VPH - Final 6

drraythe's version from 2016-04-25 13:36

RABIES Lecture 3

Question Answer
What is the 1st SIGN of Rabies we see?Behavior change
What is the post mortem test for Rabies (& what are we testing for?)Direct Fluorescent antibody (FA) on FRESH (not frozen) brain!
You are detecting the ANTIGEN
Is there an antemortem test for Rabies?No reliable antemortem test, unless they test POSITIVE FOR ANTIGEN
If you see negri bodies in a brain tissue sample, did the animal have Rabies?Still must confirm even if you see negri bodies. (Still need to do direct FA)
If a dog is exposed to Rabies & then is vxd, does it help?Nope, does nothing
What’s RIG? HRIG? Mab?RIG = Rabies Immunoglobulin (Ab)
HRIG = HUMAN Rabies immunoglobulin
MAB = Monoclonal antibody
Rabies biologics used in pre & post exposure in humans in US → what are the 2 Vx used?(1) Human Diploid Cell Vx (HDCV) Imovax® IM
(2) Purified Chick Embryo Cell Vx (PCEC) RabAvert® IM
Human Rabies Immune Globulin → how is this administered & when is it used? In who?This is used POST-EXPOSURE in humans not previously vxd!!! It is done as a Local Infusion at wound site, w/ additional amount intramuscular at site distant from Vx site
**Preexposure Rabies Vx in humans... how many & when?Series of 3 Vx injxns Days 0, 7, 21 (or 28)
When to do serology ON HUMANS after Vx? (3 situations)(1) Person at continuous risk: Check q 6 mo. Boost if ↓
(2) Person at frequent risk: Check q 2 yrs. Boost if ↓
(3) Person at infrequent risk. No serology, no boosting
(Reminder: q = 'every' in medical terms)
**Should you do post-exposure prophylaxis? (Human) → If a dog/cat/ferret bit you, what are the options?If the animal is healthy & available for 10-day observation… observe. If tests + for Rabies or Rabies suspected… start PEP. If the animal was unknown/escaped, MD consults PH officials (which should incld a PH vet)
Should you do post-exposure prophylaxis? (Human) → Exposure via a wild life reservoir host, what are the options?Regarded as rabid unless animal is proven negative by laboratory test… MD considers immediate Post EP. (May depend on circumstances of the bite & the geographic location, etc.)
Post Exposure Prophylaxis in Non-immunized people → what do you do? (3 big things)1st wound cleaning, then give human RIG on day 0. The full dose of HRIG should be thoroughly infiltrated in the area around & into the wounds. Any remaining volume injected IM at site distant from Vx site. Then there are 4 IM Vxs (Day 0, 3, 7, 14)
**Pre exposure shots vs post exposure shots (non Vx & Vx)PRE = 3 Vx Days 0, 7, 21 (or 28)
POST not Vxd
= 4 IM Vxs Days 0, 3, 7, 14
= 2 IM Vxs Days 0 & 3
When is Rabies Immune Globulin administered for post-exposure?Administered only once at the beginningPassive immunity for immediate protection (Can be administered up to 7 days after the administration of 1st Vx dose. Beyond the 7th day, not recommended since an antibody response to Vx is presumed to have occurred)
What should you know about administering Rabies Immune Globulin?Never to be given in same site as the Vx
If a person was previously Vx against Rabies, then bit, then what do you do?Wound cleaning, NO Human RIG & 2 IM Vxs on days 0 & 3
What are 3 situations where you would define a person as previously vxd?(1) Vxd w/ HDCV (Human Diploid Cell Vx) or PCEC (Purified Chick Embryo Cell Vx)
(2) Post Ex Prophylaxis w/ any of the above
(3) Or previous Vx w/ another product & documented response…. i.e. serology a “protective” titer
What is appropriate use of Rabies Serology in animals?To document a response to Vx (*NOT used to Dx clinical Rabies in animals)
Why isn't serology useful for dz Rabies in animals?Antibody may not be detectable until late in dz. Thus, cannot rule out if negative. A positive may reflect prior Vx or exposure to field strain. Can’t tell the difference

