Objectives. What Makes us Different? Multi Point Control of Rabies 10/10/2014. NC Rabies Control Laws & Policy

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1 Objectives NC Rabies Control Laws & Policy Certified Rabies Vaccinator Training Veterinary Public Health Program NC Division of Public Health To describe the rationale for the existence of such a legal framework for one disease. To summarize the individual roles and responsibilities of animal owners, bite victims, animal control officers, physicians and veterinarians when dealing with rabies exposures To know when to apply rabies control measures specified in NCGS To demonstrate basic principles of rabies control laws Estimated Burden of Human Rabies in the World What Makes us Different? NCGS 130A-185. Vaccination of all dogs, cats and ferrets Human mortality from rabies is estimated to be 55,000 deaths per year Mostly in Africa and Asia Due to uncontrolled canine rabies Weekly Epidemiological Record No. 49/50, 2007, 82, (a) The owner of every dog and cat over four months of age shall have the animal vaccinated against rabies. The time or times of vaccination shall be established by the Commission. Rabies vaccine shall be administered only by a licensed veterinarian or by a certified rabies vaccinator. We learned from Old Yeller and Atticus However, in the US there are only several cases per year Multi Point Control of Rabies Pet Owners NC DPH WDCA Local ACO Local PH NC WRC USDA WS Rabid Domestic Animals 1,2,3 Rabid Wild Animals 1. Stray animal control 2. Domestic animal vaccination 3. Vaccination of wildlife 4. Avoidance of wildlife 5. Wound treatment 6. Rabies PEP 7. Supportive Care 1 3,4 Susceptible / Exposed Person Infected Person Sick Person Dead Person 5,6 7 Keep pets currently vaccinated Risk assessments, develop laws, test animals Assist property owners remove rabies risk animals Develop wildlife and rehab policy, train WDCA Enforce state rabies law, local ordinances Implement ORV, surveillance testing Effective Rabies Control; Prevention of Human Rabies Cases Risk assessments, coordinate PEP 1

2 Why Rabies Control? To protect people Benefit to animals is secondary Stages of Prevention 1 and Rabies 2 and NC Law Primary Prevention Secondary Prevention Tertiary Prevention Prevent exposure; education Avoid contacts with unknown animals; Pet vaccination; Animal control to restrict roaming pets Screening and identification of disease (exposure) before signs/symptoms Wash bite wounds; Post-exposure prophylaxis (PEP); Determine animal rabies status Prevention of disease progression after signs/symptoms Experimental treatment; Milwaukee protocol NCGS 130A-185 NCGS Chapter 67, 153A & 160 NCWRC Policy NCGS 130A-196 & Prevention. Encyclopedia of Public Health. Ed. Lester Breslow. Gale Cengage, enotes.com Sep, Human Rabies Prevention United States, 2008: Recommendations of the Advisory Committee on Immunization Practices. MMWR May 23, 2008/ 57(RR03);1-26,28. 8 Authority is Derived from NC Statutes NC Administrative Code County Ordinances CDC or APHA guidance Peer Reviewed Literature Statute, Rule, Ordinance, Guidance? What should we follow? All can be excellent resources and provide direction but General Statutes supersede all others Rules and local ordinances cannot be less strict than general statute Published guidance from CDC may differ from general statute, but still follow the law Communicable Disease: 130A-41 Powers and duties of local health director A local health director shall have the following powers and duties: To investigate the causes of infectious, communicable and other diseases; To exercise quarantine authority and isolation authority pursuant to G.S. 130A-145; To examine, investigate and control rabies pursuant to Part 6 of Article 6 of this Chapter; Communicable Disease 10A NCAC 45C.0101 ESSENTIAL PUBLIC HEALTH SERVICES Communicable Disease Control: (i) Tuberculosis control; (ii) Immunization; (iii) Epidemiologic investigation, surveillance and general communicable disease control; (iv) HIV/STD control; (v) Rabies control; 2

