Animal Bite and Rabies Exposure Management

References

  • TC-101 ROVR Guidance for Animal Bite Rabies Quarantines

  • AR 40-905: Veterinary Health Services

  • Food Analysis and Diagnostic Laboratory Sample Submission Guide TG 361

    • CH. 8

  • TB MED 298

Rabies Overview

  • Rabies: Disease of acute/progressive encephalitis caused by Lyssavirus variants

    • Virus travels along Peripheral Nervous System (PNS) to Central Nervous System (CNS) & enters brain where it targets salivary glands (can be present for several days before clinical signs appear)

    • Reservoir hosts/populations: Racoons/Skunks/Coyotes/Foxes/Bats (Mainly wild mammals)

      • High Bite Risk: Bats (Recognized as significant/difficult rabies vectors)

        • Bite marks are extremely difficult to see/feel (All bats found in living spaces should be tested)

      • Low Risk: Opossums/Mice/Squirrels (small mammals)

        • Physiology/speed of spread are factors in low transmission rate

    • Rabies-free regions include Australia/Japan/UK/Guam/Hawaii

  • Transmission

    • Primarily transmitted via animal bites/scratches where saliva is involved

  • Incubation period

    • General 3-12 weeks (can range from days to 6 months)

Clinical Signs

  • Symptoms

    • Includes:

      • Inappetence

      • Dysphagia

      • Ataxia

      • Altered behavior

      • Paralysis

      • Seizures

      • Altered vocalizations

      • Cranial nerve deficits

      • Abnormal behavior

    • Speed of spread depends on location of bite (closer to brain/spinal cord = faster spread), severity of bite & amount of virus injected.

      • Present clinical signs of rabies = 100% fatal

    • Known as “Great Pretender”: Symptoms resemble various diseases

  • Types of Rabies Forms

    • Furious Form:

      • Animal reflects agitated behavior (snaps/bites at imaginary/real objects), excessive drooling, progressive paralysis (host unable to eat/drink), that may progress to seizures that lead to death

        • Note: Hydrophobia (fear of water) is not sign in animals (only in human rabies)

    • Dumb Form:

      • Animals reflect lack of fear, tameness, progressive paralysis (difficulty swallowing), progressing to coma and death

        • Most common form of rabies in dogs

Prevention Strategies

  • Reporting Importance:

    • Vital for public health surveillance and intervention.

    • Documentation aids prevention efforts for rabies transmission.

  • UTD Rabies Vaccination (primary)

    • Legal requirement for registration/VTF care of on-base animals

    • Vaccinations necessary for military personnel at risk of exposure (especially when deploying to areas of high prevalence)

  • Avoid Contact/Handling with Potentially Rabid Animals

    • Adherence to General Order 1

    • Proper PPE required if handling is necessary

  • Post Exposure Prophylaxis (PEP): Dose of Human Rabies Immune Globulin (HRIG) & series of rabies vaccines

    • Should be sought asap post exposure (100% effective in preventing development of rabies)

Protocol for Handling Animal Bites

  • Immediate Action/Route for Post-Exposure in Humans

    • Seek medical attention & Military Treatment Facility (MTF) initiates DD Form 2341: Report of Animal Bite — Potential Rabies Exposure

      • MTF initiates form at emergency department

        • Completes Part 1 (patient identification) & Part 2 (animal bite history)

        • Contacts (email/calls based on SOP) Preventative Medicine (PM) & VTF to notify within 24 hours

      • VTF staff (68T) receives report from MTF/emergency department & enters info into bite log & initiates investigation

        • If owner info is present, contact is made to reveal military affiliation to schedule initial quarantine exam

        • If animal is client at VTF, animal’s vaccine history is checked on VSSM

          • Direct owner to bring rabies certificate to exam if vaccine history isn’t present

        • Veterinarian is responsible to perform initial & final exam (release from quarantine after 10 days)

          • Quarantine begins date of animal bite/exposure

        • If no owner is listed in block #7:

          • Contact patient to obtain more info about animal.

        • If owner can’t be verified

          • Treat animal as stray

Handling Wild Animals or Strays

  • If the animal involved is wild or a stray:

    • Coordinate with Animal Control: Work with base or local animal control officers to locate the animal.

    • Possible Euthanasia: If located, consider euthanasia and submission of the brain for rabies testing. This action may be carried out by local authorities or by the VTF.

