Rabies Control Program

Rabies Control Program by: Joyce Pickering, physician consultant Public Health Module Cree Region Montreal General Hospital March, 1996 Revised: November 1996

TABLE OF CONTENTS 1 Persons to contact and phone numbers... 1 2. Introduction... 2 3 Rabies and Man... 4 3.1 Procedure following exposure to a rabies suspected animal... 4 3.1.1 Information to obtain... 4 3.1.2 Persons to notify... 4 3.1.3 Procedures for the animal... 5 3.2 Summary of responsibilities... 5 4 Dog and cat vaccination... 5 4.1 Technical assistance program to the Cree communities for the protection of dogs and cats against rabies... 5 4.1.1 Objective of the technical assistance program... 6 4.1.2 Vaccination procedure, vaccine and syringes... 6 4.2 The control of stray dogs and cats... 7 5. The main characteristics of the disease... 7 5.1 What is rabies?... 7 5.2 How is rabies transmitted?... 7 5.3 When does the rabies virus appear in the saliva?... 8 5.4 How long does it take for rabies to develop in pets?... 8 5.5 How does a rabid animal act?... 8 5.5.1 Furious rabies... 8 5.5.2 Dumb rabies... 9 5.6 Rabies in wildlife carnivores... 9 5.7 How to diagnose rabies in animals... 9 5.8 Specimen of choice for diagnosis... 9 5.9 How can rabies be treated?... 9 6 Rabies, a reportable disease... 10 6.1 Procedure to follow when a person has been bitten by an animal... 10 6.1.1 Domestic animals (dogs and cats)... 10 6.1.2 Wild animals... 11 6.2 Procedures for shipping specimens for rabies diagnosis from Northern Quebec... 11 6.2.1 Collecting and preparing specimens... 11 6.2.2 Collection of the specimen... 12 6.2.3 The procedure... 12 6.2.4 Details on specimen identification... 13 Rabies Control Program i

APPENDICES 6.2.5 Details on specimen shipment... 13 6.2.6 Details on information to accompany the specimen... 14 6.2.7 Disinfections of contaminated materials... 15 Nurse's responsibilities in rabies prevention for the patient Procedures for non-vaccinated persons Procedures for previously vaccinated persons Form AGR2908 Permit for equivalent level of safety ii Rabies Control Program

1. PERSONS TO CONTACT AND PHONE NUMBERS Human exposure to rabies Dr. Elizabeth Robinson 450-465-8856 (Home) See Section 3 Vaccination of domestic animals Agriculture, Fisheries and Food, Quebec See Section 4 Dr. Real-Raymond Major 819-763-3287 ext 228 Information on control of rabid animals Specimen Collection and Shipment Canadian Food Inspection Agency 450-476-1223 (à Mirabel) Dr. Pierre Vivier, Veterinaire (514) 351-1661 (Home) Fax: 450-476-1417 Dr. Charles Paquin See Section 5 Animal Disease Research Institute (A.D.R.I) (613) 998-9320 (Office) (Friday : 16:00 to 24:00, Saturday, Sunday and holidays : 08:00 to 24:00) (613) 799-6973 Please do not communicate directly with A.D.R.I. unless you are the contact to receive results on weekends. See Section 6 1 Public Health Module, Cree Region = PHMCR Rabies Control Program 1

Permit for equivalent level of safety This form, which must be used when shipping a specimen should be found in the shipping container. If not available, see the annex of this protocol, or call one of the veterinarian of Agriculture and Agro Food Canada, see page 1 Officer-in-charge, Quebec Police (819) 764-3202 Rouyn-Noranda Shipping charges must be billed to: Agriculture and Agri Food Canada 200 Rene-Levesque West, East Tower, Suite 1002V, Montreal, Qc H2Z 1Y3 2. INTRODUCTION Rabies is an infection of the brain, sometimes present in wild animals such as foxes and wolves, which can spread to infect pets and people. Rabies is always a fatal disease for both animals and humans, which is why protection is so important. Rabies is endemic in the territories north of the 55th parallel. Animal rabies has been diagnosed in 19 wild animals from 1990 to late 1995 in this area. Diagnosing rabies in wild animals requires that their heads be sent to Agriculture and Agri Food Canada for analysis. This is rarely done from the Cree communities, so our figures for this area are likely to be underestimates. From 1988 to 1994, there was a rabies epidemic in wild animals in Quebec. As of 1995, this seems to have diminished considerably. It is suspected that a new epidemic, of a type of rabies that raccoons are particularly susceptible to will soon be spreading through Quebec. Since raccoons do not live in the Cree and Inuit territories, we do not expect a major problem from this new epidemic. The graphs, on the next page, give the number of cases of animal rabies in Quebec and Nouveau Quebec from 1988 through 1995. The rabies control program in the Cree communities consists of 4 parts. These are: 1. control of stray dogs 2. vaccination of pets (dogs and cats) 3. vaccination of humans who have been exposed 4. procedures for the animal who is suspected to have rabies These parts, along with further details on the disease itself are described in this chapter. 4 Rabies Control Program

