Rabies

How do I obtain Rabies vaccination?
(Post Exposure Immunization)
See your family doctor or go to a hospital emergency room. Have the physician consult with the Arkansas Department of Health (501-661-2000) on the necessity for treatment. If you have been exposed to a rabid or suspect rabid animal post-exposure treatment is effective with the following products. The physician can obtain the vaccines from their pharmaceutical suppliers. The Health Department does not maintain a supply of vaccine but is always available for consultation on the risk of rabies from any exposure.

Type	Name	Route	Indications
Human Diploid Cell Vaccine (HDCV)	Imovax® Rabies	Intramuscular	Preexposure or Postexposure
Purified Chick Embryo Cell Vaccine (PCEC)	RabAvert®	Intramuscular	Preexposure or Postexposure
Human Rabies	Imogam®	Local infusion at wound site, with additional	Postexposure
Immune Globulin	Rabies-HT	amount intramuscular at site distant from vaccine
Human Rabies Immune Globulin	HyperRab TM S/D	Local infusion at wound site, with additional amount intramuscular at site distant from vaccine	Postexposure

Post-exposure Rabies treatment includes five (5) doses of Human Diploid Cell Vaccine in addition to administration of Human Rabies Immune Globulin (HRIG) at the rate of 2 ml for every 33 lbs of body weight. HRIG is administered around the bite if in a fleshy area; otherwise, inject the HRIG into the gluteal muscle. Administer the total dose of immune globulin on day 0. One dose of HDCV is administered on each of Days 0, 3, 7, 14, and 28.

*10 ml of (HRIG) will treat a 165 lb person, and a 2 ml vial will treat a 33 lb person. Doctor’s fees for administering the vaccine should be no different from those charged for other vaccination procedures. (Individuals with financial difficulties may contact Aventis Pasteur at 1(800)-VACCINE or Chiron Corp at 1-(800)-775-7533. You may be eligible for their indigent vaccination program.)

Will the rabies vaccine make me sick?
Adverse reactions to rabies vaccine and immune globulin are not common. Newer vaccines in use today cause fewer adverse reactions than previously available vaccines. Mild, local reactions to the rabies vaccine, such as pain, redness, swelling, or itching at the injection site, have been reported. Rarely, symptoms such as headache, nausea, abdominal pain, muscle aches, and dizziness have been reported. Local pain and low-grade fever may follow injection of rabies immune globulin.

What if I cannot get rabies vaccine on the day I am supposed to get my next dose?
Consult with your doctor or state public health officials for recommended times if there is going to be a change in the recommended schedule of shots. Rabies prevention is a serious matter and changes should not be made in the schedule of doses.

Can rabies be transmitted from one person to another?
The only well-documented documented cases of rabies caused by human-to-human transmission occurred among 8 recipients of transplanted corneas, and recently among three recipients of solid organs (see MMWR article). Guidelines for acceptance of suitable cornea and organ donations, as well as the rarity of human rabies in the United States, reduce this risk. In addition to transmission from cornea and organ transplants, bite and non-bite exposures inflicted by infected humans could theoretically transmit rabies, but no such cases have been documented. Casual contact, such as touching a person with rabies or contact with non-infectious fluid or tissue (urine, blood, feces) does not constitute an exposure and does not require postexposure prophylaxis. In addition, contact with someone who is receiving rabies vaccination does not constitute rabies exposure and does not require postexposure prophylaxis.

What are the symptoms of Rabies?
Rabies causes fatal inflammation of the brain and spinal cord. Symptoms usually develop in three to eight weeks after exposure. Early symptoms in humans include pain, burning, and numbness at the site of infection. Victims complain of headaches, inability to sleep, irritability, muscle spasms of the throat and difficulty swallowing. Loss of ability to control one’s movements occurs, followed by delirium, coma, and death in about one to three weeks.

Is there a cure for Rabies?
No, once symptoms appear, death follows in a few days.

How can I protect my pet from rabies?
There are several things you can do to protect your pet from rabies. First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs. Arkansas state law requires a yearly rabies vaccination, given by a licensed veterinarian, for all dogs and cats. Second, maintain control of your pets by keeping cats and ferrets indoors and keeping dogs under direct supervision. Third, spay or neuter your pets to help reduce the number of unwanted pets that may not be properly cared for or vaccinated regularly. Lastly, call animal control to remove all stray animals from your neighborhood since these animals may be unvaccinated or ill.

