within 24 hours of a provider's attendance on the patient, or of the provider receiving a report of a bite from a patient. See DHEC Contacts for Reporting or Medical Consultation. Reports of animal incidents may also be faxed to DHEC using the DHEC Form 1799 'Animal Incident Report'.
Administration of rabies PEP to exposed humans is a medical urgency, not considered a medical emergency according to the Department of Health and Environmental Services. The Advisory Committee on Immunization Practices advises that clinicians seek assistance from public health officials when needed, in order to evaluate the risk of rabies and determine if PEP is recommended given the circumstances of the exposure. A consultation with public health officials is known to reduce unnecessary rabies PEP, since they have expertise in the epidemiology of animal rabies and the indications for post-exposure treatment. DHEC physicians are available for medical consultations. Refer to the DHEC Contacts for Reporting or Medical Consultation if you need assistance.
Determining if PEP is indicated is based on a number of variables. The following criteria should be taken under consideration:
Is the animal available for quarantine/observation or rabies testing?
Did the exposure result in an observed wound like a bite or scratch?
Was there mucous membrane exposure?
Could there potentially be an unrecognized wound from a bat?
The severity and location of the wound do not alone determine if PEP is indicated, but may dictate the urgency of treatment if needed.
The epidemiology of animal rabies - including where the exposure occurred and the animal species involved.
The circumstances of the exposure - including whether or not there was an unprovoked attack and whether the animal exhibited abnormal behavior.
If you are in the Florence area and you may have been exposed to the Rabies virus, clean the wound immediately and thoroughly, then contact DHEC (during business hours call 843-661-4835 and after business hours call 888-847-0902) immediately, fill out a DHEC incident report, and DHEC will advise you further.
Bat Exposures
The majority of human rabies cases reported in the United States in the last few decades have been attributed to exposures to bats that were unrecognized as a risk for rabies transmission.
Bat bites cause minimal trauma making identification of a wound difficult. A potential exposure to a bat requires a thorough evaluation if the bat is not available for testing. Bat exposures are defined as:
Waking up to find a bat in your room;
Finding a bat where children, pets, or persons with impaired mental capacity (intoxicated or mentally disabled) have been left unattended;
A pet or person that has been in direct contact with a bat.
If possible, bats involved in potential human exposures should be safely collected and submitted to DHEC for rabies testing. The majority of bats submitted for testing are not rabid. Timely rabies testing will eliminate the need for risk assessments and unnecessary prophylaxis.
PEP may be indicated if a potential bat exposure cannot be ruled out. If the person can be reasonably certain a bite, scratch, or mucous membrane exposure did not occur, or the bat tested negative for rabies, post-exposure prophylaxis is not necessary.
There are both wild and domestic animals that many people think are a risk for Rabies but generally are not at risk of carrying the infection. That list includes rabbits, squirrels, chipmunks, rats, mice, guinea pigs, gerbils, hamsters, and possums/opossums. Furthermore, non-mammals (birds, reptiles, fish, and insects) cannot contract Rabies at all. Most livestock and farm animals are also at extremely low risk for the infect.
Tips to avoid being exposed:
1. Keeping your pets fully vaccinated and encouraging neighbors and surrounding family members to keep their pets up to date on Rabies vaccination can decrease your chances of exposure.
2. Some pets other than dogs and cats, such as ferrets, should also be vaccinated for Rabies.
3. If you see a wild or feral mammal of any kind (fox, raccoon, skunks, coyote, feral cat, stray dog, bat, etc.) it is best to err on the side of caution and keep a considerable distance from the animal in question.
If you have further questions about Rabies virus exposure in humans, you can contact the DHEC Helpline at 1-855-472-3432 (1-855-4-SCDHEC).
For further reference, please check out the nifty flow chart below!
Comments