3 Communicable Disease 10 NCAC 03C.4106 POLICIES AND PROCEDURES Each emergency department shall establish written policies and procedures which specify the scope and conduct of patient care to be provided in the emergency areas. They shall include the following: tetanus and rabies prevention or prophylaxis Animal Control: Cities and Counties 153A (counties) and 160A (cities) allows local governments to Adopt rabies control ordinances that supplement state laws Establish animal control agencies Regulate the possession of dangerous or exotic animals Local Rabies Ordinances Cities and counties have broad authority to adopt ordinances designed to protect the health, safety, and welfare of their citizens Local laws should not duplicate or contradict existing state law related to rabies, but in some circumstances it may be appropriate to rely on local laws to supplement the state law An Overview of NCs Rabies Control Laws Coordination is Essential NCGS places authority for communicable disease control with the Local Health Director The LHD may delegate (some) responsibility to Animal Control (AC) agencies There must be written agreements (MOA) between agencies specifically delineating responsibility AC officers must defer human rabies risk assessments to local CD nurses Local Board of Health Typical Organizational Structure for Rabies Control Understand One Another Animal Services Agencies Local Health Director County Sheriff County Manager Local Health Department Communicable Disease Staff Advise Clinicians, Veterinarians, Exposed Persons, Pet owners Animal Services Officers Advise Veterinarians, Pet owners, Instruct Exposed Persons to call CD staff or Health Care Provider Veterinarians Communicable Disease Staff Physicians / Clinicians 3

4 North Carolina Rabies Laws There are 17 individual statutes pertaining to rabies control NCGS 130A A-184 Definitions (1) Animal Control Officer A city or county employee whose responsibility includes animal control. A private organization operating an animal shelter under contract with a city or county that performs animal control functions at the shelter. Domestics under the law by Genus species Cat Felis catus Dog Canis lupus familiaris Ferret Mustela putorius furo *Areas of the law that previously referred to dogs and cats now refer to animal(s) and include ferrets. 130A-184 Definitions (2) Distinction between Stray and Feral Stray beyond the limits of confinement or lost, and without ID (tags, microchips, tattoos, or other) Feral not socialized Vaccination is generalized administration of vaccine by person authorized under 130A A-185 Vaccination required (a) Vaccination required. - The owner of an animal listed in this subsection over four months of age shall have the animal vaccinated against rabies. (1) Cat. (2) Dog. (3) Ferret. 130A-185 Vaccination required (b) Vaccination only animal rabies vaccine licensed by the USDA and approved by the Commission; shall only be administered by A licensed veterinarian A registered veterinary technician under direct supervision of a licensed veterinarian A certified rabies vaccinator. That settles who administers vaccine, but what vaccine is administered? 10A NCAC 41G.0103 APPROVED RABIES VACCINES Any animal rabies vaccine licensed by the United States Department of Agriculture is approved for use on animals in North Carolina NASPHV Rabies Compendium 4

