Worms and Germs Blog : Animal Health & Diseases : University of Guelph : Ontario Veterinary College : Zoonotic Diseases : Guelph, Hamilton, Ontario

An Indiana woman has died of rabies. Little information is currently available.  Reports state that bat rabies was involved but that the source of exposure was not known. Presumably, they have determined that she was infected by the bat rabies variant (strain), but she didn't report being bitten or otherwise exposed to a bat. Bat rabies is a serious concern because it is easy to get bitten by a bat and not know it. Most cases of rabies in Canada and the US are associated with bat exposure. This is a tragic reminder about why we pay a lot of attention to bats and rabies (and why my family received post-exposure treatment after having a bat in the house a few years ago).

More information about rabies can be found on the Worms & Germs Resources page.

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A study in the Journal of the American Veterinary Medical Association (Murray et al 2009) investigated the rabies vaccination history of dogs and cats diagnosed with rabies in 21 US states between 1997 and 2001. 

• 264 rabid dogs and 840 rabid cats were identified.
• 4.9% of rabid dogs and 2.6% of rabid cats had a history of rabies vaccination.
• Of the 13 dogs that had been vaccinated, only 2 were considered currently vaccinated. Similarly, of the 22 previously vaccinated cats, only 3 were currently vaccinated.
• Texas had the most positive dogs while Pennsylvania had the most positive cats.

This study cannot determine how effective vaccination is. You'd need to know the number of animals that were and were not vaccinated, and then the number that did or didn't get rabies to determine efficacy. The fact that a small number of properly vaccinated animals got rabies shows the vaccine is not 100% protective, which is not surprising.

Vaccination is an important part of rabies prevention, but it's not the only part. Vaccination is a last line of defense - avoiding exposure to rabies is the critical first line. To reduce the risk of rabies exposure, keep your pets under your control at all times. Keep bats out of the house and try to ensure that your house and yard are not welcoming to wild animals. Don't let your pets have contact with wildlife and pay close attention when strangely-acting wildlife are around. Active measures to reduce wildlife rabies such as rabies baiting are also important.

Don't assume because your pet is vaccinated that you don't have to worry about trying to reduce the risk of exposure to rabies.

Don't assume that an animal with neurological disease doesn't have rabies just because it's been vaccinated.

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A rabies epidemic continues in Bali, with little apparent control and inadequate access to vaccination. Another person died of rabies last week. He was bitten by a dog in July and taken to a local health centre, but rabies vaccine was not administered. It's not clear whether healthcare providers recommended post-exposure vaccination and the person declined or whether they did not offer vaccination. 

Access to post-exposure treatment in such regions is a serous concern. Apparently, up to 50 people a day are denied potentially life-saving post-exposure treatment because of a lack of adequate vaccine supplies. Because of the limited availability, doctors are focusing on treatment of people bitten by dogs in areas that are heavily infected with rabies. That makes complete sense, but it's still not a good situation.  It's not only those heavily infected areas that are a concern. More rabies vaccine needs to be secured so that everyone who has been potentially exposed can be properly treated. Local officials are blaming the current shortage on a holiday weekend, but it's unclear whether the situation is truly going to improve in the near future.

People traveling to any part of Bali need to be aware of the risks. You don't need to cancel your vacation, just use common sense. Don't approach any dogs or other mammalian pets or wildlife. If you are bitten, immediately go a physician. If rabies vaccination is not offered, ask for it. If it's not given, get on the next plane out of the country and get treated. You don't need to be vaccinated immediately after exposure, so don't panic, but you don't want to unnecessarily increase the risks if you have been bitten.

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In April, I wrote about an ongoing rabies outbreak in the popular tourist destination of Bali. Because of widespread rabies in stray dogs and fatal human infections, there were calls for the government to take aggressive action and for tourists to be aware of the risk. Apparently, things haven't improved much since then.

At least 9 people have died of rabies in Bali in slightly over a year. That's completely unacceptable for a preventable disease.

The latest victim (whose father-in-law died of rabies in August) was from an area that has not been officially declared as being part of the epidemic, so it has not received much government support. She was bitten by a stray dog in August. In any rabies-endemic area (even in the absence of an outbreak), that's clearly an indication for post-exposure treatment. However, she did not receive post-exposure treatment until 15 days after the bite, by which point it was obviously ineffective.

• Rabies post-exposure treatment must be started as soon as possible. If you wait until signs of rabies are present, death is almost certain.
• Be informed and be your own advocate. The family in this case may very well have pushed for post-exposure treatment, but it's critical to look out for yourself. If you have potentially been exposed to rabies, make sure you get treated.
• If you are going to Bali, don't be paranoid about rabies. Be smart. Avoid any contact with dogs (especially strays) and other wildlife. If you are bitten, get medical care immediately. If the animal isn't identified and quarantined for 10 days to make sure it doesn't have signs of rabies, you need post-exposure treatment. If you can't get it in Bali, get out and get to somewhere where you can be properly treated.
• If you are traveling to Bali (or any other rabies-endemic area) with the intention of working with wild or stray animals (especially dogs), get vaccinated before you go.
• More aggressive rabies control and education (including physician education) efforts are needed in Bali. Clearly, this outbreak is not under control and the fact that the latest death occurred in a new region suggests that this problem could be spreading.

More information about rabies can be found on the Worms & Germs Resources page.

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As a vet, I've been bitten by a wide range of animal species. When people talk about animal bites, they usually think about dogs and cats. Horses can (and do) bite as well. Most horse bites are probably playful nips that hurt a little yet don't cause major problems, but some bites can cause serious injuries and infections can result.

A recent paper in the Journal of Agromedicine (Langley and Morris 2009), with the rather unwieldy title of "That Horse Bit Me: Zoonotic Infections of Equines to Consider after Exposure Through the Bite or the Oral/Nasal Secretions". Bites apparently account for 3-4.5% of the approximately 100 000 annual emergency room visits in the US that are associated with horses. The authors of the paper review infections associated with bites and contact with organisms in the mouth and nose of horses.

A large number of bacteria have been associated with horse bite infections in people, including Actinobacillus, Streptococcus, Psuedomonas and Staphylococcus species. Some viruses can theoretically be transmitted by bites, but there's little evidence that this actually happens.

Although viruses are not of as much of a concern overall, rabies needs to be considered in every bite from a mammal. We pay a lot of attention to rabies with dogs, cats and wildlife, but it often gets ignored with horses. While I'm not aware of any reports of rabies transmission from horses to humans by a bite, it could happen.  Fortunately, rabies is rare in horses so the likelihood of exposure from this species is very low. However signs of rabies aren't always obvious initially, and rabies in horses may mimic other diseases. Sometimes, rabies looks like colic, and human exposure through bites or other contact is possible when handling, evaluating and treating affected horses.