Why does my pet need the rabies vaccine?
Although the majority of rabies cases occur in wildlife, most humans are given rabies vaccine as a result of exposure to domestic animals. This explains the tremendous cost of rabies prevention in domestic animals in the United States. While wildlife are more likely to be rabid than are domestic animals in the United States, the amount of human contact with domestic animals greatly exceeds the amount of contact with wildlife. Your pets and other domestic animals can be infected when they are bitten by rabid wild animals. When "spillover" rabies occurs in domestic animals, the risk to humans is increased. Pets are therefore vaccinated by your veterinarian to prevent them from acquiring the disease from wildlife, and thereby transmitting it to humans.

Dogs, cats, and ferrets should be quarantined for 10 days. Depending on the circumstances of the bite and the nature of the animal involved, confinement may be required to be in a veterinary clinic, a public pound, or may be allowed to be done at home. Costs of confinement are the owner’s responsibility. If the animal is well 10 days after the bite occurred, it could not have transmitted Rabies, and may be released from quarantine. If a dog, cat, or ferret appeared ill at the time it bit you or becomes ill during the 10 day quarantine, it should be evaluated by a veterinarian for signs of rabies and submitted for rabies testing.

You should seek medical evaluation for any animal bite. However, rabies is uncommon in dogs, cats, and ferrets in the United States. Very few bites by these animals carry a risk of rabies. If the cat (or dog or ferret) appeared healthy at the time you were bitten, it can be confined for 10 days and observed. No anti-rabies prophylaxis is needed. No person in the United States has ever contracted rabies from a dog, cat or ferret held in quarantine for 10 days.

The quarantine period is a precaution against the remote possibility that an animal may appear healthy, but actually be sick with rabies. To understand this statement, you have to understand a few things about the pathogenesis of rabies (the way the rabies virus affects the animal it infects). From numerous studies conducted on rabid dogs, cats, and ferrets, we know that rabies virus inoculated into a muscle travels from the site of the inoculation to the brain by moving within nerves. The animal does not appear ill during this time, which is called the incubation period and which may last for weeks to months. A bite by the animal during the incubation period does not carry a risk of rabies because the virus is not in saliva. Only late in the disease, after the virus has reached the brain and multiplied there to cause an encephalitis (or inflammation of the brain), does the virus move from the brain to the salivary glands and saliva. Also at this time, after the virus has multiplied in the brain, almost all animals begin to show the first signs of rabies. Most of these signs are obvious to even an untrained observer, but within a short period of time, usually within 3 to 5 days, the virus has caused enough damage to the brain that the animal begins to show unmistakable signs of rabies. As an added precaution, the quarantine period is lengthened to 10 days.

What happens if my pet (cat, dog, ferret) is bitten by a wild animal?
Any animal bitten or scratched by either a wild, carnivorous mammal or a bat that is not available for testing should be regarded as having been exposed to rabies. Unvaccinated dogs, cats, and ferrets exposed to a known rabid animal should be euthanized immediately. If the owner is unwilling to have this done, Arkansas state law requires the animal be placed in strict isolation for 6 months and vaccinated 1 month before being released. Animals with expired vaccinations need to be evaluated on a case-by-case basis. Dogs and cats that are currently vaccinated are kept under observation for 90 days.

Can Rabies be transmitted by a secondary object?
Rabies has never been transmitted from a secondary object such as the ground where a rabid animal was lying. Tools used in picking up the animal or a stick used to push an animal into a bag, for example, should NOT be considered dangerous once any saliva present has dried. It would be sensible to use precautions such as wearing gloves when handling a suspect rabid animal’s body, or to take precautions to prevent saliva from contacting the eyes or mouth.

Do all animals show the same symptoms?
No. Animals may appear to be either “dumb” or “furious”, depending on how the infection affects their brain.

What are some of the symptoms of “dumb” Rabies?
Drooping jaw; salivating; appearance of choking; less active than usual; seeking affection or avoiding people; progressive paralysis and death within 5 days.

What are some of the symptoms of “furious” Rabies?
Highly excitable and restless; changes in personality; hiding in dark places; refusing food; trying to break out; snapping at most moving objects; eating sticks and stones.

I am moving to a rabies-free country and want to take my pets with me. Where can I get more information?
The details of regulation about importing pets into rabies-free countries vary by country. Check with the embassy of your destination country or contact USDA/APHIS which regulates importation and exportation of animals in the United States. More information is available at: http://www.aphis.usda.gov/animal_welfare/pet_travel/content/wp_c_pet_travel_tips.shtml

Where should animal heads be sent for Rabies testing?
Specimens should be sent to the Arkansas Department of Health Public Health Laboratory at 302 S. Monroe St., Little Rock.

The head of the animal suspected to be infected with the rabies virus must be removed before submission to the laboratory. Do not shoot or damage the animal head in any form as it may result in rejection of the specimen. It is recommended that a veterinarian remove the animal’s head. Whole animals are not acceptable. After removal of the head, the head must remain refrigerated, not frozen, until the laboratory can process the specimen.