3 RABIES AND MAN 3.1 Procedure following exposure to a rabies suspected animal 3.1.1 Information to obtain When a person has been exposed to an animal suspected to be rabid, this person should give the local nurse the following information: 1) Circumstances of the incident - provoked or unprovoked - where it took place, etc. - the names of other people who might have been in contact with the animal 2) Animal species involved - wild animal: fox, wolf - domestic animal: dog, cat 3) Type of exposure - contact with saliva, blood, etc. - bite, scratch, etc. 4) If it is a domestic animal - name of owner - description of animal: name, sex, predominant breed and color - vaccination status of the animal 3.1.2 Persons to notify The nurse must then notify immediately the northern physician as well as the physician responsible at the Public Health Module, Cree Region (PHMCR). For the Cree territory, this is: Dr. Elizabeth Robinson (514) 861-2352 ext 29 (office: PHMCR) (450) 465-8856 (home) Fax: (514) 989-7273 (office: PHMCR) 4 Rabies Control Program

The physicians will decide the immediate action for the person involved. The nurses' responsibilities in rabies prevention for the patient are detailed in Appendix I. 3.1.3 Procedures for the animal The designated vaccinator, or the person designated by the community must kill the animal without damage to the head. In the case of a domestic animal, instead of being killed, it may be tied up and observed for 10 days. See Section 4.1. 3.2 Summary of responsibilities - the physician at the PHMCR is the reference person to consult with to take the decision to vaccinate a patient. S/he may be consulted at any time at the telephone numbers previously indicated. - the treating physician in the north, after compulsory consultation with the physician responsible at the PHMCR takes the appropriate decisions for his patient. - The nursing personnel has the responsibility to know and to apply the prevention protocol promptly. - The designated person must take the appropriate steps concerning the dog involved. 4 DOG AND CAT VACCINATION Dogs and cats play an important role in the transmission of rabies from wild animals to man. The following procedures help to shield people from rabies by protecting domestic animals from that disease: Vaccination of domestic dogs and cats Control of stray dogs and cats 4.1 Technical assistance program to the Cree communities for the protection of dogs and cats against rabies Since April 1989, the Animal Health Department, Ministry of Agriculture, Fisheries and Food of Quebec offers to the Cree technical assistance for the vaccination of dogs and cats against rabies. Rabies Control Program 5

4.1.1 Objective of the technical assistance program Training of designated people from the communities that wish to take part in the program to vaccinate the dogs and cats in their communities. Payment of people trained to vaccinate the animals is the only cost that the community taking part in the program must meet. 4.1.2 Vaccination procedure, vaccine and syringes 1) Healthy dogs and cats must be at least three (3) months old to receive the vaccine and are considered to be protected against rabies one (1) month after the vaccination. 2) Dogs and cats vaccinated against rabies between three (3) and twelve (12) months of age are protected for one (1) year and must receive a booster vaccine one year after the first shot to be protected for three (3) years. 3) Dogs and cats vaccinated against rabies at the age of one (1) year and over are considered to be protected for three (3) years. 4) The vaccine must NEVER BE FROZEN. It must be stored in a refrigerator at a temperature between 2 C and 7 C. 5) The vaccine must be administered to the dog or cat in a heavy muscle area. The thigh muscle is the site of choice. See figure 1. 6) A 20 or 22 gage needle, 3/4 or 1 inch long must be used. 7) The certificate of vaccination must provide complete and accurate identification of the animal vaccinated along with the type of vaccine used and the date of vaccination. 6 Rabies Control Program