Unlike with dogs and cats, there are no clearly defined protocols for dealing with bites from horses. Any dog or cat that bites a person is supposed to be quarantined for 10 days. The reason for this is if the animal is rabid and the disease is advanced enough for the animal to be capable of spreading rabies virus, it would invariably develop signs of rabies and die within this time period. We don't have similar guidelines for horses. I suspect the 10 day observation period would be adequate but we don't have good data. The paper states that in Kentucky, a 14 day observation period has been used by the state Department of Public Health.

At the conclusion of the paper, the authors make a few important general recommendations for reducing the risk of disease transmission from bites and oral or nasal secretions of horses:

• Use good general hygiene, especially hand hygiene, after any contact with horses.
• Use gloves and gown or lab coat when examining horses in a veterinary clinic or hospital. (This might be overkill for all horses. We don't require gloves for every horse contact, just contact with mucous membranes (e.g. mouth, nose), wounds, incision sites and other high-risk areas. I think bare hands are fine for general contact as long as there is good attention to handwashing after.)
• Consider mask and goggles if the horse is coughing or sneezing.
• Develop standard operating procedures for handling sick horses.
• Use isolation when needed.

I'd add a few more points:

• Avoid bites. Pay attention to what you are doing around horses to reduce the risk of being bitten. Do not encourage playful behaviours (e.g. nipping) that could lead to bites.
• If you are bitten and it breaks the skin, clean the site thoroughly with soap and water. If there is significant trauma, or if the bite is over a joint, hand, foot, or a prosthetic device, you should see a doctor immediately because antibiotics are most likely indicated. If you have a weakened immune system, you should be evaluated by a doctor after any bite.
• Avoid contact with the horse's mouth or nose if you have skin lesions. Cuts and scrapes can allow bacteria to enter your body and cause infections. If you have a cut on your hand, make sure it is covered with a glove or waterproof dressing if you are going to have contact with the horse's mouth or something that came from its mouth (e.g. a bit).

This Worms & Germs blog entry was originally posted on equIDblog on 02-Sep-09.

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Rabies baiting is a common and effective way of controlling rabies in some wildlife populations, particularly skunks, raccoons and foxes. It involves dropping edible rabies vaccine, by airplane or by hand, into targeted areas. Millions of rabies baits are used across North America and baiting programs have been cited as a key aspect of wildlife rabies control. In one year, 1.3 million baits were dropped in targeted areas of Southern Ontario alone over a two-month period. A good series of pictures of rabies baiting is available here.

Rabies baits are usually a small rectangular block comprised of something that smells or tastes attractive to the targeted wildlife into which a liquid vaccine has been added. Some use fish meal and fish oil to attract wildlife. Others use combinations of fats, icing sugar, vegetable oil and artificial marshmallow flavour (don't ask me why - I'm certain there's a reason but I don't know if they've done taste-testing).

Often, the local public is notified in advance of the drops being made, and it is recommended that kids be closely supervised outdoors for a week or so to ensure they don't come into contact with the baits. It is also often recommended to keep pets indoors or on leash during the same period. (Pets are much more likely to be exposed to and to eat the vaccine than kids). It's also recommended that you wash your hands thoroughly if you have contact with a bait.

Rabies baits are quite safe, and these recommendations shouldn't cause concern. It's a case of being overly cautious. The baits are safe to touch, but it is still recommended that you don't touch them (if nothing else, they may make your hands smell pretty bad). Ingestion of a rabies bait by a person or pet is also unlikely to cause a problem. Any adverse affects are more likely to occur due to the non-vaccine component of the bait, particularly because of the typically high fat content. Ingestion of a lot of baits could certainly cause vomiting or diarrhea in a dog, just like ingestion of large amounts of other inappropriate foods.

Some groups recommend that you contact Poison Control if your pet has been exposed to a bait, but I'm not sure what they'd do in such a case. Other groups ask you to report to them that a pet ingested the bait, likely so they can consider exposure of people and pets when determining target areas for the next year. There's similar variation in recommendations if a person ingests the vaccine. Often it is recommended that public health be notified so they can record it, but it's very unlikely anything would be done.

On a related note, you cannot use rabies baits as a free way to vaccinate your pet. It might work, but there is no way to know, and if your pet is exposed, it would be considered unvaccinated if it was not properly vaccinated by a veterinarian with an appropriate dog/cat vaccine.

Image from: http://www.mnr.gov.on.ca/en/Business/Rabies/2ColumnSubPage/275904.html

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A horse in Harford county Maryland has been euthanized because of rabies. The horse first starting showing signs of disease in mid-July, which manifested as "striking changes in behaviour." The report doesn't say when the horse died, but animals typically die within a few days of the onset of neurological disease. The horse was transferred to the New Bolton Center where rabies was diagnosed. Subsequent testing showed it was a raccoon rabies strain, although that does not mean that a raccoon was the actual source of infection.

Public health officials implemented a 45 day quarantine of the farm. Stray cats (about 25) were caught and euthanized. Fortunately, the family pets were properly vaccinated and have received booster shots (plus presumably a period of observation at home... a much better situation than if they were not vaccinated).

People that had contact with the horse have received rabies post-exposure treatment. This includes one person who had to be tracked down overseas.

Harford County Health Department spokesperson Bill Wiseman said "There was never a risk to public safety. This incident was a great example of public health work in action and cooperation between local, state and in this case, international authorities." I don't buy the statement that there was no risk to public health. While the risk of rabies transmission from infected horses is very low, it's not zero. Rabid horses have killed people because of their abnormal and sometimes aggressive behaviour. Further, the fact that this horse had rabies means that it got it from something. Rabies can have a long incubation period so it's not guaranteed that it acquired it on the farm, but you have to be prudent and assume that there is infected wildlife in the area that could pose a risk for other animals or people. Public health authorities managed the situation well and reduced the public health risks, but there were certainly still risks.

Rabies vaccination is highly effective. There is no statement about whether this horse was adequately vaccinated but it's unlikely. Proper vaccination would likely have prevented this horse's death, as well as the death of the stray animals, cost of vaccination of people, cost of veterinary care for this horse, quarantine of the farm and the associated financial and emotional costs. A dose of vaccine that costs a few dollars could have saved thousands of dollars and emotional stress.

Rabies is a rare disease in horses but its severity means it should not be ingored. Vaccinate your horses.

This Worms & Germs blog entry was originally posted on equIDblog on 14-Aug-09.

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If a groundhog sees its shadow, there's more winter on the way. If it doesn't see its shadow, spring is coming soon. So what does it mean when a groundhog attacks a cop?

An aggressive groundhog in New Jersey that tried to attack two police officers and one other person was confirmed to have rabies. Police were called to a house because the groundhog in the garage charged the house owner as he tried to get into his truck. The groundhog was subdued with pepper spray (I wonder if anyone has every used a Taser on a groundhog), caught, euthanized and tested for rabies. Fortunately, none of the people came in direct contact with the animal, therefore there was no exposure and rabies post-exposure prophylaxis was not required.