5 When does the Rabies Compendium apply? 10A NCAC 41G.0101 & NCGS 130A-185 (paraphrased and updated) Time of Rabies Vaccination USDA Approved Vaccine products Species Minimum Age of initial vaccine Duration of immunity (when to booster) In cases where State Law and the Compendium differ, State Law is the appropriate guidance to follow. When rabies vaccine is administered by a certified rabies vaccinator to a dog or cat or ferret, the dog, cat or ferret shall be re-vaccinated annually. When rabies vaccine is administered by a licensed veterinarian or RVT, to a dog or cat or ferret, the dog or cat or ferret shall be re-vaccinated one year later and every one, three or four years thereafter as determined by the manufacturer s vaccine package insert and species. 130A-186 Certified Rabies Vaccinators (CRVs) Appointed by local health director (typically county employees) Administer rabies vaccine only in the county & under the direction of the local health director. Shall administer only one year vaccines; per 10A- NCAC 41G.0101 (a) Shall make themselves available to participate in the county rabies control program. *Veterinarians are necessary at county rabies clinics to administer 3 & 4 year vaccines. 130A-186 Appointment and certification of a CRV At least four hours of training required The appointee has to demonstrate a knowledge and procedure acceptable for the administration of rabies vaccine to animals. A certified rabies vaccinator shall be authorized to administer rabies vaccine to animals in the county until the appointment by the local health director has been terminated. 130A-187. County Rabies Vaccination Clinics Local Health Director shall organize or assist in. One countywide clinic per year, minimally. Public notice, time, place; newspaper Fee - County board of commissioners may establish a fee for rabies vaccinations at clinics. The fee may consist of the following: Charge for administration and storage not to exceed $10.00; increased from $4.00 Actual cost of the rabies vaccine, vaccination certificate, and rabies vaccination tag Vaccine Duration of Immunity is different based on who administers the vaccine CRVs - 1 year vaccine duration Veterinarians. and RVTs (under direct supervision of veterinarian on premises) - 1, 3 or 4 year vaccine duration 5

6 130A-188 Repealed in 2009 Content merged into 130A A-189 Rabies Vaccination Certificates A person who administers a rabies vaccine shall complete a rabies vaccination certificate NASPHV Form 51 is the model t.pdf Original owner Licensed Veterinarian or CRV County Agency responsible for Animal Control 130A-190 Rabies Vaccination Tags A person who administers rabies vaccine shall issue a rabies vaccination tag to owner. Tag shall include Year issued Vaccination number North Carolina or NC rabies vaccine Dogs shall wear at all times. *Cats and ferrets must wear unless exempt by local county ordinance 130A-190 Rabies vaccination tags Fee. Rabies vaccination tags, links, and rivets may be obtained from the NC DHHS. The fee for each tag is the sum of the following: (1) The actual cost of the rabies tag, links, and rivets. (2) Transportation costs. (3) Fifteen cents (15 ). This portion of the fee shall be used to fund rabies education and prevention programs. 130A-191 Possession and distribution of rabies vaccine It shall be unlawful for persons other than licensed veterinarians, certified rabies vaccinators and persons engaged in the distribution of rabies vaccine to possess rabies vaccine Persons engaged in the distribution of vaccines may distribute, sell and offer to sell rabies vaccine only to licensed veterinarians and certified rabies vaccinators 130A-192 Animals not wearing required rabies vaccination tags Animal control officer shall canvas the county to determine: Animals not wearing rabies tags If not wearing a tag, if owner ID or owner ID known, ACO shall notify owner in writing to vaccinate animal, produce current certificate If no ID, impound Minimum impoundment 72 hours Reasonable effort to locate owner; Microchip device Modes of disposal: returned, adopted, or euthanized (AVMA, NCDA&CS, HSUS) 6

7 130A-192 Animals not wearing required rabies vaccination tags Before an animal may be put to death, it shall be made available for adoption ACO shall maintain record of all animals impounded, include Date of impoundment Length of impoundment Method of disposal Name of person or institution to whom animal released. 130A-193 Vaccination and Confinement of Animals Brought into this State Animals brought into the state shall have a Current rabies vaccine (1, 3 or 4 year USDA licensed vaccine by an accredited veterinarian as indicated by rabies certificate) if 4 months, or be vaccinated within 7 days of entry and confined 2 weeks. An Official Health Certificate Title 02 - Agriculture and Consumer Services 02 NCAC 52B.0202 OFFICIAL HEALTH CERTIFICATES: PERMITS Health Certificate from state of origin within last 30 days issued and signed by a licensed accredited veterinarian 130A-194 Quarantine of districts infected with rabies An area may be declared under quarantine against rabies by the local health director when the disease exists to the extent that the lives of persons are endangered. When quarantine is declared, each animal in the area that is required to be vaccinated under this Part shall be confined on the premises of the owner or in a veterinary hospital unless the animal is on a leash or under the control and in the sight of a responsible adult 130A-195 Destroying stray or feral animals in quarantine districts When quarantine has been declared and stray or feral animals continue to run uncontrolled in the area, any peace officer or Animal Control Officer shall have the right, after reasonable effort has been made to apprehend the animals, to destroy the stray or feral animals and properly dispose of their bodies 130A-196. Notice and confinement of biting animals (a.) Required Reporting Who reports? Person bitten or parent, guardian person standing in loco parentis of the person Person owning / in control / in possession of the animal Physician who attends a person by an animal known to be a potential carrier of rabies When? Immediately or within 24 hours (physician) How? Shall notify the local health director (ACS) and give the name and address of the person bitten and the owner of the animal. 130A-196. Notice and confinement of biting animals (a) Stray or feral animals If animal is stray or feral Local Animal Control shall make a reasonable attempt to locate the owner of the animal If owner cannot be identified within 72 hours of the event, then local health director may authorize the animal be euthanized and head shall be immediately sent to the State Laboratory of Public Health for rabies diagnosis If bite occurs on weekend or State holiday hold shall be extended 24 hours 7