Specimens can be taken to a local health unit for submission. The local health units for each county are responsible for shipment of the animal head to the laboratory. ADH courier service is provided for all health units in the state and will pick up rabies specimens for delivery to the laboratory. Each health unit should have shipping containers consisting of an insulated bucket (secondary container) containing a gel pack, watertight zip lock bag (primary container) and a rabies submission form. Gel packs should be frozen prior to submission to keep the specimen cool during transport. Wet ice or dry ice should not be used.

Rabies samples may be hand delivered to the laboratory or shipped by UPS or through the ADH courier service that serves all of the county health units. The laboratory is not responsible for transport of the specimen. It is the responsibility of the submitting agency, health unit, veterinarian or individual to ensure that the specimen integrity is preserved during shipment. If received in an unsatisfactory condition, the laboratory may reject the specimen.

Large animals such as cows should be taken to the Arkansas Livestock and Poultry Commission (ALPC) for removal of the head and preparation for testing, although a nominal fee is charged for disposal of the carcass and transportation of the specimen to the laboratory. Their phone number is 501-907-2430.

I submitted a specimen to the laboratory for testing and the laboratory did not test it. Why was my specimen rejected?
Samples that are decomposed, damaged or formalinized are unsuitable for testing. Do not shoot or damage the animal head in any form. A correctly submitted specimen must also possess the three following parts of the brain tissue of the animal: brain stem, hippocampus and cerebellum.

Decomposed specimens are rejected because bacteria in the tissue can interfere with the test. The test is called a DFA (direct fluorescent antibody). It is a test in which the brain tissue is mounted on a slide and observed under the microscope. If the rabies virus is present it will fluoresce on the slide and produce an apple-green color visible with a fluorescent microscope. Bacteria can interfere with this process. Also, decomposed brain tissue sections are difficult to distinguish from other parts of the brain.

Damaged specimens that arrive at the lab are tested by removing any or all of the required sections that are still intact. If the result is negative, the sample is rejected because a correct result cannot be reported without all three sections of the brain. If the result is positive, the sample is reported as positive.
In summary, do not shoot or damage the animal’s head and keep the head refrigerated at all times after removal from the animal’s body until it can be tested at the laboratory. This will preserve the integrity of the specimen.

How long does it take to get a result?
If the specimen is received before 10:00 am on a given day, results should be ready by the end of the working day at 4:30 pm. If received after 10:00 am, the specimen is tested the next working day unless the situation is an emergency. If for some reason, the test fails, the specimens will be retested the following day unless of an emergency.
Results are called directly to the submitting facility by the laboratory’s administrative area or by the analyst conducting the test. If a result is positive, an epidemiologist or physician is notified as well as anyone with an exposure to the animal, so that proper treatment can be administered to the exposed.

What is considered an emergency situation?
Face-bites to a human being from a suspected infected animal are considered emergency situations and the laboratory will test the suspected animal. A family physician should be notified immediately as well as the ADHHS Epidemiology department. If bitten on the face, seek help as quickly as possible.

Is there a fee for the rabies virus test?
No, the laboratory does not charge for the rabies virus test. It is offered as a public health service to the community. Veterinarians may charge for removal of the head and for transportation costs for submission to the rabies laboratory. ALPC also charges to remove brain tissue from large animals and for disposal of the carcass and transportation of the specimen to the laboratory. The laboratory is not responsible for any charges.

What animals may transmit rabies to humans?
Any animal that is infected with Rabies may transmit it to humans. In Arkansas, the most commonly infected animals are skunks and bats.

Rabies in raccoons is rare in Arkansas and has only been documented once. Arkansas does not have the raccoon variant, or type, of rabies, which is very common in all of the eastern states. But this does not mean a raccoon cannot get rabies from skunks or bats, and contact with raccoons should be avoided.

Opossums and rodents almost never have Rabies, and a bite does not require postexposure Rabies treatment unless the brain tests positive for Rabies virus. Questions about individual cases should be referred to the Veterinary Public Health Office for consultation (501-28904136).

What is the danger of capturing and keeping wild animals as pets?
Arkansas Game and Fish regulations prohibit taking some wild animals as pets. Skunks and bats are prohibited as pets if taken in the wild. Any animal taken from the wild and domesticated is dangerous, and the experience often ends in disaster for the animal or the adoptive family.

How often should I have my pet raccoon or skunk vaccinated?
There are no approved Rabies vaccines for wild animals except ferrets. Veterinarians may vaccinate wild animals but must state on the vaccination certificate that it is unknown whether or not the vaccine will be effective

What is the quarantine period that applies to wild animals?
There is no applicable quarantine period for animals other than dogs, cats, or ferrets. There are no studies which determine the length of time that other animals may be infected before they show symptoms or have Rabies virus in their saliva.