Groundhogs are not high on the list of animals that tend to get rabies. One-hundred twenty-three rabid groundhogs have been identified in the state since 1989 (I'm actually surprised it's that high), compared to 4 175 raccoons. Like every other mammal, groundhogs are susceptible to rabies virus but they are less likely to carry the virus, because they are rather shy vegetarians and would often not survive attacks from rabid predators. This case is a good reminder that rabies must be considered in any animal acting strangely.

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In Canada, access to rabies vaccine for animals is restricted to veterinarians (i.e. only vets can buy the product itself and administer it to people's animals). In general, this is an excellent approach because it ensures that the vaccine has been handled and stored appropriately, animals have been vaccinated properly and accurate vaccination records are kept. I certainly wouldn't want rabies vaccine freely available, whereby anyone could buy vaccine, handle it poorly, vaccinate their animal improperly, and yet believe or claim to have a properly vaccinated pet.

The problem with this restriction is the fact that veterinary care is not always available. Specifically, I'm referring remote northern communities that do not have veterinary care on a regular or even a sporadic basis. I received an e-mail the other day from a medical professional in a fly-in First Nations community in Northern Ontario. They have not had a visit from a vet in a while, so the dogs there aren't vaccinated. Unfortunately, a dog was attacked by a wolf recently so it must be considered possibly  exposed to rabies, resulting in euthanasia or long quarantine. The question was about what can be done in those communities to provide rabies vaccine for people's animals. I didn't know, so I inquired with the Canadian Food Inspection Agency, the federal agency in charge of all-things-rabies.

There are actually provisions in Canadian regulations for situations like this (a provision in the Health of Animals Regulations Section 132.4 (2), if you want to know specifically). This allows rabies vaccine to be sold in accordance with written permission granted by the Minister, in specific circumstances such as in a remote area where veterinary services are not readily available. The provincial veterinary association is typically contacted to determine whether or not there is a veterinarian who could arrange to do the vaccinations. If the provincial association agrees that there is no veterinary service available to the community, then permission can be granted to purchase vaccine. 

It's quite a reasonable and logical approach that allows for access to rabies vaccine when needed, but has enough controls in place to ensure that this can't lead to abuse of the exception. People in remote communities in Canada should be aware of this. Some communities get periodic visits from vets but there are many others such as the one in this case that don't have any direct access to veterinary care, and this is a way of at least providing protection for people and pets against rabies.

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There are two situations when animals may be quarantined because of rabies concerns:

1. After biting a person.
2. After potentially being exposed to a rabid animal.

The time frame for quarantine in these two situations is quite different because of what the quarantine is meant to accomplish.

Animals that have bitten someone are quarantined for 10 days under observation to see if they develop signs of rabies. Most animals that bite do not have rabies, and this is the easiest way of determining whether the animal could have potentially transmitted rabies by way of the bite. If an animal was rabid and infectious at the time of biting, it would die from the disease within 10 days. Animals can only transmit rabies virus after it has reached the brain and started to spread outwards via nerves - it gets into saliva by working its way down nerves from the brain to the salivary glands. Once an animal gets to that stage of disease, they die quickly. So, if the animal is still alive after 10 days, it was not rabid at the time of the bite. Quarantine is important so that it can be clearly proven one way or the other whether the animal was rabid. If the biting animal was not quarantined and ran away, the recommendation would be to err on the side of caution and treat anyone bitten as if they'd been exposed... but we want to avoid that if at all possible.

The second type of quarantine (for a potentially exposed animal) is based on less solid evidence. The idea in these cases is to keep the potentially exposed animal isolated while waiting to see if it develops signs of rabies, because there is no other reliable test for rabies in a live animal. For example, if an unvaccinated dog gets into a fight with a rabid raccoon, it would be considered potentially exposed. It would be quarantined (or immediately euthanized... the other option) and monitored to see if it develops signs of rabies. The length of quarantine for non-vaccinated dogs is usually 6 months, but this may vary by region. This helps reduce further rabies transmission by ensuring that a dog that develops rabies during the quarantine period is not roaming at large and able to infect people or other animals. One weakness of this approach is the incubation period of rabies, which can be very long. There is not a lot of objective research on which to base the 6 month time frame (unlike the 10 day quarantine described above). After 6 months, it's very unlikely the dog will develop rabies, but we can never say it's 100% because of the rare cases of rabies in humans with extremely long incubation periods. In reality, it's likely that the vast majority of animals that are exposed will develop rabies before 6 months, so it's a reasonable time frame. Would it be better to use 4 or 8 months, or something else? Possibly, we just don't know.

The easiest ways to avoid hassles associated with rabies quarantine are:

• Prevent bites. If your pet is trained and observed properly, it's unlikely to bite anyone, so the 10-day post-bite quarantine shouldn't be an issue.
• Vaccinate your pet. Properly vaccinated pets are not subject to the same long, strict quarantine (although a shorter period of isolation (often at home) is usually still required).

More information about rabies can be found on the Worms & Germs Resources page.

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At the same time that the country is drafting an animal welfare law that would ban widespread killing of dogs, a Chinese city has killed 36 000 stray and pet dogs in an effort to eliminate rabies. Since late May 2009, more than 6 000 people in Hanzhong have been bitten or scratched (presumably by dogs), and 12 have died of rabies. Certainly, this indicates multiple problems. One is the massive number of bites and scratches. Contributing factors probably include a large stray animal population, limited routine animal control efforts, and inadequate education of the public regarding bite avoidance. The number of injuries and deaths certainly indicates that an aggressive response is needed. However, there is little evidence that culls (i.e. mass killings of this type) have any effect on controling rabies and animal-associated injuries. Efforts are probably better directed at other forms of population control, vaccination of stray and pet dogs, and education of the public to keep stray dogs away and reduce the risk of bites. These types programs cost money, but the costs of treating 6 000 bites and 12 fatal rabies infections can be enormous. I don't know how many people received post-exposure treatment for rabies, or what such treatment costs in China, but it's estimated to cost  about $1500 per person in North America. That would pay for a lot of rabies vaccine for dogs.

Photo: Hanzhong, China (source: www.panoramio.com)

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A recent question from a reader:

"We live adjacent to the Oak Ridges Moraine in Aurora (Ontario) so our property has always been popular to local wildlife.  For years, neighbourhood animals have enjoyed dry cat food in our backyard but the town has ordered this practice must stop immediately.  Among reasons given, were that this food is harmful to the animals.  This should be appropriate food for stray and feral cats but am writing to enquire if there is any information available about the effect of dry cat food on birds, raccoons and other domestic wildlife. Since the Premier declared Ontario free of the raccoon strain of rabies last year and there have been no recorded cases in York region, the main health concern is likely raccoon roundworm.  I understand that incidence is quite rare but, coincidentally, the recent articles about roundworm cases in New York led me to you. Can you recommend sources of information to learn if feeding dry cat food is harmful to wildlife (raccoons) and if this food would cause increased risk of raccoon roundworm in the immediate area."

This raises some very interesting points.

