Page 958 - Clinical Small Animal Internal Medicine

896 Section 9 Infectious Disease

rescue efforts has led to dramatic increases in animal Bats and Public Health
VetBooks.ir translocation. Rabid dogs have been imported into the Bats represent a special case when it comes to rabies.
US several times. As a result of the increasing number
Rabid insectivorous bats may transmit rabies via very
of imported dogs and an increase in noncompliance
with import regulations, dog import requirements in shallow bites, even bites that do not bleed. In fact, two
bat variants appear to have greater ability to infect
the US were modified in 2014 to reduce the risk of through shallow bites than the canine variant. Clinic
importing rabies.
staff may hear about clients or staff who have handled
CDC Requirements bats. They should urge such people to seek public health
As of 2019, a health certificate is not required to or medical consultation. Bats found near pets, children
import a dog or cat, but the imported pet must appear or sleeping people, or people with lowered levels of con-
healthy on arrival. Importers of dogs must provide sciousness, may have bitten a person or pet, and rabies
proof of rabies vaccination when the dog is imported testing of the bat should be prioritized. If the bat is not
from countries designated as high‐risk for rabies tested, it should be assumed to have been rabid for
importation (see www.cdc.gov/importation/bringing‐ the sake of safety, and the exposed person needs to be
an‐animal‐into‐the‐united‐states/rabies‐vaccine. referred for medical care.
html). The vaccination must have been given 28 days
or more before entry, when the dog was at least 3
months of age. Oral Rabies Vaccination and Public Health
Unvaccinated dogs may only be imported if they Clients and their pets may encounter oral rabies vaccines
have lived in a country with a very low risk for rabies (ORVs) that are intended for wildlife. ORVs distributed in
exposure for the past six months or longer, are being wildlife habitats in North America and Europe have been
imported for research purposes, or on a rare case‐by‐ very successful in controlling the spread of rabies in rac-
case basis. See www.cdc.gov/importation/bringing‐ coons, coyotes, and foxes. Government agencies typically
an‐animal‐into‐the‐united‐states/index.html. work to alert the local population as to when and where
USDA Requirements the baits are being distributed. These vaccines contain a
The US Department of Agriculture (USDA) requires live, attenuated Vaccinia virus‐vectored rabies recombi-
dogs and cats to be at least 8 weeks old when shipped nant liquid vaccine in a packet surrounded by a flavored
without their mothers. Dogs imported specifically for bait. There is no live rabies virus in the vaccine. The
resale or adoption (i.e., importation by international Vaccinia virus may cause illness in immunocompromised
dog rescue groups) must be healthy, at least 6 months people if the liquid vaccine comes into contact with
old and be accompanied by a health certificate, rabies abraded skin or mucous membranes. Human exposure to
certificate, and proof of vaccination against distem- ORVs is rare. During 10 years of distribution of over 86
per, leptospirosis, parvovirus, and parainfluenza million ORVs in 18 states, only 296 incidents of human
(DHLPP). See www.aphis.usda.gov/aphis/pet‐travel/ exposure were reported, with six illnesses. Most people
bring‐pet‐into‐the‐united‐states. were exposed when trying to remove the bait from their
Federal, state, and local regulations regarding pet dog’s mouth. Clients should be advised to keep their dogs
importation may vary over time, and can include leashed when in areas that are part of an ORV baiting
additional requirements depending on the animal’s program. If a client may have had direct contact with the
country of origin. Veterinarians are recommended liquid vaccine inside the bait, they should wash their
to check the latest information on the websites for hands, and collect the vaccine without touching it directly,
both CDC and USDA‐APHIS as well as any addi- such as by wearing gloves or covering their hand with a
tional requirements from US Customs and Border bag. There is a toll‐free phone number printed on the side
Protection (https://help.cbp.gov/app/answers/ of the ORV bait that the person should call to report the
detail/a_id/3695/kw/3695) and from the state incident and seek medical consultation.
where the animal is arriving.
Unfortunately, many imported dogs and cats are not
physically inspected on arrival, so it is still possible Rabies Preexposure Prophylaxis for Humans
that sick animals, or those incubating rabies, will be The CDC recommends preexposure vaccination for all
imported. Private practice veterinarians play a crucial people who routinely handle animals. Clinical staff, such
role in detecting imported cases of rabies, since they as veterinarians and veterinary technicians, should be
may the first person to examine the pet after arrival. If prevaccinated against rabies. The preexposure vaccine
a clinician suspects an imported pet has rabies or any series consists of three intramuscular human rabies vac-
other unusual disease, they should immediately con- cinations given on days 0, 7, and either 21 or 28. Antibody
tact their local authorities. titer levels should be checked every two years to insure