When a domestic animal living in an area where rabies is endemic has bitten people, the nursing staff needs to know the vaccination status of that animal. 8) Distribution of the certificate of vaccination - one copy each to the: owner of the animal nursing staff of the community clinic person designated by the community to vaccinate the animal. 4.2 The control of stray dogs and cats When rabies is present in an area, stray dogs and cats must be controlled because they are at high risk of being exposed to an infected animal. Because these exposures are not always known by people, they are more dangerous. For example, a stray dog or cat can be attacked or can fight with a rabid fox and nobody will be aware of the incident. If this dog or cat was not vaccinated, it will probably develop rabies symptoms during the following 2 to 6 weeks. If the animal is in the village at that time and is always stray, we can see the danger it represents. It is almost impossible to vaccinate stray dogs and cats. If additional information is needed on this program, do not hesitate to contact the following person: Dr. Réal-Raymond Mayor Tel: (819-763-3287) ext 228 Veterinarian Agriculture, Fisheries and Food Rouyn-Noranda, Qc (updated August 28, 2000) 5. THE MAIN CHARACTERISTICS OF THE DISEASE 5.1 What is rabies? Rabies is an infectious and contagious disease caused by a virus affecting the nervous system of all warm-blooded animals and man, and is uniformly fatal. 5.2 How is rabies transmitted? Rabies is usually transmitted by the deposition of saliva containing the rabies virus in open wounds, cuts, on abraded skin or mucosa (mouth, tongue, inside of eyelids, inside of nostril). Rabies Control Program 7

5.3 When does the rabies virus appear in the saliva? Rabies virus can be found in the saliva of an animal up to 10 days before the animal shows signs of rabies. Bat bites, however, should always be considered infectious. 5.4 How long does it take for rabies to develop in pets? Symptoms of rabies may be observed from two to six weeks following the exposure (bite) of a dog or cat to the rabies virus. Dogs, however, may incubate the disease for up to six months before developing the disease. The length of time between infection and onset of the symptoms depends on many factors such as the severity of the bite or wound, its distance from the brain, the quantity of virus deposited in the wound, etc. Rabies virus travels at a speed of 100 to 400 mm a day along the nerves. 5.5 How does a rabid animal act? There are two forms of rabies: furious and dumb rabies. In dogs, dumb rabies is more common. Cats nearly always suffer from the furious form. Livestock usually have dumb rabies. The symptoms described below are characteristic of the different forms, but a rabid animal will not necessarily exhibit all of them. 5.5.1 Furious rabies In the dog, the first symptom noticed is usually a change in its behavior. A normally friendly dog may become shy, hide in dark places, resent attention and snap when bothered. A normally shy or snarly dog may become unusually friendly. During this stage, a dog's voice becomes hoarse and its appetite diminished or perverted; it will bite at sticks, stones, rubber, etc. Soon after this, the dog becomes very nervous and excitable. The expression of its eyes and face is a combination of alertness, fear and ferocity. This has been described as a fox-like expression. During this stage, the dog may travel several miles, trotting along with its head and tail down, drooling saliva and biting at anything and everything it meets. A dog that is tied or shut up will often chew at its chain or the bars of its cage, injuring teeth and mouth so that blood appears in its saliva. This period may last several days and the dog will become thin because it is not eating. In the third or paralytic stage the dog staggers, is soon unable to stand up, and eventually becomes completely paralyzed. Death follows unconsciousness or a violent convulsion, about 4 to 7 days after symptoms first appear. 8 Rabies Control Program