What are the bad points about feeding wildlife?
Wildlife is best kept wild. The more we feed wild animals, the more contact there can be with people. That can be dangerous, depending on the animal (e.g. coyotes). It can also bring disease-carrying wildlife in closer proximity to peoples’ living spaces, such as encouraging roundworm-shedding raccoons to live next to houses. If you feed raccoons and they decide to stay, you may end up with a highly contaminated raccoon latrine somewhere on your property. That could pose a particular risk if you have young children or developmentally delayed individuals at home.

The natural food supply is one of nature’s ways of keeping animal populations at appropriate levels. If lots of people feed wild animals, their numbers can increase, resulting in more exposure to people, increasing animal population density (with corresponding risks to the animals from disease transmission) and an unsustainable population should the "free food" source disappear.  It can also have a huge impacts on the local ecosystem of which we may not even be aware. Making wild animals dependent on humans is not a good thing.

Cat food is for cats. Dog food is for dogs. Neither of these necessarily provide appropriate nutrition for a raccoon, because dietary needs are different for each species. That being said, eating small amounts of pet food periodically likely doesn't do any harm to the raccoons.  However, if raccoons rely on pet food as their main food source, I wonder whether health problems could develop, because the animals may stop eating the foods they need to provide a balanced diet.
   
What does "raccoon-rabies free" really mean?
Raccoon rabies is a type of rabies virus (example of other types are bat rabies virus and skunk rabies virus). Raccoons can be infected by other rabies viruses, so even though Ontario may be free of raccoon rabies, the province is not necessarily free of raccoons with rabies. Raccoon rabies control efforts have been highly successful in Ontario, but it is important to be aware that raccoons can still carry rabies. Any feeding practices that encourage contact with raccoons (as well as skunks, foxes and other wildlife) are of concern because these animals can carry rabies, of one type or another.

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Quarantining animals that have potentially been exposed to rabies is a standard practice, but quarantining a whole town is new to me. Because of a large increase in rabies cases in the Flagstaff, Arizona area, a rabies quarantine was established on April 8th by the Coconino County Board of Supervisors. The quarantine requires all dogs and cats to be enclosed or secured on their owner's property. When off the property, animals must be on a leash that is no longer than six feet in length. All dogs and cats must be vaccinated, and low-cost rabies vaccine clinics have been held to help increase compliance with this requirement. Vaccination of wildlife using baits containing an oral form of rabies vaccine will also be performed. The quarantine also restricts feeding and interacting with wildlife. Also, people cannot leave pet food outside after sunset and all compost piles must be completely enclosed.

This is an aggressive approach to rabies control in an area experiencing a wildlife outbreak of the disease. They've implemented comprehensive but still quite practical measures that should help reduce the risk of exposure of domestic animals (and people) without a significant negative impact on pet owners. I've mentioned my concerns about rabies vaccine clinics in the past, but this is a situation where I think it's a good idea.

It's always hard to evaluate the effectiveness of outbreak measures, because you never know what would have happened if nothing had been done. Regardless, it will be interesting to see how well this quarantine works, both in terms of the number of new rabies cases they see and the response of citizens to these restrictions. It would be very useful if Coconino County personnel provide information about how things went when the quarantine is over - the information might be useful for management of future rabies outbreaks.

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The British Columbia Centre for Disease Control (BCCDC) has changed its rabies exposure guidelines and gone against established protocols used elsewhere. Typically, anyone who has slept in a house where a bat was present at the same time is considered to have been exposed to rabies if the bat was rabid or the bat's rabies status is not known. This is because bats can bite people while they are sleeping and the bite wounds can be so small that someone may not even notice after they wake up. People who get rabies from a bat bite almost always die. Because of the severity of this disease, the general rule has been to err on the side of caution and consider anyone even possibly bitten by a bat as exposed to rabies.

Now, the BCCDC has stated that this is "overkill," and that people who do not have known physical contact with a bat will not be given the usual post-exposure rabies vaccinations. 

Yes, rabies is a very rare disease in people in this part of the world... but you don't want to be the rare person that gets it. I understand that risk analysis may indicate that there is, overall, low risk from sleeping in the same house with a bat, and that almost all people that receive post-exposure treatment didn't actually need it. However, for a fatal disease with the potential for uncertain exposure in such a situation, I think this is important to err on the side of caution. It's always difficult to reconcile risk analysis data with human lives. The BCCDC estimates that this new policy will only result in one (1) additional rabies death every 675 years. That's not a lot, but how would you like to be that one person?

I hope this isn't a decision influenced by cost. Post-exposure treatment costs about $1500 per person, and they expect that this protocol will result in "hundreds" of fewer people receiving treatment. The treatment of all people sleeping in houses with bats actually costs a huge amount of money to prevent a small number of cases. However, what is the cost (financial and otherwise) of even a single case of rabies that could have been prevented? That's a lot harder to incorporate into a risk analysis. Personally, if I had a bat in the house overnight and my kids were potentially exposed (again!), I'd go for post-exposure treatment without any hesitation. Call me a paranoid parent if you will, but I'd sleep much better at night (for years, since the incubation period following exposure can be a long, long time).

The full BCCDC report can be found here.  More information on rabies can be found on the Worms & Germs Resources page and in our archives.

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ProMed mail reports two more rabies fatalities in an ongoing outbreak in Bali, Indonesia.  The first person was bitten by a stray dog, which always must be considered a potential rabies exposure, especially in an area where an outbreak is underway. He received one rabies shot but did not undergo the whole post-exposure series because of a fear of needles, and he died.

The second person was bitten by both a stray and a pet dog, another clear indication for post-exposure treatment. She refused treatment because of a fear of needles, and also died of rabies.

These were two completely preventable deaths. The decision to forgo treatment almost certainly cost these people their lives - rabies is preventable with appropriate and timely post-exposure treatment. These cases also highlight the need for proper education of the public when it comes to rabies, both in terms of avoiding strays and the need for prompt attention when there's potential exposure to the disease. I have no idea how forcefully medical or public health personnel explained the need for proper treatment. For people that want to decline treatment, aggressive and comprehensive education is needed. Ultimately, people are allowed to make bad decisions, but we need to make sure they at least make informed bad decisions.

There are various other concerning issues with this outbreak, particularly the government's response to it. Multiple sources have apparently advised the government that aggressive vaccination and halting of dog movement between the peninsula and the mainland could contain this outbreak. So far, this has not been done. Amazingly, importing rabies vaccine into Bali was illegal until December 2008, and it is still illegal to vaccinate dogs outside of the outbreak area! The cost of vaccination has been used as an excuse not to do so. Certainly, financial issues are important in developing countries. However, the estimated cost is only about $0.50 US per dog. When one considers that this area is highly dependent on the tourist industry, they need to consider this as an investment to maintain their economy. Would you like to spend your vacation in an area with an ongoing rabies outbreak?

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The World Organization for Animal Health (OIE) has released a statement emphasizing the importance of rabies vaccination in dogs. They state:

"Rabies is a neglected and severely under-reported zoonotic disease in developing countries, killing each year worldwide an estimated 50,000 to 60,000 people, mostly children with terrible suffering and a much higher number of animals...  Eliminating rabies in dogs is the optimal control method for preventing spread of the disease."

