| Health Advisory -- December 1, 2006
Rabies Post-Exposure Prophylaxis for Raccoon and Other Wild Terrestrial Carnivore Bites
The following information is intended to help
King
County
healthcare providers make decisions regarding administration of rabies post-exposure prophylaxis (PEP) in cases with raccoon and other wild terrestrial carnivore bites.
Because rabies is preventable before onset of symptoms with appropriate PEP, and is almost universally fatal after onset of clinical illness, all cases of animal and bat bites require careful risk assessment regarding the need for PEP. This assessment should take the following factors into consideration1,2:
| 1. |
The local and regional epidemiology of rabies among susceptible species and the adequacy of local and regional animal rabies surveillance data, |
| 2. |
The circumstances of bite or non-bite exposures (provoked versus unprovoked), |
| 3. |
The behavior of the biting animal (although the absence of abnormal behavior does not indicate absence of rabies, abnormal behavior as judged by a qualified professional should raise the suspicion for rabies). |
Often it is the first of the three factors above that leads some healthcare providers to recommend against PEP. They feel that because there are no known cases of raccoon rabies in Washington State, PEP is not indicated.
We agree that currently the risk of rabies from the bite of a raccoon that does not exhibit abnormal behavior appears to be low. However, the lack of an active surveillance system for rabies in
Washington
State
makes it incorrect to assume that there are no raccoons or other wild terrestrial carnivores with rabies in our state. Rabies is a dynamic disease among animal populations and may be introduced into a new geographic area through animal translocation, natural disease spread into new areas, and development of new hosts. Since 2000,
Oregon
has reported fox rabies, and
Idaho
,
California
and
British Columbia
have reported skunk rabies. Furthermore, the spillover of bat-rabies into terrestrial mammals leading to a sustained epizootic has been documented in Arizona.3 In light of this information from other states, and in the absence of an active rabies surveillance system in our state, we cannot be certain that rabies is not present below our threshold to detect it in our area. We also expect that if an emerging rabies epizootic were to occur, there would be a delay in our detection of the disease.
Therefore, after consultation with the Centers for Disease Control and Prevention (CDC), Public Health – Seattle & King County continues to recommend rabies PEP for raccoon and other wild terrestrial carnivore bites when the animal is not available for rabies testing. The decision to administer rabies PEP after an animal bite should be made by the health care provider and the bite victim after consideration of the species involved, circumstances of the exposure, the risk for rabies, and risks and benefits of PEP.
Animal bites due to wild terrestrial carnivores should be reported to public health jurisdictions immediately in Washington State. Prompt capture and rabies testing of wild animals that bite humans is the best option whenever possible. To report cases and receive guidance for assessing rabies exposure or to arrange testing of a wild animal that has bitten a human: Call Public Health - Seattle & King County 206-296-4774; after hours please follow the directions for contacting the public health official on call.
For additional information and resources regarding rabies, including information about PEP and contact numbers for animal control agencies, see Animals and Bat Bites on our web page Health Advisories & Resources at: www.metrokc.gov/health/providers/epidemiology
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