8 130A-196 Notice and confinement of biting animals. (b.) Confinement 130A-197. Infected animals to be destroyed; protection of vaccinated animals. All dogs, cats and ferrets that bite a person shall be immediately confined for 10 days in a place designated by the local health director -Owner s property, -Veterinary hospital, or -County shelter Enforced by Animal Control and Local Health Director When the Local Health Director reasonably suspects a dog, cat, or ferret to be exposed to rabies... PROTOCOL FOR DOGS/CATS/FERRETS EXPOSED TO RABIES Dog/Cat/Ferret Exposed 1 to Wild Mammal that can be Reasonably Suspected of Having Rabies Exposed Dog/Cat/Ferret has a Current 2 Rabies Vaccination Revaccinate against Rabies within 5 days of Exposure 3 In North Carolina Animals Reasonably Suspected of Having Rabies Include: Raccoons Bats Red and Gray Foxes Skunks Bobcats Coyotes Beavers Groundhogs (woodchucks) If there is any question as to whether or not an animal poses a risk, call VPH at What is a Currently Vaccinated animal? Initial vaccine 28 days after immunization Dogs and cats should be re-immunized within 12 months (1 year) after the initial (first) vaccination, regardless of age And vaccinated every 1, 3, or 4 years thereafter depending on the vaccine, species and the vaccine used. DO NOT LET VACCINES LAPSE! Educate owners to obtain next vaccination prior to expiration. Work with veterinarians. Dog/Cat/Ferret Exposed 1 to Wild Mammal that can be Reasonably Suspected of Having Rabies Exposed Dog/Cat/Ferret does NOT have a Current 2 Rabies Vaccination Test Mammal 4 that Exposed the Dog/Cat/Ferret NCGS 130A 197 Six Month Quarantine when Dog/Cat/Ferret exposed to Rabies 1. virus enters body 2. virus dormant for variable time period 3.virus enters PNS travels toward brain 4. virus enters brain NCGS 130A 196 Ten day Confinement when Dog/Cat/Ferret bites a person 5. virus spreads to salivary glands 6. Animal shows signs of rabies Results are Positive or Unsatisfactory for Rabies Euthanize Exposed Dog/Cat/Ferret 5 OR Results are Negative for Rabies Vaccinate Dog / Cat against Rabies Incubation Shedding At the Discretion of the Local Health Director, a 6 Month Quarantine may be an Acceptable Alternative to Euthanasia 5 Exposure: bite, scratch, saliva touches eyes, nose, mouth Animal NOT infectious, appears healthy, up to 180 day duration Animal IS infectious, may appear healthy or ill 1-10 day duration DEATH 8