They also say:

"Dog vaccination and stray dog population control are more efficient and cost effective that post bite treatment in humans."

As with many diseases, prevention is much more effective (and potentially cheaper) than treatment. As OIE Director General Dr. Bernard Vallat explains, "The cost of a post-bite treatment in humans is about twenty to one hundred times more costly than the vaccination of a dog. Currently with only 10% of the financial resources used worldwide to treat people after a dog bite Veterinary Services would be able to eradicate rabies in animals and thus stop almost all human cases."

I think that the sentiment is excellent; we need to focus on vaccination. However, the thought that we could eradicate rabies altogether seems a little optimistic and surprisingly naive. Eradication of a disease such as rabies that has multiple wildlife and stray animals as hosts is difficult, and bordering on impossible. Providing more money for vaccination is excellent, but one of the major problems with rabies control in developing countries is actually vaccinating the animals, even if lots of free vaccine is available. Dedicating personnel and logistical time and money for vaccinating dogs may not be high on the priority list in many countries with other major economic, social and healthcare system challenges. Catching and vaccinating all stray animals is not going to happen. Vaccinating as many animals as possible is important, along with stray animal population control, education of the public about bite avoidance, education of the public and healthcare personnel about bite treatment and prompt availability of adequate post-exposure treatment.

With a good medical and public health system and an informed population, rabies deaths could one day be few and far between. Emphasizing more money for vaccination in the absence of other efforts isn't addressing the big picture. In a perfect world, we'd be able to vaccinate all animals - unfortunately, our world is far from perfect, and while thinking about best-case scenarios is good, we need to focus on what is practical and achievable. That involves more money for vaccination, along with broader approaches by groups such as Vets Without Borders.

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A search is on for a woman in Spring Hill, Florida who was attacked by a rabid cat while jogging.  The cat apparently jumped on the woman's back without provocation while she was out for a jog. The cat was later caught and found to be rabid, but not until after it had attacked three more people and a dog. Since the cat has been confirmed as rabid, and it is certainly possible that it may have bitten the jogger during the attack, there is a real risk to the unknown woman of developing rabies.

The potential for rabies exposure should be considered following any bite from a mammal. If the animal is acting strangely (attacking joggers would certainly qualify) and it's rabies vaccination status is unknown, the concern is much greater. It's important to identify any animal that has bitten someone so it can be evaluated to deterimine whether there is a risk of rabies. This would include examining the animal for clinical signs of rabies, and checking its vaccination status. Being vaccinated against rabies doesn't guarantee the animal doesn't have rabies, but it makes it very unlikely. Depending on the degree of risk and the status of the animal, observation of the animal in the home, strict quarantine, or euthanasia and testing might be indicated.

This jogger probably needs to be treated for rabies exposure, unless a bite can be completely ruled-out. This post-exposure prophylaxis (PEP) consists of an injection of anti-rabies antibodies, followed by 5 doses of rabies vaccine given over 28 days. It's not fun, but it's nothing like the old PEP method that people often hear about, which involved many more injections given in the abdomen. It's a small price to pay to avoid an almost invariably fatal disease.

More information about rabies can be found in our rabies archives and on the Worms&Germs Resources page.

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Rabies clinics are common in some areas. They are typically one or two day events where people can get their pets vaccinated against rabies at very low cost. The good aspect of these clinics is that some animals that get vaccinated there would not otherwise be vaccinated. The downside of rabies clinics is that they are not the same thing as a normal vaccine appointment with a veterinarian. Rabies clinics are usually "assembly line" vaccination - the goal is to get as many animals vaccinated as quickly and efficiently as possible.  The animals are not given a physical examination and there is no discussion with owners about preventive medicine or other problems. Therefore, there is no opportunity to detect and address other health problems, which is (in my opinion) the most important aspect of routine vaccination appointments. There is also no opportunity for vaccination against other important diseases. 

Rabies vaccine clinics can be beneficial in situations where some people are unable (or, unfortunately, unwilling) to pay for a normal veterinary examination and complete vaccination. Anything that increases the number of animals vaccinated against this devastating disease is useful. However, rabies clinics also can compromise the health of animals (and potentially their owners) if they are the only routine veterinary contact. They can also end up hurting owners financially in situations where early disease would have been detected and addressed during a regular vaccine appointment. Often, diseases are much more difficult and expensive to treat when they are identified later.

So, while it's obviously tempting to take the cheapest option available, if you can afford a regular veterinary appointment, don't use rabies vaccine clinics. It will be better for your pet and for you to have a regular vaccination appointment with a good physical examination and full consultation.

More information on rabies can be found on the Worms & Germs Resources page.

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A few years ago, a tour agent in a Caribbean country tried to convince me that taking my young children in an open-sided vehicle on a drive over the country's highways was perfectly safe. My response was that the laws of physics don't go on vacation when I do - meaning that a car accident with unrestrained children is a bad thing even on a nice sunny island. The same concept goes for infectious diseases: when on vacation, you should try to leave your worries behind, but not your common sense. Travel-acquired diseases are extremely common. Transient, annoying, but usually self-limiting problems like food poisoning affect thousands of people on vacation, but more serious diseases can also be encountered.

A recent rabies outbreak in dogs in Bali highlights some of these concerns. Rabies is common in stray/feral dogs in many countries, and there can be huge dog populations in some common tourist areas. It's human nature for many people to want to feed or pet these strays. However, people often forget about the potential for rabies exposure. An additional concern is that proper post-exposure treatment for rabies may not be readily accessible in many countries. Some countries are mounting aggressive vaccination programs of strays in response to the risk to local inhabitants and tourists, but people need to be aware that the risk exists and can be very significant. It has been reported that 23 people from Britain have died of rabies acquired abroad since 1946. That's not a huge number, but it's not good if you are one of those 23, and such tragedies are preventable.

Remember these simple points when you are on vacation:

• Stay away from strays (dogs or cats).
• Report dogs that are acting strangely to local authorities or someone else that might be able to help (such as a hotel concierge).
• If you are bitten, take it seriously. If you cannot identify the dog, confirm its rabies vaccination status and ensure that it is properly quarantined, you should probably be considered exposed to rabies. If that is the case, get post-exposure treatment as soon as possible.
• If you are going to have contact with stray dogs or wild mammals during your vacation, such as volunteering with animal care groups, get vaccinated against rabies before you go.
• Always remember to pack some common sense.

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In 2008, the American Association of Equine Practitioners (AAEP) published updated vaccination guidelines for horses.  One of the changes from the previous set of guidelines was the inclusion of rabies as a core vaccine (meaning every horse should receive it).  There was lots of discussion about this at the recent AAEP Annual Convention in San Diego, CA.

