depar depar depar depar department of health and human ser tment of health and human ser tment of health and human ser tment of health and human ser tment of health and human services vices vices vices vices# Part I: Rabies Prevention and Control
A. Principles of Rabies Prevention and Control. 1. Rabies Exposure. Rabies is transmitted only when the virus is introduced into bite wounds, open cuts in skin, or onto mucous membranes from saliva or other potentially infectious material such as neural tissue (2). Questions regarding possible exposures should be directed promptly to state or local public health authorities. 2. Public Health Education. Essential components of rabies prevention and control include ongoing public health education, responsible pet ownership, routine veterinary care, and professional continuing education. The majority of animal and human exposures to rabies can be prevented by raising awareness concerning rabies transmission routes; avoiding contact with wildlife; and following appropriate veterinary care. Prompt recognition and reporting of possible exposures to medical professionals and local public health authorities are critical.

# Human Rabies Prevention.
Rabies in humans can be prevented either by eliminating exposures to rabid animals or by providing exposed persons with prompt local treatment of wounds combined with the administration of human rabies immune globulin and vaccine.
The rationale for recommending preexposure and postexposure rabies prophylaxis and details of their administration can be found in the current recommendations of the Advisory Committee on Immunization Practices (ACIP) (2). These recommendations, along with information concerning the current local and regional epidemiology of animal rabies and the availability of human rabies biologics, are available from state health departments. 4. Domestic Animals. Local governments should initiate and maintain effective programs to ensure vaccination of all dogs, cats, and ferrets and to remove strays and unwanted animals. Such procedures in the United States have reduced laboratory-confirmed cases of rabies in dogs from 6,949 in 1947 to 76 in 2005 (3). Because more rabies cases are reported annually involving cats (269 in 2005) than dogs, vaccination of cats should be required (3). Animal shelters and animal-control authorities should establish policies to ensure that adopted animals are vaccinated against rabies. The recommended vaccination procedures and the licensed animal vaccines are specified in Parts II and III of this compendium, respectively. Rabies vaccinations also may be administered under the supervision of a veterinarian to animals held in animalcontrol shelters before release. Any veterinarian signing a rabies certificate must ensure that the person administering vaccine is identified on the certificate and is appropriately trained in vaccine storage, handling, administration, and in the management of adverse events. This practice ensures that a qualified and responsible person can be held accountable for properly vaccinating the animal. Within 28 days after initial vaccination, a peak rabies virus antibody titer is reached, and the animal can be considered immunized. An animal is considered currently vaccinated and immunized if the initial vaccination was administered at least 28 days previously or booster vaccinations have been administered in accordance with this compendium.

# Rabies in
Regardless of the age of the animal at initial vaccination, a booster vaccination should be administered 1 year later (see Parts II and III for vaccines and procedures). No laboratory or epidemiologic data exist to support the annual or biennial administration of 3-or 4-year vaccines following the initial series. Because a rapid anamnestic response is expected, an animal is considered currently vaccinated immediately after a booster vaccination. a. Dogs, Cats, and Ferrets. All dogs, cats, and ferrets should be vaccinated and revaccinated against rabies in accordance with Part III of this compendium. If a previously vaccinated animal is overdue for a booster, it should be revaccinated. Immediately following the booster, the animal is considered currently vaccinated and should be placed on a vaccination schedule according to the labeled duration of the vaccine used. b. Livestock. Consideration should be given to vaccinating livestock that are particularly valuable. Animals that have frequent contact with humans (e.g., in petting zoos, fairs, and other public exhibitions) and horses traveling interstate should be currently vaccinated against rabies (12,13). c. Confined Animals.
1.) Wild. No parenteral rabies vaccines are licensed for use in wild animals or hybrids (i.e., the offspring of wild animals crossbred to domestic animals). The AVMA has recommended that wild animals or hybrids should not be kept as pets (14-17).

# 2.) Maintained in Exhibits and in Zoological
Parks. Handling and consumption of tissues from exposed animals might carry a risk for rabies transmission. The risk depends in part on the site(s) of exposure, amount of virus present, severity of wounds, and whether sufficient contaminated tissue is later excised. If an exposed animal is to be slaughtered for consumption, it should be done immediately after exposure. Barrier precautions should be used by persons handling the animal, and all tissues should be cooked thoroughly. Historically, federal guidelines for meat inspectors have required that any animal known to have been exposed to rabies within 8 months be rejected for slaughter. USDA Food and Inspection Service (FSIS) meat inspectors should be notified if such exposures occur in food animals before slaughter.
In infected animals, rabies virus might be widely distributed in tissues (21). Tissues and products from a rabid animal should not be used for human or animal consumption (22). However, pasteurization temperatures will inactivate rabies virus; therefore, drinking pasteurized milk or eating thoroughly cooked animal products does not constitute a rabies exposure.
Multiple rabid animals in a herd or herbivoreto-herbivore transmission is uncommon; therefore, restricting the rest of the herd if a single animal has been exposed to or infected by rabies is usually not necessary. c. Other Animals. Other mammals exposed to a rabid animal should be euthanized immediately. Animals maintained in USDA-licensed research facilities or accredited zoological parks should be evaluated on a case-by-case basis. 6. Management of Animals that Bite Humans. a. Dogs, Cats, and Ferrets. Rabies virus might be excreted in the saliva of infected dogs, cats, and ferrets during illness and/or for only a few days before illness or death (23)(24)(25). A healthy dog, cat, or ferret that bites a person should be confined and observed daily for 10 days (26); administration of rabies vaccine to the animal is not recommended during the observation period to avoid confusing signs of rabies with possible side effects of vaccination. Animals in confinement should be evaluated by a veterinarian at the first sign of illness. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be euthanized and the head shipped for testing as described in Part I.A.8. Any stray or unwanted dog, cat, or ferret that bites a person may be euthanized immediately and the head submitted for rabies examination. b. Other Biting Animals. Other biting animals that might have exposed a person to rabies should be reported immediately to the local health department. Management of animals other than dogs, cats, and ferrets depends on the species, the circumstances of the bite, the epidemiology of rabies in the area, the biting animal's history, current health status, and the animal's potential for exposure to rabies. Previous vaccination of these animals might not preclude the necessity for euthanasia and testing. 7. Outbreak Prevention and Control. The emergence of new rabies virus variants and the introduction of nonindigenous viruses pose a substantial risk to humans, domestic animals, and wildlife (27)(28)(29)(30)(31)(32)(33)(34). In such situations, the public health response should be rapid and comprehensive and should include the following measures: a. Characterize the virus at a national or regional reference laboratory. b. Identify and control the source of the introduction. c. Enhance laboratory-based surveillance in wild and domestic animals. d. Increase animal rabies vaccination rates. e. Restrict the movement of animals at risk. f. Evaluate the need for vector population reduction. g. Coordinate a multi-agency response. h. Provide public and professional outreach and education. USDA and marketed in the United States at the time of publication. New vaccine approvals or changes in label specifications made subsequent to publication should be added to this list. Any of the listed vaccines can be used for revaccination, even if the product is not the same as previously administered. Vaccines used in state and local rabiescontrol programs should have at least a 3-year duration of immunity. This constitutes the most effective method of increasing the proportion of immunized dogs and cats in any population (46). No laboratory or epidemiologic data exist to support the annual or biennial administration of 3-or 4-year vaccines following the initial series. C. Adverse Events. Currently, no epidemiologic association exists between any licensed vaccine and adverse events, including vaccine failure (47,48)