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The following information includes information of concern for wildlife
rehabilitators. Included is information about suggested protocols for
Some information was published in the late
1990's and has since changed or specified vaccines are not available or used.
Consult the CDC website for the most current protocols on rabies vaccines and
by Jo Balliet, LWR
Wounded Knee Wildlife Refuge, Inc.
Protocol for working with raccoons:
Only pre-immunized handlers should work with raccoons.
All raccoons should be considered rabies exposed.
Latex examination or household gloves should be worn at all times
while working with nursing raccoons. Soiled bedding, bottles and nipples,
and soiled housing should be handled with latex gloves.
Raccoon litters should not be housed together until such time that
killed rabies vaccine inoculation has been boostered; a minimum of
three (3) weeks. (See publication #1 of the Pacific Wildlife Project
Inoculation should be considered at intake, regardless of age.
To each litter, assign a bottle/nipple which we carry a number
corresponding to the number assigned to the housing tank. (Aquarium
tanks are recommended for neonates for many reasons, including ease
After use, thoroughly disinfect each bottle (externally) with
Novalsan Surgical Scrub (while hands are still gloved), dry, encase in
a plastic sandwich bag, and refrigerate. If empty, the bottle should
be cleaned internally in the normal manner before storage. Sterilize
bottles and nipples at least once daily.
After care of litter, disposal of latex examination gloves is a
must. Latex household gloves shall be disinfected in the manner
Do not hold the animal near your face. (Prevents accidental mucous
Do not place soiled gloves, bottles, or bedding near your face.
If unknown mucous membrane invasion is
questionable, the use of a
face mask and safety glasses is recommended. (One doesn't go scuba
diving without the necessary equipment!)
Use latex household gloves during all phases of outdoor cage and
accessory cleaning. Disinfect gloves frequently.
Each raccoon's assigned admission number should follow it from
intake to release.
NOTE: Excluding vaccination, these procedures should be applied to all
mammal species with the possible exception of squirrels and rabbits.
by Jo Balliet, LWR
Wildlife rehabilitators who work with mammal species should strongly
consider participation in a pre-exposure rabies immunization program.
As rehabilitators, we are in the "frequent" risk category as classified
by the U.S. Department of Health and Human Services. Included in that
category are rabies diagnostic laboratory technicians. The Department
recommends a course of pre exposure rabies vaccine, followed at two years
by a serology (serum titer) test and, if necessary, a booster shot.
(See BOOSTER DOSE).
VACCINE SUPPLY AND ADMINISTRATION:
The vaccine, manufactured by Pasteur Merieux Serums and Vaccines S.A.,
Lyon, France, is distributed by Connaught Laboratories, Inc., Swiftwater,
Pennsylvania (1-800-822-2463). It is pre-packaged for the route in
which it is to be administered; 1.0 ml for IM (intramuscular) injections.
There have been reported cases of inadequate protection when the ID route
was used. (Pers. conv., Getson, 1989, Nash, 1992.) This could have been
the result of improper administration.
Intradermal (ID) injections must be administered
between layers of the
skin, not subcutaneously (beneath the skin). The vaccine instruction sheet
clearly states, "If the intradermal inoculation was not performed
satisfactorily (vaccine injected subcutaneously), another dose should
be given intradermally at a different site."
When scheduling the ID route of pre-exposure vaccine administration
through your primary caregiver, confirm that the vaccine will be given
as directed by the manufacturer. Keep in mind that the ID route of
administration is for pre-exposure only. The IM injection is effective
for pre- and post-exposure but is much more expensive per injection.
If unable to acquire the less expensive ID pre-exposure inoculation through
your primary caregiver, ask to join the vaccine program of the local
health department or a veterinary hospital. If eligible to use a
military hospital, contact the communicable disease section of that
facility for information. Some HMO programs will cover the cost of the
vaccination and its administration.
