Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies...
Transcript of Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies...
![Page 1: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/1.jpg)
Rabies and Utah Public Health: Surveillance and Epidemiology
Dallin Peterson
Zoonotic/Vectorborne Epidemiologst
Utah Department of Health
![Page 2: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/2.jpg)
Rabies and Public Health
![Page 3: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/3.jpg)
• Who wrote the first record of canine rabies?
– Cardanus (1525 A.D.)
– Homer in the Iliad ( 850 B.C.)
– Democritus (500 B.C.)
– Aristotle (4th century B.C.)
Question 1
![Page 4: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/4.jpg)
• Celsus (Greek Physician)
• American Settlers-Madstones
Historical Treatments
![Page 5: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/5.jpg)
Pasteur and Prophylaxis (PEP)
• 1885 Rabies PEP
• Joseph Meister
![Page 6: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/6.jpg)
Rabies in Utah
y = 0.5071x - 1005.9
0
5
10
15
20
25
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018
Cas
e C
ou
nt
Year
Bat
Fox
Skunk
Linear (Bat)
![Page 7: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/7.jpg)
![Page 8: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/8.jpg)
• How does rabies develop in humans?
a. Viremia in blood stream
b. Migrates along the nervous system
c. Both a and b
d. Neither a or b
Question 2
![Page 9: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/9.jpg)
Brief Pathway of Rabies
![Page 10: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/10.jpg)
Human Rabies Signs and Symptoms
• Prodromal Phase
• Neurologic Phase
![Page 11: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/11.jpg)
Clinical Illness
• Duration of illness is 7-10 days
– Respiratory paralysis
• Almost always fatal
![Page 12: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/12.jpg)
• Human
– Average 3-8 weeks
– 9 day incubation period
• Animals
– Average 1-3 months
Incubation Period
![Page 13: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/13.jpg)
• What animals vectors do we need to worry about being infected with rabies?
Question 3
![Page 14: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/14.jpg)
Animal Vector and Non-VectorVectors Non-Vectors
![Page 15: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/15.jpg)
Wildlife Reservoirs for RabiesDistribution of Major Rabies Virus Variants, 2008 to 2014
Source: CDC.gov/rabies
![Page 16: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/16.jpg)
Animal Clinical Symptoms
• Two common types of rabies
– “Furious” rabies
– Paralytic or “dumb” rabies
![Page 17: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/17.jpg)
When can an animal transmit disease?
• Depends on animal and strain of virus
Animals showing no symptoms may transmit disease!
![Page 18: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/18.jpg)
What is an exposure?
• Two types:
– Bite Exposure
– Non-Bite Exposure
• Modes of Transmission
– Bite
– Scratch
– Breaks in the skin
– Mucous Membrane
– Airborne
![Page 19: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/19.jpg)
What to do following possible exposure?
1. Don’t panic
2. Clean the wound with soap and water
3. Seek medical attention
4. Consult with health department
![Page 20: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/20.jpg)
Testing Flow Chart
![Page 21: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/21.jpg)
Animal Quarantine
• Human exposure from domestic animal
• Vaccinated domestic animal from wild animal
• Unvaccinated domestic animal from wild animal
• Human exposure from wild animal
![Page 22: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/22.jpg)
Post-Exposure Prophylaxis (PEP)
• Should begin as soon as possible following exposure
– Medical urgency, not emergency
• PEP
– Rabies Immune globulin (RIG) (Day 0)
– Four doses of rabies vaccine (Days 0, 3, 7, and 14)
![Page 23: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/23.jpg)
Pre-Exposure Prophylaxis
• High risk groups
• 3 doses of rabies vaccine on days 0, 7, and 21 or 28
• Does not eliminate need for health care following exposure
• Reduces # vaccinations following exposure
• May provide protection when exposure not apparent
![Page 24: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/24.jpg)
• Clean wound
• No Rabies Immune Globulin
• Vaccine 1.0 mL on day 0 and 3
Post exposures PEP for Previously Immunized Individuals
![Page 25: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/25.jpg)
Rabies Appeal Document
![Page 26: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/26.jpg)
![Page 27: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/27.jpg)
![Page 28: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/28.jpg)
![Page 29: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/29.jpg)
![Page 30: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/30.jpg)
![Page 31: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/31.jpg)
![Page 32: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/32.jpg)
• For a 170 pound person
• 10.3 ml HRIG = 6 x 2ml vials @ $131 = $ 786
• 4 vials rabies vaccine @ $203 = $ 812Total biologicals cost $ 1,598
Programs for underinsured or uninsured
• http://www.cdc.gov/rabies/medical_care/programs.html
Post-exposure Cost
![Page 33: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/33.jpg)
Rabies Vaccines • Purified Chick Embryo Cell Vaccine
(PCEC)
• Human Diploid Cell Vaccine (HDCV)
• Adverse reactions
![Page 34: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/34.jpg)
Animal Laboratory Testing• Euthanized animal
• Leak-proof container with wet ice
• Received within 72 hours of collection
• Complete Rabies Test Request Form
• Contact Public Health for Requisition Form– http://health.utah.gov/epi/diseases/rabies/UDOH_Rabies_Testing_Request_Form.
![Page 35: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/35.jpg)
• What measures would you take if this circumstance?
– You receive a phone call from an individual who one morning, found a dead bat on the floor after waking up.
Question 4
![Page 36: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/36.jpg)
Laboratory Testing
• Animal
–Direct Fluorescence Antibody (DFA)
– Tissue from the animal’s brain
Positive test
Negative test
![Page 37: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/37.jpg)
Human Laboratory Testing
• Antemortem Specimens
– Saliva
– Neck Biopsy
– Serum
– Cerebral Spinal Fluid
• Postmortem– Brain biopsy
• Consult with State Health Department before specimens collection
![Page 38: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/38.jpg)
Rabies Testing Request Form
Source: http://health.utah.gov/epi/diseases/rabies/UDOH_Rabies_Testing_Request_Form.pdf
![Page 39: Rabies and Utah Public Health: Surveillance and Epidemiology...Brief Pathway of Rabies. Human Rabies Signs and Symptoms •Prodromal Phase •Neurologic Phase. Clinical Illness •Duration](https://reader034.fdocuments.us/reader034/viewer/2022052520/6098164b34ad3037e80eb3bb/html5/thumbnails/39.jpg)
Questions?