VPH- Final 6

untimely's version from 2015-04-26 23:57

RABIES lecture 3

Question Answer
what is the FIRST SIGN of rabies we see?behavior change
what is the post mortem test for rabies (and what are we testing for?)Direct Fluorescent antibody (FA) on FRESH (not frozen) brain! You are detecting the ANTIGEN.
is there an antimortem 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, and then is vaccinated, does it help?nope, does nothing
what's RIG? HRIG? Mab?Rabies ImmunoGlobulin (Ab). HUMAN rabies immunoglobulin. Monoclonal antibody
Rabies biologics used in pre and post exposure in humans in US--> what are the two vx used?(1) Human Diploid Cell Vaccine (HDCV) Imovax® IM (2) Purified Chick Embryo Cell Vaccine (PCEC) RabAvert® IM
Human Rabies Immune Globulin--> how is this administered, and when is ti used? in who?This is used POST-EXPOSURE in humans not previously vaccinated!!! It is done as a Local infusion at wound site, with additional amount intramuscular at site distant from vaccine site
preexposure rabies vx in humans... how many and when?Series of 3 vaccine injections Days 0, 7, 21 (or 28)
When to do serology ON HUMANS after vaccination? (three situations)(1) Person at continuous risk: q 6 mo. Boost if low (2) Person at frequent risk: q2 yrs. Boost if low (3) Person at infrequent risk. No serology, no boosting
should you do post-exposure prophylaxis? (human) ---> if a dog/cat/ferret bit you, what are the options?if the animal is healthy and 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 include 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 and the geographic location, etc.)
Post Exposure Prophylaxis in Non-immunized people--> what do you do? (3 big things)First wound cleaning, then give human RIG on day 0. The full dose of HRIG should be thoroughly infiltrated in the area around and into the wounds. Any remaining volume injected IM at site distant from vaccine site. Then there are 4 IM vaccinations (0, 3, 7, 14,)
pre exposure shots vs post exposure shots(non vx and vx)PRE= 3 vx Days 0, 7, 21 (or 28). POST nonvx= 4 IM vaccinations (0, 3, 7, 14,). POST vx=2 IM vaccinations on days 0 and 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 first vaccine dose. Beyond the 7th day, not recommended since an antibody response to vaccine is presumed to have occurred)
what should you know about administering Rabies Immune Globulin?Never to be given in same site as the vaccine
if a person was previously vx against rabies, then bit, then what do you do?Wound cleaning, NO Human RIG, and 2 IM vaccinations on days 0 and 3
what are three situations where you would define a person as previously vaccinated?(1) Vaccinated with HDCV(human diploid cell vx) or PCEC (purified chick embryo cell vx) (2) Post Ex Prophylaxis with any of the above (3) Or previous vaccination with another product AND documented response…. i.e. serology a “protective” titer.
What is appropriate use of rabies Serology in animals?To document a response to vaccination (*NOT used to diagnose clinical rabies in animals)
why isn't serology useful for dz rabies in animals?Antibody may not be detectable until late in disease. Thus, cannot rule out if negative. A positive may reflect prior vaccination or exposure to field strain. Can’t tell the difference