Compendium of Rabies

Question Answer
When is an animal Vx for Rabies considered immunized?28 days post initial Vx & immediately after booster bc of anamnestic response
After the initial Rabies Vx, the booster should be when? What kinda booster?Should be 1 year later, but CANT use a 3-4 year Vx for the booster
What kinda Vx CANT you give to wild animals/hybrids?Parenteral
Is 1 cow in a herd is exposed to Rabies, should you quarantine the other cows?No, herb-to-herbivore xmission very rare
Does inadvertently drinking Pasteurized milk or thoroughly cooked meat from a rabid animal count as exposure?No
If a dog/cat/ferret bites a human & they are put into a 10 day quarantine, should you Vx them while theyre in it? (If theyre Vx or unVx?)No matter what, no. Bc adverse rxn to Vx might result in false sign of clinical sings
Oral Rabies Vx is what kinda Vx for who?Vaccina-vectored Vx for coyotes & raccoons
Can you control Rabies in bats?Controlling Rabies in bats to reduce populations is not feasible or desirable
If a human exposed to parenteral Rabies Vx, what are you thinking?Not considered risk for Rabies infxn but vaccinia-vectored Vx can cz dz from vaccinia virus & shd be reported
Monovalent inactivated Vx → who is this for? How is it administered?Dogs
Some can be IM or SQ or both
Monovalent inactivated Vx → WHEN is this administered?Vx begins at 3mo (except HORSES, 4mo..) & then either annually, or a 1yr booster & then triennially or quadrennial
Monovalent-Rabies glycoprotein, OR live canary pox vector Vx → who can get this Vx? How do you admin?Cats
Some can be admin IM or SQ
Monovalent-Rabies glycoprotein, OR live canary pox vector Vx → WHEN do you give this?All admin @ 3 mos. of age. Some are annually, some are 1 yr booster & then triannual
Combination Rabies glycoprotein, live canary pox vector → who can get this Vx? How do you admin?CATS ONLY - IM or SQ (as early as 8 weeks)
Combination Rabies glycoprotein, live canary pox vector → WHEN do you give this?Vx @ 8 wks. & boostered every 3 weeks until 3 mos. old. Then admin annually
Oral Rabies glycoprotein, live vaccinia vector → for who? How is it given?Coyotes & coons, oral Vx
***If mom cat 2.5 yr old which was Vx at 8 mo. & 1.5 yr w/ a triennial Rabies Vx, was exposed to Rabies kitten.... do what?She’s up to date! She was exposed to Rabies tho. Not concerned about animal biting human so no 10 days thing. It re-Vx & confined & observed for 45 days (insurance, not strict isolation)
***If you accidentally inoculate yourself w/ 1 of the canary pox Rabies viruses... do what?Draw up another dose of Vx & properly Vx the animal
***What is the RFFIT? What is it good for?Measures ability of Rabies specific Abs to neutralize the virus. (Rabies Focused Fluorescent Inhibition Test) not viable test for Rabies. (If test was positive, cant conclude it was bitten...bc might be cross rxn, or something weird...also Ab could be a maternal Ab or previous unreported Vx, or exposure. if RFFIT neg, cant r/o Rabies, as Abs can show up late in course of dz)
***Is maternal Ab protective against Rabies?Not reliably

Colorado & wolf hybrids (ppt & reading)