Some veterinarians don't like the idea of vaccinating every horse against rabies.  Just like veterinarians and owners of dogs and cats who are concerned about over-vaccination in these species, the same concerns exist in equine medicine.  Equine rabies vaccines are not approved for use every three years like some canine and feline vaccines, so they still need to be given every year until someone can determine for how long a vaccinated horse is protected from infection.   Furthermore, there has never been (to my knowledge) a case of human rabies due to transmission from a horse.  These are all valid points, but there are also a lot of reasons why including rabies as a core vaccine for horses is very good idea:

• Rabies is a very deadly disease, in both animals and people.  To some owners, their horse is every bit a part of their family as any dog or cat could be.  To other owners, their horses represent a great investment, and part of their livelihood.  Even if the risk of disease in horses is low, protecting them is safe and easy, so it just makes sense.  As the saying goes, an ounce of prevention is worth a pound of cure, but when there is no cure and prevention is so simple... you do the math.
• Rabies vaccination is extremely effective in horses, producing an excellent immune response even with a single dose.  It does not require complex adjuvants that some other vaccines need to stimulate the immune system, which also makes it less likely to cause an abnormal vaccine reaction.
• Rabies is not a seasonal disease like many of the respiratory viruses or insect-borne diseases (e.g. West Nile) for which horses are also typically vaccinated.  Rabies boosters only need to be given once a year, so this can be done during a time of year when no other vaccines are required, if there are concerns about giving too many vaccines at once.
• Horses live outside and in barns.  Most are far less supervised than dogs and cats, but even these animals are at risk of rabies exposure.  A rabid animal could easily be "brave" enough to attack a horse, even though it normally wouldn't.  Bats can also easily get into and out of many barns - you may never know one was there, and finding a bite mark from a bat on a horse would be like looking for a needle in a haystack, but that's all it takes to transmit the virus.  So it makes sense to give your horse added protection by vaccinating it.
  
• Rabies in horses may not look like rabies at first.  One of the most common early signs is actually colic.  A rabid horse that looks like a colic may expose the people who are trying to look after it before they realize what the horse has.  In other horses the signs may be recognized too late, like the rabid horse that was found at the Missouri State Fair earlier this year, that resulted in exposure of many people.
• While rabies transmission from horses to people has not been documented, rabid horses have killed people, particularly horses that develop the "furious" form of rabies, which can cause them to become very violent.

For more information on rabies, see our rabies archive or the information sheets available on the Worms & Germs Resources page.  For more information on rabies in horses specifically, visit our sister site, www.equIDblog.com.

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A 55-year-old man in Missouri recently died of rabies.  He was the first human rabies victim in that state in close to 50 years. He was apparently bitten by a bat in mid-October and started to show signs of rabies about six months later.

This tragic incident highlights a few important points. All bats should be considered rabid until proven otherwise. Any bite from a bat should be considered rabies exposure. If this person had received treatment for rabies exposure, he almost certainly would not have developed rabies. Post-exposure treatment consists of a dose of antibodies against the rabies virus as well as a series of 5 vaccinations over four weeks.  These are normal vaccines given in the arm - not like the old horror stories of reaction-prone vaccines given in the abdomen.

• Treat every bat as rabid. If you are bitten or may have been bitten (i.e. you were asleep in a room with a bat), you should consider yourself exposed unless the bat is tested and shown to be negative.
• If you are exposed to rabies, get proper treatment. It's not a big deal and it can save your life. See this post for my experience with bat rabies.
• Dogs and cats must be vaccinated against rabies. Even if they don't go outside they can still be exposed. It's also the law in most areas.
• Bat-proof your house.  Seal up holes and crevices where bats may hide or through which they may get into your home.
• If you wake up in a room and see a bat, don't let it out. It must be caught and tested for rabies, or you should receive post-exposure treatment. Bats can bite sleeping people without them noticing.
• Wildlife should want to stay away from people. Wild animals that are acting strangely or do not appear afraid of people could be rabid. Stay away from such animals and report them to your local animal-control official.

More information about rabies can be found on the Worms & Germs Resources page, and in our rabies archives.

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In some areas, pet vaccines are readily available from multiple sources, including the internet. Some people like to purchase vaccines and administer them to their pets themselves in order to save money. But are the cost savings really worth the risk? Here are some things to consider:

• Your veterinarian gets vaccines through a reputable distribution system, which ensures quality control, tracking of products and proper shipping and storage conditions. When buying elsewhere (especially the internet), you don't have the same level of assurance. Vaccines that have been improperly handled or stored may not be effective.
• Vaccines and drugs from some sources are of questionable quality, and you can't always be sure that you're actually getting what you wanted. Ineffective vaccines or contaminated products are a big concern. It's not saving you money if the vaccine doesn't work!
• While uncommon, vaccine reactions do occur. If your pet has an anaphylactic (severe allergic) reaction at a veterinary clinic, the chances that your pet will survive are much greater because the needed expertise, drugs and equipment are readily available. You don't have these things at your house.
• If your pet develops a problem associated with a vaccine administered by your veterinarian, the vaccine manufacturer may get involved and assist with the problem. This will NOT happen if you buy the vaccine from another source and give it yourself.
• Rabies vaccines MUST be given by a veterinarian. (In some areas it's illegal for a non-veterinarian to even possess rabies vaccine.)  A pet that has received a rabies vaccine by a non-veterinarian is considered unvaccinated by public health authorities.  If an unvaccinated animal is exposed to rabies, the repercussions may be much more severe, and may even include euthanasia.
• Vaccination is just one part of your pet's "wellness program." Some of the pressure for people to vaccinate their own pets is a failure of the veterinary profession to adequately emphasize the importance of preventive medicine, of which vaccines are just one component. Simply charging an owner for "annual vaccines" leads people to want to vaccinate their pets themselves because they can get the vaccines for much less money.  Veterinarians need to emphasize that what they are charging for (and what is the most important component of the preventative medicine program) is an annual physical examination and health consultation, and that only a small portion of the fee is for the vaccines.

Vaccination is a minor component of your pet's preventive medicine program. A careful physical examination and consultation about potential, developing and ongoing health issues are the most important parts of this program. Even if you vaccinate your pet yourself (which is still not recommended for the reasons above), it is still critical that your pet has an annual examination. It's better for your pet's health, and it can be easier and cheaper in the long run because problems can be detected and treated early.

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This Sunday, September 28th, is World Rabies Day. The goal of this day its to raise awareness about rabies, a disease that still kills thousands of people and animals in many parts of the world every year. While human rabies is thankfully rare in most developed countries, it is a major health concern in many other regions. Even in countries such as Canada and the US, where human cases are uncommon, diligent vigilance is required, because rabies continues to be present in wildlife, and therefore people and pets can still be exposed to this deadly disease.

A key part of rabies prevention, which is also a major focus of rabies education programs, is the need for vaccination of pets, even strictly indoor pets. Rabies vaccination is a cheap and effective way of protecting your pet, yourself and your family from this disease. It's also required by law in many areas.  The implications of rabies exposure of pets that are not properly vaccinated can be severe, possibly including euthanasia or very long quarantine, even if they are not infected.