Compendium of rabies + CQs

Question Answer
When is an animal vx for rabies considered immunized?28 days post initial vx. and 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 one cow in a herd is exposed to rabies, should you quarantine the other cows?no, herb-to-herbivore xmission very rare
does inadvertanly drinking pasteurized milk or thoroughly cooked meat from a rabid animal count as exposure?no
If a dog/cat/ferret bites a human, and they are put into a 10 day quarentine, should you vx them while theyre in it? (if theyre vx or unvx?)no matter what, no. Because adverse rx to vx might result in false sign of clinical sings
Oral rabies vx is what kinda vx for who?vaccina- vectored vx for coyotes and 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 inf- but vaccinia-vectored vx can cause dz from vaccinia virus and shd be reported
Monovalent inactivated vx--> who is this for? how is it administered?dogs, cats, horses, sheep, ferrets, cattle. Some can be IM or SQ or both
Monovalent inactivated vx--> WHEN is this administered?vx begins at 3mo (except HORSES, 4mo..) and then either annually, or a 1yr booster and then triennially or quadrennially
Monovalent- rabies glycoprotein, OR live canary pox vector vx--> who can get this vx? how do you admin?cats, dogs, horses. 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 and then triannual
Combination rabies glycoprotein, live canary pox vector--> who can get this vx? how do you admin?CATS ONLY- I or SQ
Combination rabies glycoprotein, live canary pox vector--> WHEN do you give this?vx @ 8 wks and boostered every 3 weeks until 3 mos old. Then admin annually
Oral rabies glycoprotein, live vaccinia vector--> for who? how is it given?coyotes and coons, oral vx
CQ: if mom cat 2.5 yr old which was vx at 8 mo and 1.5 yr with 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's re-vx and confined and observed for 45 days (insurance, not strict isolation)
cq: if you accidentally innoculate yourself with one of the canary pox rabies viruses... do what?draw up another dose of vx and properly vx the animal
CQ: what is the RFFIT? what is it good for?measures ability of rabies specific Abs to neutralize the virus. (rabies focused flourscent inhibition test) not viable test for rabies. (if test was positive, cant conclude it was bitten...bc might be cross rx, 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.)
CQ: is maternal Ab protective against rabies?not reliably.

colorado and wolf hybrids (ppt and reading)

Question Answer
can you vx them?in colo, yes, with inactivated canine rabies vx. however owners must be informed that there is No evidence of efficacy. Consent form required!
if a wolf hybrid in colo bites a human, what happens?REGARDLESS OF VACCINATION STATUS Euthanize AND TEST… or If previously vaccinated: revaccinate and 30-day observation… not in the home.... AND bite victim must agree.
if a wolf hybrid is exposed to rabies (not bite person) what do?REGARDLESS OF VACCINATION 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 vaccine is not licensed for use in hybrid-wolves and its efficacy is unknown (2) The owner signs a consent form that acknowledges (the unknown efficacy of the vaccine, 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 vaccinated;the release from liability of the veterinarian and their staff, health department, vaccine manufacturer and distributor, and other involved parties.)

Ebola crap

Question Answer
has a dog or cat ever been sick with ebola?none reported
can cats/dogs spread ebola to people?none reported
can dogs be infected with ebola?if super lots of contact-- sort of. transient and non-productive. only found Abs and no ebolavirus
is exposure to dogs a risk for human infection?nope
Exposure of ebola with blood or body fluids of a person with 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 with public health officials should collect the information on identification and medical history of the pet, assessment of risk of exposure and infection, and assessment of contacts of the pet with other animals and people
what kind of info should be collected to help evaluate the pet’s history of exposure to the patient?Exposure to blood or body fluids of human Ebola patient (including, but not limited to, urine, saliva, sweat, feces, and vomit); this includes licking, consuming, or walking through any of these fluids, sitting in lap of pt, Being cuddled or kissed by patient, Licking the patient, including the face or mouth, Sleeping in the same bed as the patient, Sharing food with the patient, Any other types of contact or interactions with the Ebola patient
signs or symptoms may cause concerns for health monitoring during quarantine include..Recent history of decreased appetite, fever, vomiting, diarrhea, lethargy, (or other signs or symptoms) since the onset of the Ebola patient’s symptoms. Also Medical history in the last year, including history of gastrointestinal illness or bleeding disorders
if you are transporting the dog to quarentine, what do you take?ONLY the animal, not even collars etc
when dealing with quarentined animal, PPE shall consist of, at a minimumDouble gloves, with outer glove taped to the suit with waterproof tape, Splash-resistant disposable hooded suit, with 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 quarentined?minimum of 21 days following the last date of exposure to the symptomatic Ebola patient (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 and incinerate
The pet will be considered releasable and able to move out of quarantine after all three 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 and active monitoring, what should they know about their pets?People under direct active monitoring should avoid contact with dogs, cats, livestock (e.g. pigs, cattle, sheep, and goats), and other mammals out of an abundance of caution to prevent possible transmission of Ebola from people to animals and also to prevent the need for quarantine of an animal due to contact with a person with symptomatic Ebola.
if you were in contact with someone with ebola, what about your animals?let someone else care for them

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