On July 28, 1995, the South Dakota Public Health Laboratory
diagnosed rabies in an 8-week-old puppy; on July 23, the puppy had
had onset of neurologic signs (e.g., head tilt, ataxia, and
somnolence) that culminated in seizures, and the puppy was
euthanized. A clinically normal littermate owned by a neighboring
family was euthanized on July 31 and tested positive for rabies.
This report summarizes the epidemiologic investigation and
follow-up management by the South Dakota Department of Health
(SDDH), with assistance from CDC, of persons and domestic animals
potentially exposed to rabies.
On July 8, the neighboring families acquired the two puppies
from a private owner near Summit, South Dakota. The puppies were
from a litter of nine born on May 29. On June 13 or 14, a skunk
attacked the litter in a garage where they were kept. The skunk was
killed by the owner of the puppies but was not tested for rabies.
All the puppies were free of clinical signs consistent with rabies
when given away between July 8 and July 27. However, the original
owner of the puppies was uncertain of the identity of all the
persons who had adopted them. Through announcements in the local
news media and distribution of flyers door-to-door by the Aberdeen
Area Indian Health Service in Sisseton, by August 4 the remaining
seven puppies were identified to be in private residences located
throughout eastern South Dakota. Six of the puppies tested negative
for rabies at the South Dakota Public Health Laboratory; the
seventh puppy had been killed by the owner because it was part of
the exposed litter, and it was unavailable for testing. The dam of
the litter and another contact dog -- neither of which were
currently
vaccinated against rabies -- were euthanized and tested negative
for
rabies. Two other potentially exposed pet dogs, past due for rabies
vaccination, were identified; they were managed by home quarantine
and booster vaccination according to the 1995 animal rabies
compendium (1) and remained symptom-free.
The SDDH initiated efforts to identify persons with potential
exposure to the two puppies and determine their risk for rabies
infection. In response to the alert, the state health department
and four major health-care facilities screened by phone or personal
interview approximately 150 persons possibly exposed during July
13-31 (the established period of potential rabies transmission). In
addition, SDDH conducted town meetings and provided briefings to
health-care providers, the news media, and animal-control
authorities. Of the 150 persons, 22 (15%) (including nine persons
from the veterinary clinic in which the ill puppy had been treated
and euthanized and seven persons who had had contact with the puppy
that had been destroyed and was unavailable for rabies testing) met
the criteria used to determine the need for rabies postexposure
treatment (PET) for either a bite or nonbite exposure as defined by
the Immunization Practices Advisory Committee (2). Specific
antirabies treatment was initiated for 31 persons; the other nine
persons requested and received PET despite reassurance they were at
low risk for rabies infection.
Reported by: K Peterson, DVM, Milbank Veterinary Clinic, K
Vanadurongvan, MD, Milbank Medical Clinic, Milbank; H Burrish, DVM,
Sisseton Veterinary Clinic, Sisseton; F Zambrana, MD, J Leith,
Aberdeen Area Indian Health Service, Sisseton; S DeCoteau,
Sisseton-Wahpeton Sioux Tribe, Sisseton; G Larson, MD, H Nipe, MD,
K Peterson, MD, C Gerrish, MD, R Peshek, MD, M Preys, MD, L
Danforth, Brown Clinic, Watertown; J Ostby, MD, C Breske, MD, M
Jergenson, Bartron Clinic, Watertown; L Volmer, L Schaefer, G
Welch, S Lance, DVM, State Epidemiologist, South Dakota Dept of
Health; R Steece, PhD, South Dakota Public Health Laboratory. Viral
and Rickettsial Zoonoses Br, and Special Pathogens Br, Div of Viral
and Rickettsial Diseases, National Center for Infectious Diseases,
CDC.
Editorial Note
Editorial Note: In the United States, the most frequently reported
rabid wild animals are raccoons, skunks, bats, and foxes (3).
Although the exposure for the two rabid puppies in this report was
not confirmed, the skunk that attacked the litter in mid-June was
probably the source of infection. Measures for preventing pets from
contacting wild animals include keeping them indoors, on leashes,
or in fenced outdoor areas. If pets are wounded by wild animals,
wounds should be washed immediately with soap and water, and the
pet should be evaluated by a veterinarian. Wildlife that attacks
persons or pets should be apprehended by trained personnel,
euthanized, and tested for rabies. Wild and stray domestic animals
exhibiting signs of neurologic illness or of abnormal behavior
(signs of rabies among wild animals cannot be interpreted reliably)
should be reported to appropriate local health authorities,
especially if the animal bites or scratches a person. Only trained
personnel should attempt to trap or capture these animals and
submit them for rabies testing.
The economic burden of the exposures in South Dakota was
minimized because of the small number of persons requiring PET and
as a result of efforts to inform and reassure persons who
unnecessarily were seeking medical services for exposures not
associated with true risk (e.g., petting a rabid puppy, handling a
noninfected littermate, or having contact with a human who had been
exposed to a rabid puppy). Nonetheless, substantial resources were
required to educate potentially exposed persons about rabid animals
and to conduct the prompt and standardized assessment of persons
who received PET (4). The estimated cost associated with the public
health response, assessment, and PET was $115,000: $97,900 for
chemoprophylaxis and provider services, $16,500 for the
investigation by public health officials, and $600 for laboratory
testing of animals. In South Dakota, from 1990 through 1995, an
estimated $1.4 million was spent for PET for 632 persons exposed to
approximately 704 rabies-positive animals. Although this estimate
is for a 5-year period, it is similar to the cost ($1.5 million)
associated with the single-point source exposure to a rabid kitten
in New Hampshire, in which PET was initiated for 665 persons (5).
To facilitate efforts to investigate rabies exposures such as those
described in this report, persons involved in the private sale or
adoption of pets are encouraged to maintain records of buyers' or
adoptees' names and addresses.
References
CDC. Compendium of animal rabies control, 1995: National
Association of State Public Health Veterinarians, Inc. MMWR
1995;44(no. RR-2).
CDC. Rabies prevention -- United States, 1991: recommendation of
the Immunization Practices Advisory Committee (ACIP). MMWR
1991;40(no. RR-3).
Krebs JW, Strine TW, Smith JS, Rupprecht CE, Childs JE. Rabies
surveillance in the United States during 1993. J Am Vet Assoc
1994:205:1695-709.
CDC. Mass treatment of humans exposed to rabies -- New
Hampshire,
1994. MMWR 1995; 44:484-6.
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