General Protocol for Bite Quarantine

  • If the animal is a Gone On Arrival (GOA):

    • Initiate Quarantine: Start a working bite quarantine regardless of whether a bite report was filed.

    • Complete Documentation: After the final quarantine exam and/or lab test results are received, finalize the DD Form 2341 and enter the data into the Veterinary Service Information Management System (VSIMS).

Veterinary and Preventive Medicine Collaboration

  • Once the veterinary portion of the bite report has been completed, forward it to Preventive Medicine.

  • Preventive Medicine Role: Responsible for completing Part IV (case review) of the bite report. They serve as a quality control entity overseeing the treatment provided to the patient.

  • Veterinary Services Responsibilities: Ensures the correct gathering of information about the animal, adherence to quarantine and observation procedures, as well as the collection and analysis of samples.

Installation Rabies Control Program

  • The Veterinary Commanding Officer (VCO) should collaborate with Preventive Medicine and the installation commander to develop an installation-specific Rabies Control Program.

  • Rabies Advisory Board Meetings: The VCO and animal care specialists assigned to the VTF must meet at least quarterly (or more frequently if necessary) with the MTF, Preventive Medicine, and installation personnel to review the rabies control program and discuss incidents of rabies on the installation or in the surrounding community, including discussion on bite reports.

  • Finalization of Reports: All organizations involved in the bite report process need to confirm that bite reports are properly completed and closed according to local Standard Operating Procedures (SOPs).

Animal Quarantine Procedures

  • Regulatory Guidance: AR 40-905 provides explicit instructions for quarantining animals involved in human bites.

  • Type of Animals Affected:

    • Department of Defense owned animals

    • Government-owned (non-DoD) animals

    • Privately owned dogs, cats, and ferrets

  • Observation Requirements: Animals must be confined under observation as ordered by the responsible Veterinary Commanding Officer (VCO) until:

    • Definite signs of rabies develop.

    • The animal has been confined for a minimum of 10 days post-incident.

  • Euthanasia Protocol: Animals that display signs of rabies during the 10-day observation period must be euthanized, and appropriate specimens shall be sent for laboratory evaluation to the Foreign Animal Disease Laboratory (FADL) or another accredited laboratory.

Rabies Control Procedures

  • Animal Quarantine:

    • Dogs, cats, and ferrets monitored for 10 days post-bite for signs of rabies.

    • Home confinement permitted where local regulations allow.

  • Role of Veterinary Personnel ( 68T):

    • Management of bite reports and coordination of animal testing/quarantine protocols.

Submission of Rabies Samples

  • Testing Requirements:

    • Direct fluorescent antibody test is the gold standard for rabies diagnosis.

    • Submission should ideally be the entire head or whole bats for testing.

  • Packaging and Shipment:

    • Secure shipping practices defined, labels required for compliance.

    • Coordination with laboratories essential to ensure sample testing timeline.

Documentation and Reporting

  • Reporting Requirements

    • Complete DD Form 2341 for animal bite potential rabies exposure in Military Treatment Facilities (MTFs).

    • Accurate information about the incident and animal is crucial.

  • Routing Procedures

    • MTF initiates the report, then communicates with Preventive Medicine and Veterinary Treatment Facility (VTF) within 24 hours.

  • Bite Log Book

    • Maintain a local Rabies Log Book reflecting all actions taken for animal bites.

Quarantine Procedures

  • Quarantine Requirements

    • Animals involved in bites must be monitored for a minimum of 10 days.

    • DoD Form 2623 is used for documenting home quarantine.

  • Post-Exposure Protocols for Humans

    • If exposed, receive post-exposure prophylaxis (PEP) promptly.

Rabies Specimen Submission

  • Preparation

    • For rabies testing, submit either the head (for dogs/cats) or the whole bat.

    • Use direct fluorescent antibody test as the gold standard for diagnosis.

  • Shipping Requirements

    • Sealable bags for specimens, with refrigeration during transport.

    • Use labels indicating "Biological Substance, Category B".

Prevention and Vaccination

  • Vaccination Importance

    • Vaccination required for pets and high-risk personnel (including military personnel).

    • PEP is critical after exposure.

  • ** Avoid Contact with Rabid Animals**

    • General Order No. 1 restricts adopting stray animals in deployed areas.