Many groups are holding events to increase awareness about rabies, such as the People and Pets Walk to End Rabies which is being held by the University of Guelph. Information from an advertisement for this event states "Although rabies does not seem like an issue at home, it is a major health problem for both humans and animals in developing countries, claiming the life of one person every ten minutes.  If we work together, we can make a difference. Please show your support and join us at the walk to help make rabies history!" That statement should make it clear why we talk about rabies so much. One human death every 10 minutes is a startling figure for a disease which we should be able to control.

More information about rabies is available on the Worms & Germs Resources page.

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Rabies is an important disease that is almost always fatal. An important part of rabies control programs is mandatory vaccination of pets such as dogs, cats and ferrets. In general, rabies vaccination is very safe and effective. Complications from rabies vaccination are rare, but in recent years concerns have been raised about vaccine-associated sarcoma, a type of tumour that can develop at the site of vaccination. Since this complication was recognized, the vaccines themselves and the way they are administered have been changed in order to decreased the likelihood of this problem occuring, but the risk cannot be eliminated completely. For this reason, some people have tried to avoid having their pets vaccinated for rabies. 

A blood test can be performed to determine antibody levels (also called a titre) against rabies virus. However, there is not enough information available to determine what antibody titre is high enough to say that an animal does not need to be re-vaccinated. Skipping rabies vaccination based on blood test results is dangerous and not recommended. While rabies is uncommon in most areas, exposure can occur, even in strictly indoor animals (e.g. if a bat gets into the house). Rabies vaccination is a legal requirement in most areas of Ontario. The implications of rabies exposure in an animal that is not "up-to-date" on its vaccines can be severe, including prolonged quarantine or euthanasia. I do not know of any jurisdictions that allow rabies antibody levels to be used in place of vaccination, and animals that are not recently vaccinated are treated as non-vaccinated, regardless of their antibody titre.  The risk to your family or your pet from rabies is greater than the very tiny risk of vaccine-associated sarcoma. If you care about your pet and your family, make sure your pet is properly vaccinated against rabies.

More information about rabies can be found on the Worms & Germs Resources page.

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People often wonder why it is recommended that they have their pet vaccinated every year, but rarely get vaccinated themselves after childhood. Traditionally, dogs and cats receive a series of vaccines as puppies and kittens, and then yearly booster vaccines for the rest of their lives. However, there are concerns about rare but serious adverse effects associated with vaccines. There are also questions about whether yearly vaccination is truly necessary for most pets and most diseases.

There is no doubt that the beneficial effects of vaccination greatly outweigh the risks, but even so adverse effects cannot be ignored.  Information about duration of immunity after vaccination, vaccine safety and disease rates need to be considered when determining how often to vaccinate an animal. Unfortunately, minimal information is available about how long most vaccines are protective in dogs and cats. So there is a logical tendency to err on the side of caution and vaccinate more frequently, rather than less.

New guidelines for vaccination of cats are now available from the American Association of Feline Practitioners.  The guidelines recommend longer intervals between vaccines in most older cats that have been previously (and adequately) vaccinated.

Rabies vaccination also has important legal aspects to consider. Different jurisdictions have different requirements. While a three-year rabies vaccine is available, many regions still require more frequent vaccination. Even if an animal is properly vaccinated with a three-year vaccine, if local rules require yearly vaccination, an animal vaccinated more than one year earlier could be considered unvaccinated. This can have a tremendous impact if the animal is exposed to rabies -  it could mean the difference between monitoring the pet at home, or a long quarantine, or even euthanasia. Therefore, it is important to consider the duration of immunity induced by the rabies vaccine used AND the local regulations.  Rabies vaccination is even important for indoor cats.

The bottom line is:

• Vaccination is an important part of your pet's preventive medicine program.
• Different cats need different vaccination programs, depending on their age and what diseases they may be exposed to.
• Potential vaccine reactions should be reported to your veterinarian, who should then report them to the appropriate regulatory authorities, so that a better understanding of adverse reaction rates can be obtained.
• Don't let vague fears of adverse reactions deter you from vaccinating your pet. If you have concerns, get informed, talk to your veterinarian, and get accurate information.

One last point...I think the biggest potential problem with moving beyond annual vaccination is the potential loss of annual veterinary exams. Particularly for older pets, I feel that the annual physical exam and veterinary consultation are much more important than vaccination. Regardless of a pet's vaccination program, it is essential that a pet receives an annual veterinary examination to identify potential health problems as early as possible. Every few years is not enough.

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Another incident of importation of a dog with rabies has been reported. A number of dogs have been brought home by US soldiers, and a few cases of rabies have been found. In the latest case, rabies was diagnosed in 1 of a group of 26 dogs that was flown back to the US to join returning soldiers. All customs and health regulations were followed, but rabies was diagnosed in the dog approximately 3 weeks after arrival.

This incident highlights a few things, including the fact that rabies, even in dogs, can be quite common in some areas of the world, and that movement of animals across borders may increase the risk of introducing infectious diseases. Certainly, cases such as this should not be used to say that these dogs should not be adopted. Rabies (or other serious disease) is a rare event in these situations, and the overall risks to people are minimal if proper procedures are followed. This includes making sure that all animals remain accounted for after arrival, and pursing proper diagnostic testing in the event that they show signs of illness (as was done here). The other dogs that came back with the rabid dog are being monitored. The risk of transmission from this dog to the others is quite low, since it is unlikely that the dog was able to transmit rabies 3 weeks ago, well in advance of developing signs of disease. In some cases it can be weeks to months from the time a dog (or other animal) is exposed to rabies until they become infectious to others.  Presumably, people that had contact with this dog recently are now undergoing post-exposure treatment.

More information about rabies can be found on the Worms & Germs Resources page.

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June has been declared Rabies Awareness Month in New York State. The focus of the occasion is on education, particularly with respect to bats.  Since 1990, 38 of 41 human rabies cases in the US  involved bats. Approximately one-third of bats tested in New York are positive for rabies. In 2007, 559 animals were confirmed as infected with rabies in New York, and  more than 3000 people were treated for rabies exposure. Further, more than 1400 New Yorkers undergo treatment each year following exposure to bats that were not caught and tested. State health personnel are emphasizing the need to catch and test bats if people have had contact with them, or when a bat has been present in a house with a sleeping person. They have produced a video on how to safely catch a bat in the house.

Important points to remember about rabies and bats are:

• Never touch a bat.
• Consider every bat to have rabies until proven otherwise.
• If you have slept in a house overnight with a bat, you are considered exposed. Unless the bat is caught and tested (and shown to be negative) you should undergo post-exposure treatment.
• If you or your pet may have been in contact with a bat, try to catch it (safely) so that it can be tested for rabies.
• Vaccinate your pets against rabies, even if they never leave the house.

More information on rabies and rabies prevention can be found on the Worms & Germs Resources page.

