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Rabies Suspects

Definitions:

  • Rabies Suspect - clinician or pathologist deems rabies is among the top differential diagnoses.
  • Rabies unlikely but possible - rabies is lower on the list of differential diagnoses.
  • Rabies Contact Log (login required) - a sign in/sign out log of all those who have contact with the animal. It will include date, name, address, time, and procedure performed. The log will become part of the permanent medical record.
  • Exposure - a puncture wound inflicted by the animal, or saliva, or CSF from the animal coming in contact with open wounds or any mucous membranes of a person, household pet or livestock.
  • Vaccinated - current rabies vaccination history provided by referring veterinarian.

Rabies Suspects

Senior clinician is responsible for ensuring all procedures are followed.

Admission and Confinement

  • Dead on arrival (DOA) rabies suspect

    • DOA's will not be admitted. These animals should be directed to Rollins Diagnostic laboratory. (Rollins will send the head to the rabies laboratory).
  • Alive rabies suspect

      • Obtain a signed Consent/Release Form for euthanasia, necropsy and disposal if a diagnosis of rabies is considered likely in the event that the animal dies or is euthanized.
      • If permission cannot be obtained from the owner contact the state public health veterinarian.
      • Animal must be housed in a restricted stall and identified on such as a “RABIES SUSPECT”.
      • The hospital nursing supervisor and the appropriate epidemiologist will immediately be notified.
      • The animal will only be handled and treated by individuals with prior rabies vaccination. The number of individuals in contact with the animal will be kept to a minimum.
      • Gloves, mask, and protective eye wear or face shield will be worn by all individuals working with rabies suspects.
      • A rabies contact log (login required) will be kept on a clipboard on the animal's stall door during the animal's entire stay in the hospital and will become part of the patient's permanent medical record.
      • If the animal dies or is euthanized, necropsy personnel should be appropriately notified that a rabies suspect will be submitted.

Antemortem Specimens

  • All specimens obtained from an animal noted as a rabies suspect and confined in the hospital must be identified: "RABIES SUSPECT" with a sticker.
  • Laboratory request forms must be appropriately labeled: "RABIES SUSPECT".
  • The clinician in charge of the case is responsible for verbally notifying the appropriate laboratory service that the specimen comes from a rabies suspect.
  • After-hours submission of antemortem specimens to hospital laboratories should be kept to a minimum.

Field Service

  • Animals identified as a rabies suspect prior to a visit by ambulatory service clinicians must be handled by a minimum number of personnel.
  • If the animal dies or is euthanized it must be sent to Rollins Laboratory for preparation for submission to the Rabies Laboratory.
  • A rabies contact log (login required) must be kept and placed in the medical record.

Submission to Necropsy

  • Appropriately identify the animal and the necropsy request with: "RABIES SUSPECT".
  • Senior clinician assumes responsibility for notification of the pathologist on duty about the case.
  • Signature of the senior clinician on the necropsy request form is required.
  • Complete history and addressograph information must be on the necropsy request form.
  • Attach a copy of the rabies contact log. Participants in the necropsy must include their names on the contact log.
  • All participants in the pathological exam will be informed that it is a rabies suspect. The brain will be removed, one half placed in formalin and the other half (longitudinal section) delivered to the State Laboratory of Public Health (SLPH). To get results back on the same day the brain must be at the SLPH before 11:00 a.m. (no exceptions). The body will be clearly labeled as a "RABIES SUSPECT" and stored in the necropsy cooler until results are received. Students will not be involved in any of these procedures. When negative results are obtained, the necropsy will be completed (usually 6-24 hours after the brain is removed). Students may participate in the necropsy at this point. If the brain tissue is positive for rabies, the remainder of the carcass will be incinerated.
  • The key point to keep in mind in any case is communication. If either the clinician or pathologist have questions, they should discuss them and come to an agreement on what is the best way to handle a case for all concerned. The degree of autolysis that will be introduced by these precautionary steps is minimal and should not interfere with a final diagnosis. The only situation in which autolysis might be significant is if an animal dies or is euthanized on a weekend. The SLPH will not perform tests for rabies antigen after midmorning on Saturday and, therefore, no results will be available until Monday.

Rabies Unlikely but Possible

Senior clinician is responsible for ensuring all procedures are followed.

Admission

  • The owner will sign a Consent/Release Form permitting necropsy to be performed if the animal dies.

Confinement

  • The nursing supervisor will be notified of this patient's rabies status.
  • The animal will be identified on the stall as "ZOONOTIC POTENTIAL."
  • A rabies contact log (login required) will be hung on the stall door.
  • Gloves, mask and protective eyewear or face shield will be worn by all individuals working with the patient.
  • The animal will only be handled and treated by persons with prior rabies vaccination.
  • The number of individuals handling the patient will be kept to a minimum.
  • Any patient with neurological signs or displaying behavioral changes that are not attributable to other known disease.

Antemortem Specimens

  • All specimens must be labeled with a "ZOONOTIC POTENTIAL" sticker.
  • Laboratory request forms must be labeled: "ZOONOTIC POTENTIAL."

Submission to Necropsy

  • Senior clinician will personally notify the pathologist on duty about the case.
  • Signature of the senior clinician on the necropsy request is required.
  • A complete history and addressograph information must be on the necropsy request form.
  • A complete necropsy will be performed on the animal, the carcass will be incinerated and one half of the brain will be placed in formalin and the other half frozen. The brain (hippocampus and cerebellum) will be evaluated light microscopically for inclusion bodies ASAP. If inclusion bodies or suspicious structures are seen then the frozen half of the brain will be submitted to the SLPH for rabies analysis and histochemical stains will be applied to the histopathology sections. The clinician will be informed as each piece of information is acquired.

Notification of Positive Test Results

  • The nursing supervisor and hospital epidemiologist must be immediately notified by the attending pathologist when an animal that was admitted or handled by hospital personnel is identified to have rabies.
  • The state public health veterinarian must also be notified.
  • All personnel who have had contact with the animal must be notified by phone or in writing by registered mail with instructions to immediately contact their physician. If the individual cannot be located by phone, then the health department or police will be asked to provide direct personal contact.
  • The individual must provide written documentation that they have contacted their physician.
  • The dean of the VHC must also be notified immediately by the appropriate epidemiologist . The dean will notify all other College staff, faculty and students.

Visitors

  • Tours, visitors and clients are not permitted in the stalls area beyond the breezeway.