In the cat, the symptoms are much the same as in the dog. It becomes restless and moves about persistently in erratic manner. It will not wander as far as a dog. Muscle spasms occur and are often brought on by sudden noise or excitement. During these spasms, the cat will jump about furiously and attack other animals and man. 5.5.2 Dumb rabies In this form, the period of excitability and viciousness is either absent or very short and often goes unnoticed. Paralysis usually starts in the throat so that the animal is unable to bite or swallow and saliva drools from its partly open mouth; it may appear as if it had a piece of bone stuck in its throat. It rapidly loses weight; paralysis develops quickly; and the animal dies shortly afterwards. 5.6 Rabies in wildlife carnivores Infected foxes or other wild carnivores will change their behavior; they may come close to houses and may attack domestic animals. Such cases must be reported to local authorities. 5.7 How to diagnose rabies in animals The clinical diagnosis of rabies may be based on the change in the normal behavior of the animal and/or characteristic clinical signs but the diagnosis MUST be confirmed by a laboratory examination of the animal's brain. Therefore, if it is necessary to kill an animal, it should be done humanely and in a manner that will not damage the head. 5.8 Specimen of choice for diagnosis The specimen of choice for a diagnosis is the brain of the animal suspected of rabies. When an animal has been shot in the head and no brain tissue can be recovered, the head may be submitted for diagnosis. In this case, the laboratory technicians will use the salivary glands and the nerves of that area as specimen. Part of spinal cord nearest to the brain can be used when nothing else is available. 5.9 How can rabies be treated? There is no treatment for rabies in animals and the disease is almost always fatal. Prevention is the only option. Rabies Control Program 9

6 RABIES, A REPORTABLE DISEASE Rabies is a reportable disease under the Health of Animals Act. This means that an animal suspected of rabies MUST be reported to Animal Health division, Food Production and Inspection Branch, Agriculture and Agri Food Canada. The clinical diagnosis must be confirmed by the Animal Disease Research Institute of Agriculture and Agri Food Canada in Nepean, Ontario. The diagnosis is done using the Fluorescent Antibody Technique on brain tissue: therefore, it is of utmost importance for the laboratory to receive the specimen in good condition. The specimen must be shipped by the shortest and quickest route possible. The result is usually available within 24 hours following receipt of the specimen at the laboratory, except for weekends and holidays. If you wish to have the results on these days, please contact Agriculture and Agri Food Canada (see telephone numbers on page 1) and give them your name and the telephone and fax numbers where you can be reached during the weekend or holiday. Following a human exposure to the rabies virus and a negative result to the Fluorescent Antibody Test, a second test (the tissue culture test) is performed with the result available a week later. A diagnostic service is available to physicians who wish to have rabies diagnosis performed on human tissues. Agriculture and Agri Food Canada also provides general information on rabies through lectures, abstracts and telephone assistance. 6.1 Procedure to follow when a person has been bitten by an animal 6.1.1 Domestic animals (dogs and cats) 1) If the animal is still alive and seems in apparent good health (see section 5 of this manual), the following procedure must be applied. OR * Tie the biting animal securely and keep it under observation for 10 days. On the 11 th day, if the animal still seems healthy, the animal may be released since rabies virus is present in the saliva not more than 10 days before the onset of rabies symptoms. * Keep in mind that this animal could still develop signs of rabies later but would not have been infectious at the time of the bite in question. 10 Rabies Control Program

* Kill the animal and ship the head frozen to the Animal Disease Research Institute (A.D.R.I.), Nepean, Ont. according to the procedure outlined in 6.2, after reporting the case to a veterinary inspector of Agriculture and Agri Food Canada. 2) If the animal is alive but displays unusual behavior. Kill the animal and ship the head frozen to the A.D.R.I., Nepean, Ont. according to the procedure outlined in 6.2, after reporting the case to a veterinary inspector of Agriculture and Agri Food Canada. 6.1.2 Wild animals When they bite, these animals must be killed and the head shipped frozen to the A.D.R.I., Nepean, Ont. according to the procedure outlined in 6.2, after reporting the case to a veterinary inspector of Agriculture and Agri Food Canada. 6.2 Procedures for shipping specimens for rabies diagnosis from Northern Quebec To confirm the diagnosis of rabies in animals, laboratory examination of the brain is necessary. To assure accurate and reliable reports, instructions mentioned below must be followed. 6.2.1 Collecting and preparing specimens The intact and well preserved brain is the specimen of choice for laboratory diagnosis of rabies. However, when the animal has been shot in the head and no brain tissue is available, salivary gland, spinal cord nearest to the head or the head itself in the case of small wild and domestic animal (fox, skunk, wolf, coyote, dog and cat) can be sent to the federal laboratory. * When an animal must be killed, precautions must be taken to prevent the destruction of the brain and to prevent it from going bad during transit. PREVENT ANY CONTAMINATION BY WEARING HEAVY RUBBER GLOVES AND GOGGLES WHEN HANDLING A SPECIMEN (CUTTING THE HEAD OR TAKING THE BRAIN AND PUTTING IT IN A PLASTIC BAG). DISINFECT THE INSTRUMENTS AND THE GLOVES AFTER USING THEM TO TAKE A SPECIMEN. When the specimen has been taken, the carcass must be disposed of by burial or burning. Rabies Control Program 11