Photo: Little brown bat (M.B. Fenton)

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While visiting my parents this weekend, we came across a litter of stray kittens in the backyard. This is not an uncommon event and many people obtain their cats this way. Adopting stray kittens can be a great way to get a cat because it provides  a good home for kittens that would otherwise end up increasing the feral cat population. However, there are some things to consider to reduce the risks to your family and your other pets.

Various bacteria that can cause diarrhea in people can be carried by kittens, including Salmonella and Campylobacter. These are shed in the stool of infected animals, and people can become ill from handling the animal or stool-contaminated areas. Kittens may have higher rates of carriage of these bacteria than adult cats. Another bacterium that can be carried commonly by kittens is Bartonella henselae, the cause of cat scratch disease. This is transmitted by bites, scratches and fleas, and is just one reason for proper flea control.

Stray kittens are also more likely to carry Toxoplasma, a parasite that is a concern in pregnant women and immunocompromised individuals. Other intestinal parasites such a roundworms are also a concern. Kittens are more likely to have these parasites than adult cats.  Stool contamination of the haircoat is presumably more common in kittens as well because they are not as good about cleaning themselves as adult cats.  So just handling a kitten, even if you avoid its stool, may result in exposure to some of these parasites and bacteria.

Rabies is always a concern, and widespread exposure of people to rabies has occurred from infected litters of kittens.  While uncommon, rabies is a major concern because it is almost invariably fatal. Any stray (or recently rescued) animal that starts acting strangely should be considered a rabies-suspect and be taken to a vet immediately. [More information on rabies, and other topics, is available in our Resources page].

Stray kittens can also carry various infectious diseases that can be transmitted to other cats in the household, such as feline leukemia virus, panleukopenia, rhinotracheitis and calicivirus.

Overall, the risks from adopting stray kittens are low, but they are real. If you are going to adopt/rescue a stray kitten, keep these things in mind:

• Take the kitten to your vet as soon as possible to identify any health issues and determine the required vaccination, deworming and flea control program
• Wash your hands after handling the new kitten
• Keep the new kitten in a confined area while litterbox training is underway to reduce accidents throughout the house
• If you have another cat, make sure it is up-to-date on vaccinations before the kitten comes into the house.
• If the kitten gets sick, make sure it is taken to a vet. If it dies suddenly, make sure you take it to your vet to determine whether testing for rabies is required.
• Pregnant women and households with immunocompromised individuals should not adopt stray kittens.
  

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The warm weather is just about here, and that means the start of camping season. Lots of people love to spend time in the great outdoors during the summer, whether it’s at a summer cottage on the lake, trailer camping in a park with electricity and running water, or roughing it in a tent in the peace and solitude of a more remote wooded location. And many people bring along their faithful companions – their dogs – who enjoy the experience just as much, if not more, than we do.

But there are also dangers lurking in the forests – microscopic dangers carried by tiny insects and other bugs. Ticks in particular are problematic. Certain ticks can carry a number of diseases that can make dogs sick, including Lyme disease (caused by Borrelia burgdorferi) and Rocky Mountain Spotted Fever (RMSF)(caused by Rickettsia rickettsii ). Both Lyme disease and RMSF are more common in certain areas where the tick species that carry them are present.  You can NOT catch these diseases from your dog, but both you and your dog can be infected by the ticks that carry them. People can also be exposed to these pathogens by accidentally crushing an infected tick while trying to remove it from their dog. Ticks must be removed very carefully to ensure that the entire tick is removed, including the head and mouth pieces, without crushing it. If you're not sure how, contact your veterinarian.  Also, the sooner the tick is removed, the less likely it is to transmit certain diseases, so be sure to check your dog thoroughly for ticks when you come back from a walk in the bush.

The Minnesota Department of Health recently reported that the number of cases of (human) Lyme disease increased in that state in 2007. This could be because of spreading tick populations, more people participating in activities in tick-inhabited areas, or increasing awareness and diagnosis of the disease by physicians.

If you and your canine companion will be spending time in some of the wilder and woodier parts of the great outdoors, talk to your veterinarian about what you can do to protect your dog. There are vaccines available for Lyme disease and the bacterial infection leptospirosis (which is also transmissible to people). Flea and tick preventatives are also very important, and many of today’s products are very effective. People should always wear insect repellent when camping or hiking in the woods. Visit the Health Canada website for safety tips on using personal insect repellents. All dogs should be vaccinated for rabies, whether they go camping in the backwoods or they’re house-bound city-slickers.

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In Beijing, 700 000 dogs have recently been vaccinated against rabies in order to combat the growing rabies epidemic there, and reduce the risks to people attending the 2008 Olympic games.

Unfortunately, rabies is common in China, with the number of cases increasing dramatically over the last decade.  In 1996, there were 163 humans deaths due to rabies. This number increased to 3380 in 2007.  Because of the seriousness of disease, the number of deaths and the low vaccination rate in dogs, a mandatory vaccination policy for dogs has been put in place. Free rabies vaccination is provided annually for each licensed dog. This could have a tremendous impact on the number of rabies cases, at least in certain regions. Control of rabies in rural areas is more problematic because of the lack of an organized registration and vaccination system for dogs in those areas. Perhaps not surprisingly, most cases of rabies occur in these rural regions.

So, the 2008 Beijing Olympics may have benefits for the dogs of China as well, or at least those in Beijing. This is certainly a preferred approach to the reports from last year of mass killing of thousands of dogs (including pets).  Let's hope this progressive approach continues and the impact of this horrible disease decreases.

On a related note, the latest human death from rabies in Beijing was a person who was bitten by a stray dog two months before he became ill. He didn't seek medical attention at the time of the bite, he just cleaned the wound himself.  If he had been treated for possible rabies exposure, he'd be alive today.  While rabies is uncommon in many areas, no bite from an animal should be taken lightly.  Rabies should always be considered and appropriate measures taken. More information about rabies is available in our Resources section.

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INFORMATION SHEETS specifically for KIDS, for VETERINARIANS, for PHYSICIANS and for PUBLIC HEALTH PERSONNEL are also available on the Worms & Germs RESOURCES page!

Click on the highlighted topics below for information sheets. Topics that are not highlighted are in development and coming soon. Sheets for other animal species and diseases are also under development and will be added when they are available.

Animals	Diseases	Other
Dogs	Rabies	Litter Boxes
Cats	Giardia	Sandboxes
Turtles	Toxoplasma	Cat Bites
Hamsters	Leptospira	Raw Meat
Rabbits	Clostridium difficile	Petting Zoos
Pet Birds	Cryptosporidium	Needlestick Injuries
Reptiles	MRSA
	MRSP
	Salmonella
	Ringworm
	Campylobacter
	Bartonella henselae

 
Please Remember:

• Your veterinarian and physician are your ultimate resource for information about the health of your pets or your family.
• Information provided here is accurate to the best of our knowledge, but infectious diseases can be unpredictable and these sheets are for general information purposes only.
• There can be great variation in disease risks in different geographic areas. The information provided was developed for Ontario, Canada, but most of the information is relevant for other regions as well.

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