Epidemiology of Rabies

John R. Dunn, DVM, PhD

Communicable and Environmental Diseases
Tennessee Department of Health
Centers for Disease Control and Prevention
 Overview
Rabies virus

Rabies epidemiology in the US and Tennessee

Skunk rabies
Raccoon rabies and ORV

Guidance documents
ACIP: Pre-exposure vaccination
Compendium
 Rabies virus- Lyssavirus

Rhabdoviridae-
bullet shaped
RNA virus

Neurotropic, fatal
encephalitis

Variants- host
adapted
 Transmission
Transmission: BITE of a RABID animal
Virus-laden saliva contacts nerves

Saliva in fresh cut or abrasion, mucous

membranes (scratch?-- no)

Person to person: theoretical risk, never

documented in health care worker
Rabies Epidemiology in the
United States
 Human rabies in US: 2 5 cases / year
Tennessee case 2002

PEP: 100% effective

~ 40,000 treatments/ year
$2000 6,000 / treatment
~ 75% unnecessary based on rabies risk

Animal rabies: 7,000 8,000 cases / year (wildlife)

4 variants: raccoon, skunk, bat, fox
Canine variant no longer enzootic in US
Terrestrial
Wildlife
Rabies
Bat
Rabies
 Bat-associated Rabies

U.S.- majority of human rabies caused by bats

From 1980-2000, 26/35 (74%) cases
Silver-haired/Eastern pipistrelle bat
Minor wound from bat bite
Difficult to detect
Persons may not recognize exposure
Most human rabies diagnosed post-mortem
Not on differential
Healthcare workers exposed
Rabies Epidemiology in
Tennessee
 Rabies Testing by the Tennessee
Department of Health (TDH)
Three testing centers
Nashville
Knoxville
Jackson

Rabies Diagnosis: Direct Fluorescent Antibody testing

(DFA) of brain tissue

Testing performed free of charge

Not much attention paid to number and characteristics

of negative results
 Results from 2005
Review of laboratory slips from 3 testing centers in
2005

2017 animal submissions

2010 submitted to testing centers in TN
92 (96%) of 95 counties
362 different localities
18 out-of-state

7 additional specimens from USDA-WS surveillance

program (submitted to CDC)
 *

*N=4: Cat 2001 (1), 2003 (1);

Cow 2002 (1); Opossum 2004 (1)
 TN Rabies Positives
(n=48) by County, 2005

S-1 n
Pickett Hancock Sullivan

so
Sumner Macon Clay

John
Stewart Montgomery Robertson Claiborne

S-1 gton
S-1 Scott Hawkins
Fentress Campbell

R- shin
Trousdale
Lake Jackson B-1 er Carter
Henry ng

m
Obion Overton

Wa
1,
Weakley Union ai R-2
len

tha
Houston Smith Gr mb Greene
Ha

ea

R- 1 i
S1

F ic o
Ch
Davidson Putnam Morgan D-1

Un
Dickson Wilson Knox
B-2 B-1 Jefferson
Dyer

1
S-1 B4
Gibson
Carroll Humphreys Dekalb F-1 Cocke
Cumberland
Rutherford White S-2
Benton Williamson
S5 Roane
Crockett Hickman S-4 Sevier

on
H-1

nn
Lauderdale

Va - 1
Ca
Loudon Blount

ren
Henderson

B
Perry Warren

n
Bu
Madison Maury Rhea
tur

Haywood Lewis
Tipton B-1 Bledsoe
ca

F-1 Bedford Coffee

De

Seq
Chester S-2 S-1 Monroe

sig
Mar Grundy McMinn

ua
sha B-1

Me
ll

tchie
Mo
o re
Shelby Giles Hamilton
B-2 Fayette Hardeman McNairy Hardin S- 1 Franklin Marion B 2 Bradley Polk
Wayne Lawrence Lincoln
B-1 S-1
S-2

Bat - - - - - - - 16 Horse---- 1
Skunk - - - - - 23 Fox - - - - 3
Raccoon - - - -4 Dog - - - - 1
 TN Rabies Positives (n=26)
by County, 15 April 2006

s on
Pickett Hancock Sullivan
Sumner Macon Clay

John
Stewart Montgomery Robertson Claiborne

to n
Scott Hawkins

ing
Trousdale Fentress Campbell

sh
Lake Jackson er Carter
Henry ng

Wa
m
Obion Overton
Weakley Union ai len

tha
Houston Smith Gr mb Greene
Ha

ea

i
C ic o
Ch

1
Davidson Morgan

Un
Dickson Wilson Putnam
Dyer S-2 Jefferson
Gibson Knox S-1
Carroll Humphreys Dekalb Cocke
Cumberland
White
Benton Williamson
Rutherford Roane
Crockett Hickman S-4 Sevier

on
S 10

nn
Lauderdale

Ca

ren
Loudon Blount

Bu n
Henderson

Va
Perry Warren
Madison Maury S-1 Rhea
tur

Haywood Lewis
Tipton Bledsoe
ca

Bedford Coffee
De

Seq
Chester D-1 Monroe

sig
Mar Grundy McMinn

ua
sha

Me
ll

tchie
Mo
o
S- re
Shelby 3
Giles Hamilton
Fayette Hardeman McNairy Hardin
Wayne Lawrence Lincoln Franklin Marion Bradley Polk
S-1 F-1

Skunk - - 23 Fox - - 1 (Racc Var)

Cat ------- 1 (Racc Var) Dog - 1 (Sk Var)
Raccoon variant
 East TN counties with raccoon
variant rabies, 2002-Apr 15, 2006
Pickett Hancock
Sullivan
Claiborne

n
Hawkins

o
Johns
Scott
Fentress Campbell
Carter

n
r
Overton ge

gto
Union a in
Gr

n
blen

shi
Greene
Ham

Wa
Putnam
Morgan Anderson

i
ico
Jefferson

Un
Knox
Dekalb Cocke
Cumberland
White
Roane
Sevier
ren

Loudon Blount
Bu

Warren
Van

Rhea
Bledsoe
Sequ

Monroe
Grundy McMinn
atchie

gs
Mei

Marion Hamilton Bradley Polk

Why is raccoon rabies problematic?

Raccoons thrive in suburban settings

Aggressive and swift
Increase in dog and cat (2X) rabies
Increase in other rabid species (foxes,
groundhogs, livestock, etc.)
Increase in human exposures and need for
PEP risk assessment
Increased animal control calls & anxiety
 Tennessee response to
raccoon rabies
Education
Reducing risk
Protecting pets through vaccination

Increase surveillance
USDA-Wildlife Services (> 20 East TN counties)

Oral rabies vaccination (ORV) campaign

Appalachian Ridge baiting
GAT baiting
 Anticipated ORV Barrier Zone for
Raccoon Rabies in the United States

ORV barrier zones for

raccoon rabies

2004 cases Proposed ORV

ORV in Tennessee, 2005

Appalachain Ridge

GAT
Guidance documents
http://www.cdc.gov/mmwr/PDF/rr/rr4801.pdf
 Imovax (Sanofi Pasteur)
Previously used off-label, 0.1ml
intradermal for pre-exposure vaccination

TDH no longer advocating use of Imovax

off-label consistent with new ACIP
recommendations

Important for state, regional and local HD

to promote rabies vaccination for at-risk
persons
http://s94745432.onlinehome.us/RabiesCompendium.pdf
Questions?

John Dunn
Tennessee Department of Health
Communicable and Environmental Diseases
4th Floor, Cordell Hull Building
425 5th Avenue North
Nashville, TN 3724
615.741.7247