If an exposure to the virus should occur during the handling of the specimen, the incident must be reported immediately to the nearest medical authority. 6.2.2 Collection of the specimen The game warden of the "Ministere de 1'Environnement et de la Faune du Quebec", the designated vaccinator or the person designated by the Band Council are responsible for the collection of the specimen. 6.2.3 The procedure 1) Obtain as much information as possible on the case and the person exposed to the animal suspected or rabies (cf. appendix II: "Rabies Specimen Submission" form). 2) Wearing heavy rubber gloves or the equivalent and with the metal container and the kit it contains at hand, (the metal container containing the necessary bags, forms, etc is usually stored at the clinics): Remove the head, put it in a first orange plastic bag. Tie off the bag by making two knots to prevent leakage. Put the orange bag in a second orange bag and tie it off by making two knots in it. Attach an identification tag to the second bag by using a piece of string. The bag with its contents should then be frozen. 3) The bags containing the frozen head should be inserted in the metal container with absorbent material (newspapers) and Ice Packs (never use dry ice or ice). The metal container must be closed with the nut and bolt. 4) Contact the local medical authorities (clinic physician or nurse, etc) to report all information concerning the incident. 5) The physician or the nurse at the clinic or station must complete the form AGR 2908 for the shipment of the specimen and put it in an envelope fixed to the container. See the appendices for a copy of AGR 2908. 6) The metal container must be forwarded by the safest and fastest route (usually by plane "counter to counter") to the Quebec Police station responsible for the territory of each community listed hereafter. You must also forewarn the persons listed below. For the Hudson and James Bay - Coastal Cree communities Quebec police officer Kuujjuarapik station (819) 929-3090 12 Rabies Control Program

Hélène Laliberté Dr. Paul Seguin or Dr. Denis Brochu or Dr. Michel Charbonneau Montreal/Lanaudiere district office Agriculture and Agri Food Canada Montreal, Qc 450-476-1223 For the Inland Cree communities: Nemiscau, Waswapini, Mistissini and Ouje Bougoumou Dr. Paul Seguin or Dr. Denis Brochu or Dr. Michel Charbonneau Montreal/Lanaudiere district office Agriculture and Agri Food Canada Montreal, Qc 7) The police officer receiving the notice must look after the container upon arrival. 8) The police officer responsible for the container must ship it by plane to Dorval Airport, Montreal. Qc. Address the metal container to: c/o André Anctil Animal Health Agence Canadienne Inspection de Aliments 975 Romeo Vachon N # 001D Dorval Airport Montreal, Quebec H4Y 1H1 Tel: 514-633-7755 Fax: 514-633-7757 6.2.4 Details on specimen identification All specimens forwarded to A.D.R.I., Nepean, Ontario must be properly identified. This can be done with an Animal Health eartag or another identification number attached to the orange plastic bag containing the specimen by a string. The identification number must be recorded on form AGR 2908. The identification number on the form must be the same as the one tied to the plastic bag containing the specimen. 6.2.5 Details on specimen shipment The specimen should be shipped frozen. Rabies Control Program 13

