Rabies is a life threatening viral infection which can spread by contact with the saliva and urine of infected animals. While all mammals can potentially be infected with the rabies virus, only bats are a significant carrier of this infection in Washington State.
The following is an adapted version of Clallam County's rabies policy. It outlines recommended procedures to follow when a person has been exposed to an animal that may have rabies.
Endemic rabies infection in the Pacific Northwest is essentially confined to bats. All abnormally acting bats (such as those present during daylight hours, appearing sick, or who bite humans) must be presumed to be rabid. In addition to obvious exposure, rare cases of unobserved exposure to rabid bats have been reported in Washington State and elsewhere. To determine if a bat is infected with rabies, laboratory tests on the brain tissue of the bat must be performed.
The public health nurse epidemiologist and health officer should be consulted for specific treatment recommendations. General guidelines to follow are:
- A bite from a bat or contact with saliva or urine from a bat is a significant exposure risk for rabies infection
- If a known exposure or a possible unobserved exposure (i.e. to a sleeping adult or a young child unable to speak) to humans occurs, the bat should be:
- caught only by an experienced individual wearing suitable protective gloves
- euthanized by a veterinarian
- refrigerated or placed in cooler with ice (wrap in plastic, do not allow direct contact with ice, do not use dry ice or allow specimen to become frozen)
- submitted to the Clallam County Environmental Health Division for packaging and shipment to the State Public Health Lab.
Rabies exposure should be presumed, and post-exposure treatment should be started if a significant exposure to a bat occurs and the bat is not available for testing.
Dogs and Cats
Rabies is extremely rare in domestic dogs and cats in Washington State. The last rabid cat was detected in 1976 and a possible case of rabies in a dog was noted in 1987. Human exposure to rabies is highly unlikely from domestic animals, especially those that have been appropriately vaccinated against rabies. In the rare event of an unprovoked attack from a cat or dog, individual clinical assessment must be made.
If someone is bitten by a domestic dog or cat, the animal should be evaluated for abnormal behavior:
- Animals that seem sick or exhibit neurological problems should be evaluated by a veterinarian and, when appropriate, euthanized and submitted to the State Public Health Lab.
- Dogs or cats that appear healthy should be quarantined and observed for 10 days for signs of illness.
- If symptoms of rabies do develop during quarantine, the animal should be examined by a veterinarian and euthanized with submission of clinical specimen to the State Public Health Lab.
- If symptoms of rabies do not develop within this time period, the animal is presumed to be rabies free and no post-exposure rabies treatment is necessary.
If a person is bitten by a wild dog or cat:
- The wild animal should be caught, euthanized, and submitted to the State Public Health Lab.
- If the animal is not available for observation and/or testing, the bite must be evaluated on an individual basis by a licensed health care practitioner. Heath care practitioners are encouraged to consult the Health Officer regarding risk assessment and clinical recommendations.
Raccoons, rodents and lagomorphs (hamsters, guinea pigs, squirrels, rabbits, and hares) have never tested positive for rabies in Washington State. Unless the animal is behaving in a very unusual way or has had a confirmed bat exposure, testing for rabies is not recommended and no post-exposure treatment for rabies is indicated.
If a person is bitten by a mammal other than a dog, cat or bat…
- The bite should be evaluated on an individual basis.
- When very unusual behavior is reported, individual assessment must be made by the health officer in consultation with local veterinarians and state officials.
- In most cases, neither testing nor treatment will be necessary.
- In very unusual circumstances, submission of clinical specimens to the State Public Health Lab and/or post-exposure rabies treatment of human contacts may be indicated
All mammals are susceptible to rabies infection. The rabies vaccine is safe and effective for a variety of domestic animals, including dogs, cats, sheep, cattle, horses, and ferrets. Using vaccine for wildlife and hybrid animals (wildlife crossbred with domestic dogs or cats) is not licensed and is strongly discouraged.
Rabies vaccination is strongly encouraged for all pets and other appropriate domestic animals. This is in accordance with the Compendium of Animal Rabies Prevention and Control, 2002, published by the National Association of State Public Health.
Unvaccinated dogs or cats exposed to a rabid animal (including untested bats) should be euthanized and examined. If the owner refuses to sacrifice their pet, the animal should be quarantined for a 6 month period, with rabies vaccination administered in the final month of quarantine.
- Bite wounds should be immediately cleaned with an antiseptic soap and water.
- When rabies exposure is strongly suspected, it may be appropriate to begin treatment before testing confirms rabies in the animal.
- In addition to wound cleaning and surgical care, treatment consists of:
- Rabies Immune Globulin (RIG) 0.06 ml per lb. body weight IM. Half of the dose should be infiltrated around the wound, the remainder administered intramuscularly in the gluteal area. RIG should not be administered in the same syringe or in the same anatomical site as rabies vaccine.
- 2.Human Diploid Cell Rabies Vaccine (HDCV) 1 ml IM (deltoid) on days 0, 3, 7, 14, and 28. For previously immunized individuals, 2 doses of HDCV at days 0 and 3 are sufficient.
The Washington State Department of Health has guidelines on their website to help medical practitioners determine the appropriate course of treatment.
It is the policy of Clallam County that financial responsibility for rabies post-exposure treatment is a personal medical expense and not a publicly supported service. Billing of medical expenses for post-exposure treatment to private insurance vendors or managed care plans is appropriate. Staff will provide assistance in finding a medical practitioner who can provide the necessary evaluation and treatment services. In addition, should publicly funded post-exposure treatment services become available in Washington State, eligible individuals will be offered assistance in applying for these benefits.
Environmental Health staff will collect information about the incident, animal and affected person. They will contact the State Lab before the specimen is collected and sent. The lab will either accept or deny the specimen based on information provided.
Keep the animal cold, as soon after death as possible, and in transit to the lab.
Do not freeze.
Do not use dry ice.
Do not allow direct contact with wet ice.
If the animal is a dog, cat or similar-sized animal, have a veterinarian remove the head. Decapitate at a point which is several vertebrae below the head. This will ensure that brain stem will be present in the submitted head. The Lab also needs the cerebellum and at least one side of the hippocampus for a valid test.
If the animal is a bat, send the whole body. Veterinarians can euthanize live bats. It is against the law to ship live bats or any other live animal.
Clallam County has an arrangement with a local veterinarian to euthanize animals and prepare specimens for shipment. Individuals are free to have their own veterinarian perform this procedure, or may contact the Environmental Health Division to arrange for this professional service.
The Environmental Health Division has containers available for shipping specimens to the lab: a shipping box, and either a Biojar or metal drum, depending on the size of the animal. Packaging of biological specimens for shipment to the State Public Health Lab should occur at the Veterinarian's office. Environmental Health will complete the required forms and arrange for transport to the laboratory.
Notification of Results
Public health officials will notify the exposed individual of the results of rabies testing as soon as it becomes available. Results are generally available within 24 hours following receipt of the specimen by the State Health Lab.