Question Answer
Can you Vx them?In Colo, yes, w/ inactivated canine Rabies Vx. however owners must be informed that there is No evidence of efficacy. Consent form red!
If a wolf hybrid in Colo bites a human, what happens?REGARDLESS OF VX STATUS Euthanize & TEST… or If previously vxd: revaccinate & 30-day observation… not in the home.... & bite victim must agree
If a wolf hybrid is exposed to Rabies (not bite person) what do?REGARDLESS OF VX STATUS Euthanize… or 6-month quarantine… not in home
Which Vx for wolf-dog hybrids?Inactivated canine Rabies Vx
You can only Vx the hybrid after... (2)(1) The owner has been advised that the Vx is not licensed for use in hybrid-wolves & its efficacy is unknown
(2) The owner signs a consent form that acknowledges (the unknown efficacy of the Vx, that a hybrid-wolf will not be handled as a domestic dog following a human bite, that a hybrid-wolf exposed to a known or suspected rabid animal could be euthanized even if currently vxd; the release from liability of the veterinarian & their staff, health department, Vx manufacturer & distributor & other involved parties)

Ebola crap

Question Answer
Has a dog or cat ever been sick w/ Ebola?None reported
Can cats/dogs spread Ebola to people?None reported
Can dogs be infected w/ Ebola?If super lots of contact-sort of. Transient & non-productive. Only found Abs & no ebolavirus
Is exposure to dogs a risk for human infxn?Nope
Exposure of Ebola requires...Contact w/ blood or body fluids of a person w/ Ebola while the person is symptomatic (As a result, it is recommended to keep all animals away from blood or body fluids of a person who may have Ebola)
Information to Collect for Risk Assessment to see if should quarantine dog/catA public health veterinarian in collaboration w/ public health officials should collect the information on identification & medical Hx of the pet, assessment of risk of exposure & infxn & assessment of contacts of the pet w/ other animals & people
What kind of info should be collected to help evaluate the pet’s Hx of exposure to the PTx?Exposure to blood or body fluids of human Ebola PTx (including, but not limited to, urine, saliva, sweat, feces & vomit); this inclds licking, consuming, or walking through any of these fluids, sitting in lap of PTx, Being cuddled or kissed by PTx, Licking the PTx, including the face or mouth, Sleeping in the same bed as the PTx, Sharing food w/ the PTx, Any other types of contact or interactions w/ the Ebola PTx
Signs or symptoms may cz concerns for health monitoring during quarantine incld...Recent Hx of ↓ appetite, fever, vomiting, diarrhea, lethargy, (or other signs or symptoms) since the onset of the Ebola PTx’s symptoms. Also Medical Hx in the last year, including Hx of gastrointestinal illness or bleeding disorders
If you are transporting the dog to quarantine, what do you take?ONLY the animal, not even collars etc
when dealing w/ quarantined animal, PPE shall consist of, at a minimumDouble gloves, w/ outer glove taped to the suit w/ waterproof tape, Splash-resistant disposable hooded suit, w/ foot covers impervious to fluids, Eye protection (goggles or face shield), Air purifying respirator (N-95 or equivalent level of protection)
**How long will the cat/dog be quarantined?Minimum of 21 days following the last date of exposure to the symptomatic Ebola PTx (legal adult is free to go)
How would they test the animal for Ebola?RT-PCR
If animal tests positive, what do they do?Euthanize & incinerate
The pet will be considered releasable & able to move out of quarantine after all 3 criteria listed below are met(1) A minimum of 21 days in quarantine
(2) ONLY if animal testing was pre-authorized by CDC, a confirmed negative test for Ebola virus based on all appropriate specimens
(3) Evaluation by the designated veterinarian to ensure the pet is healthy upon release or to determine the appropriate course of action for a pet exhibiting any signs of illness
If someone is under direct & active monitoring, what should they know about their pets?People under direct active monitoring should avoid contact w/ dogs, cats, livestock (e.g. pigs, cattle, sheep & goats) & other mammals out of an abundance of caution to prevent possible xmission of Ebola from people to animals & also to prevent the need for quarantine of an animal due to contact w/ a person w/ symptomatic Ebola.
If you were in contact w/ someone w/ Ebola, what about your animals?Let someone else care for them