1) The specimen should be shipped in the appropriate container with the accompanying form AGR 2908. 2) The specimen must be shipped with the appropriate permit for equivalent level of safety and with a properly filled shipper's declaration attached to the outside of the metal drum. For an example, see the appendices. CAUTION THE DEPARTMENT OF TRANSPORT FORBIDS SHIPPING OF DANGEROUS GOODS IMPROPERLY PACKAGED OR UNACCOMPANIED BY A VALID PERMIT FOR EQUIVALENT LEVEL OF SAFETY AND A PROPERLY FILLED SHIPPER'S DECLARATION. IN CASE OF EMERGENCY, A COPY OF THE PERMIT AND AN EXAMPLE OF A PROPERLY FILLED SHIPPER'S DECLARATION CAN BE OBTAINED BY FAX FROM THE OFFICE OF AGRICULTURE AND AGRI FOOD CANADA, MONTREAL/LANAUDIERE DISTRICT OFFICE IN MONTREAL. Send your request to: c/o District Veterinarian Place Carillon II 7101 Jean-Talon east / Room 600 Anjou/Qc H1M3N7 (514/493-8859 After office hours contact one the veterinarians of Agriculture and Agro Food Canada at home, see page 1 N.B. In case of a human exposure to the virus and a refusal from the transporter to accept the shipment, ask the airline cargo manager to transport the dangerous good under "Life saving drug and/or Life or Death diagnostic specimen". 6.2.6 Details on information to accompany the specimen A minimum of information must accompany the specimens to the federal laboratory. It must be recorded on form AGR 2908 which should be filled and sent fixed to the metal container with tape. The nursing stations or clinics must keep the last copy of the form for filing. 14 Rabies Control Program

If the above-mentioned form is not available, send the equivalent information on a regular piece of paper. In the case of hand written information, make sure that the information given is readable. Upon departure of the specimen for Dorval Airport, Qc, the police officer must phone the following information to Animal Health office, Agriculture and Agri Food Canada, Montreal, Qc. Information needed 1) Place of departure of the specimen 2) Date and hour of departure 3) Estimated time of arrival in Dorval Airport 4) Flight number 5) Company (transporter) 6) Airwaybill number. Phone the information to (514) 493-8859 Office hours: Monday through Friday: 8hl5 to 12h - 13h to 16h30 Nights and weekends, contact one of the veterinarians from Agriculture and Agro Food Canada at home, see page 1 Please do not forget to advise the nearest medical authorities about the case. If there is a high probability that as specimen with human exposure reach the laboratory on a Saturday or a statutory holiday and if a diagnosis is requested immediately when available, a request must be transmitted by telephone to a veterinarian from Agriculture and Agro Food Canada at (514) 493-8859. 6.2.7 Disinfection of contaminated materials A solution of "Javex" at a dilution of 1/10 kills the virus. Rabies Control Program 15

APPENDICES Nurse's responsibilities in rabies prevention for the patient Procedures for non-vaccinated persons Procedures for previously vaccinated persons Form AGR2908 Permit for equivalent level of safety

Nurse's responsibilities in rabies prevention for the patient 1) Advise northern physician and Public Health module physician immediately. 2) Wear rubber gloves, and if possible, a smock to prevent contact with the saliva of the patient or of the animal. 3) For local treatment of the wound: a) Wash and thoroughly rinse the wound with water and soap. b) Disinfect with an iodine solution. c) LEAVE THE WOUND OPEN AND DO NOT SUTURE IF POSSIBLE. d) If necessary, apply antitetanic and antibacterial prophylaxis. e) Make sure that no other person has been in contact with the saliva of the animal. 4) Make sure that the person who has taken the head of the animal has not been exposed to the rabies virus during the act. 5) Apply immunization procedures. A person exposed to rabies must receive active and passive immunization except if previously vaccinated. In the latter case, a booster (2 doses) of active immunization is sufficient. 6) Disinfect all material contaminated by saliva (cloths, instruments, etc) and advise family, if necessary, of disinfection procedures to be applied at home. N.B. Human Diploid Cell Vaccines (HDCV) and Rabies Immuno globulin (R.I.G.) are available at the clinics/ hospitals.

Procedures for non-vaccinated persons Active immunization: Human Diploid Cell Vaccine (HDCV). The decision to vaccinate is taken by the treating physician in the North after consultation with the "Public Health module" physician. The vaccine must be given as soon as possible after the decision is made. Vaccine administration: 1 ml intramuscularly, in the deltoid muscle at days 0, 3, 7, 14, 28 following exposure. Passive immunization: Dosage: Administration: Rabies Immuno globulin (R.I.G.). 20 i.u./kg Half the dose by infiltration around the wound. Half the dose by intramuscular route, changing syringe and needle and avoiding injection at the same site as the vaccine. Procedures for previously vaccinated persons Active immunization: Human Diploid Cell Vaccine (HDCV). Vaccine administration: After the medical decision is taken, administer 1 ml intramuscularly in the deltoid muscle at days 0 and 3 following exposure. Revised 96.01 SA4.3