Do bats get rabies?
Yes. Bats are mammals and are susceptible to rabies, but most do not have the disease. You cannot tell if a bat has rabies just by looking at it; rabies can be confirmed only by having the animal tested in a laboratory. To minimize the risk for rabies, it is best never to handle any bat.

Why should I learn about bats and rabies?
Most of the recent human rabies cases in the United States have been caused by rabies viruses from bats. Awareness of the facts about bats and rabies can help people protect themselves, their families, and their pets. This information may also help clear up misunderstandings about bats.

When people think about bats, they often imagine things that are not true. Bats are not blind. They are neither rodents nor birds. They will not suck your blood -- and most bats do not have rabies. Bats play key roles in ecosystems around the globe, from rain forests to deserts, especially by eating insects, including agricultural pests. The best protection we can offer these unique mammals is to learn more about their habits and recognize the value of living safely with them.

Rabies in humans is rare in the USA. There are usually 1-2 human cases per year. The most common source of human rabies in the USA is from bats. For example, among the 19 naturally acquired cases of rabies in humans in the USA from 1997-2006, 17 were associated with bats. Among these, 14 patients had known encounters with bats. Four people awoke because a bat landed on them and one person awoke because a bat bit him (these events occurred within their primary residences). One person was reportedly bitten by a bat from outdoors while he was exiting from his residence. Six persons had a history of handling a bat while removing it from their primary residences. One person was bitten by a bat while releasing it outdoors after finding it on the floor inside a building. One person picked up and tried to care for a sick bat found on the ground outdoors. Three males ages 20, 29 and 64 had no reported encounters with bats but died of bat-associated rabies viruses.

What do I do if I come in contact with a bat?
If you are bitten by a bat -- or if infectious material (such as saliva) from a bat gets into your eyes, nose, mouth, or a wound -- wash the affected area thoroughly and get medical attention immediately. Whenever possible, the bat should be captured and sent to a laboratory for rabies testing.
People usually know when they have been bitten by a bat. However, because bats have small teeth which may leave marks that are not easily seen, there are situations in which you should seek medical advice even in the absence of an obvious bite wound. For example, if you awaken and find a bat in your room, see a bat in the room of an unattended child, or see a bat near a mentally impaired or intoxicated person, seek medical advice and have the bat tested.
People cannot get rabies just from seeing a bat in an attic, in a cave, or at a distance. In addition, people cannot get rabies from having contact with bat guano (feces), blood, or urine, or from touching a bat on its fur (even though bats should never be handled!).

What should I do if I find a bat in my home?
If you see a bat in your home and you are sure no human or pet exposure has occurred, confine the bat to a room by closing all doors and windows leading out of the room except those to the outside. The bat will probably leave soon. If not, it can be caught, as described below, and released outdoors away from people and pets.

However, if there is any question of exposure, leave the bat alone and call animal control or a wildlife conservation agency for assistance. If professional assistance is unavailable, use precautions to capture the bat safely, as described below.

When the bat lands, approach it slowly and place a box or coffee can over it. Slide the cardboard under the container to trap the bat inside. Tape the cardboard to the container securely. Contact your health department or animal control authority to make arrangements for rabies testing.

How can I tell if a bat has rabies?
Rabies can be confirmed only in a laboratory. However, any bat that is active by day, is found in a place where bats are not usually seen (for example in rooms 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 the most easily approached. Therefore, it is best never to handle any bat.

How do I capture bats safely?
Most bats that enter living areas do so accidentally. They can be caught in a butterfly net, a leather-gloved hand, or a coffee can slowly placed over them while a piece of cardboard is slid between the bat and wall. All bats found in the home should be considered for rabies testing.

If vaccination is effective, why do people still die of rabies in the USA?
In some cases, persons who died of rabies knew they were bitten by a bat. However, they may not have been aware that bats can have rabies and transmit it through a bite, and so did not seek medical attention. In other cases, it appears possible that young children may not fully awaken due to the presence of a bat (or its bite) or may not report a bite to their parents. For example, one 4-year-old patient, who died of rabies, was still sleeping when her caregivers checked on her because they heard strange noises that were from a bat that was found on the floor of her bedroom. She was most likely bitten and did not fully awaken. This patient developed parasthesia (an abnormal sensation which may occur at the site of a rabies exposure) on her neck as she became sick with rabies a few weeks later. In another case, a 10-year-old child removed a bat from his bedroom without adult supervision and several months later developed parasthesia on his arm and one side of his head as he became sick with rabies.