9 130A-198 Confinement A person who owns or has possession of an animal that is suspected of having rabies shall immediately notify the local health director or county ACO, and securely confine the animal in a place designated by the local health director Confinement period is 10 days Other animals may be destroyed at the discretion of State Public Health Veterinarian 130A-199 Rabid animal to be destroyed; heads to be sent to State Laboratory Public Health (SLPH) An animal diagnosed as having rabies by a licensed veterinarian shall be destroyed and its head sent to the SLPH. The heads of all animals that die during 10 day confinement shall be sent immediately to SLPH for rabies diagnosis. 130A-200 Confinement or leashing of vicious animals A local health director may declare an animal to be vicious and a menace to the public health when the animal has attacked a person causing bodily harm without being teased, molested, provoked, beaten, tortured or otherwise harmed. The local health director shall order the animal to be confined to its owner's property. Superseded by Chapter 67 of statutes 130A-201 Rabies emergency A local health director in whose county or district rabies is found in the wild animal population as evidenced by a positive diagnosis of rabies in the past year in any wild animal, except a bat, may petition the State Health Director to declare a rabies emergency in the county or district Executive Director of the Wildlife Resources Commission to develop a plan to reduce the threat of rabies exposure to humans and domestic animals by foxes, raccoons, skunks, or bobcats in the county or district Some Thoughts on Exotic Animals Legal Status of Exotic Animal Ownership in NC NC Senate Bill 954; 1997 did not pass Exotic: an animal that is not indigenous to North Carolina; and that poses a significant threat to human health and safety Intent of bill was to create a registry so exotic animals could be known to community There is no statewide law restricting possession of exotic animals NC WRC does generally prohibit possession of native wildlife 9

10 Legal Status of Exotic Animal Ownership in NC Counties have acted independently and created ordinances that restrict ownership / possession / keeping of exotics Legal Authority NCGS 153A-131 Possession or harboring of dangerous animals A county may by ordinance regulate, restrict, or prohibit the possession or harboring of animals which are dangerous to persons or property NCGS 160A-187 Possession or harboring of dangerous animals A city may by ordinance regulate, restrict, or prohibit the possession or harboring within the city of animals which are dangerous to persons or property Definitions vary by County Surry: Inherently Dangerous Exotic Animal Non human primates Member of family canidae excluding Canis familiaris Member of the family felidae excluding Felis catus, if over 15 pounds Member of the family ursidae reptiles, insects, or arachnids which are venomous and which are not indigenous to Surry County Iredell: Wild and Exotic Animals Reptiles which are poisonous or constricting and more than ten (10) feet in length. Nonhuman primates weighing greater than twenty-five (25) pounds Members of the feline family other than domestic house cats, including, but not limited to lions, tigers and leopards Reptiles that are members of the crocodile family, including, but not limited to alligators and crocodiles. Rabies The primary concern with mammal bites is rabies but there are some important considerations when dealing with animals kept as pets other than dogs, cats, and ferrets Hybrid dogs and cats that bite Give us a call These animals are not dogs or cats as defined by NC rabies statutes Standard control measures will not generally apply What happens if a bites a person? Rabies The viral shedding period is known only for dogs, cats, and ferrets Other mammals that bite, even if kept as pets, may need to be submitted for rabies testing But what if the was vaccinated against rabies? Animal rabies vaccines are licensed for use only in: dogs, cats, ferrets, cattle, horses, sheep Use of rabies vaccines in other species is an off label use that carries no guarantee of efficacy 10

11 But my has a demonstrated rabies antibody titer, therefore it is protected False Titers do not directly correlate with protection because other immunologic factors also play a role in preventing rabies, and our abilities to measure and interpret those other factors are not well-developed. Therefore, evidence of circulating rabies virus antibodies in animals should not be used as a substitute for current vaccination in managing rabies exposures or determining the need for booster vaccinations Exotic Animal Bites Often confusing as the disease risks may not be fully understood Human and animal follow up can be expensive People have often spent thousands of dollars to obtain exotic and are reluctant to relinquish Local animal control has little to no experience in handling these species It is better to prohibit possession / ownership through ordinance 11