**NOTE: Intradermal vaccine was discontinued
for use in the USA and Canada. Some studies as to its effectiveness are
currently underway (June 2010)
ORGANIZING A PRE-EXPOSURE VACCINE PROGRAM:
Team up with regional rehabilitators and their volunteers and set up your own vaccine program. Contact the distribution laboratory at the telephone number listed above for a price quote. A donor/supporter of your rehabilitation program may be a medical caregiver who will administer your program or can fefer you to other medical personnel who will donate their services. Or contact an RN in a regional hospital's immunization clinic or ICU. You may be surprised at the cooperation you will receive because you rehabilitate wildlife.
When all participants are signing up and an RN's volunteer services have been confirmed, your will need a volunteer physician to oversee your program and order the vaccine. Collect the cost of the vaccine up front so funds will be available when it's shipped. Finally, if you are ot comfortable with having the vaccine administered at your facility, contact your veterinarian concerning use of his/her animal hospital facility. With the cooperation of our veterinary, our vaccine program begins at 10am on Sunday morning which coincides with the kennel person's presence to open and close the facility. Each participant of the vaccine program is asked to sign a release agreement prior to receiving the vaccine. The release agreement lists the physician, vaccine administrator, animal hospital, hospital owner, wildlife refuge, refuge director, and other agents involved. A parent or guardian must sign for minors. All agreements are witnessed and dated. By By prior agreement with all agents involved, releases are kept on file at the refuge. Along with thank you notes to everyone who donated professional services, a small gift would be appreciated. The cost can be alleviated by rounding off the cost of vaccine per per person up to the nearest $5.00.
IMPORTANCE OF VACCINE:
Pre-exposure rabies vaccine is recommended for the following reasons:
Inability to receive timely post-exposure treatment
Reduction in the number of post-exposure injections
Without pre-exposure immunization:
a. Rabies immunoglobulin (20 IU/kg BW)
Day 0 (Divided doses around bite wound and/or in buttocks)
b. Rabies vaccine (1 ml IM) on days 0, 3, 7, 14, and 28 in deltoid
region of the arm
With pre-exposure immunization:
a. Rabies vaccine (1 ml IM) on days 0 and 3.
If exposure to rabies occurs, post-exposure vaccine is necessary but with
a reduced treatment regimen. The need for globulin has been eliminated
and you have already received the first three (3) of five rabies vaccine
injections at a lower cost. Also important for the rehabilitator is the
savings in time, inconvenience, and possible mental anguish concerning
Varying reactions to the vaccine have been reported. Swelling, redness,
itching, or pain at the injection site are the most commonly reported
reactions. Possible systemic reactions are headache, nausea, muscle aches,
abdominal pain, or dizziness.
Following a booster dose, immune-complex complaints such as rash, nausea,
vomiting, fever, fatigue, or arthritis have appeared between days 2-21 in
up to 6% of recipients. No reaction has been life threatening. (Pasteur
In areas of high rabies incidence, Merieux recommends a booster every
two years, or serologic testing at two years and a booster if the titer
level is inadequate. The author had adequate titers for five (5) years
following the initial vaccine. After a booster, the subsequent eight
(8) years have shown adequate titers. In this case, rabies vaccine has
proven to be an inexpensive, blue chip investment of protection and mental
security while rehabilitating mammal in a rabies epizootic area.
The following information concerning the titer test is provided for your
primary caregiver. The RFFIT (pronounced "riffit") test it the only
reliable rabies titer test. Serum specimens may be sent to the following
Department of Veterinary Diagnosis
Veterinary Medical Center
Kansas State University
Manhattan, KA 66506
Two (2) mls of serum should be shipped on ice by overnight express mail.
Include billing information as well as where the results should be sent.
The cost is $22.50 (1995)
As a wildlife rehabilitation center, we did not anticipate becoming
involved in a broad scale pre-exposure rabies vaccine program. When it
became evident that one was needed, our human medical and legal
advisors/board members recommended that one should be made available when
warranted. Since 1990, approximately 140 people have participated in our
pre-exposure rabies vaccine program. Beyond the refuge volunteers, those
participants have included veterinarians, animal health technicians, pest
control personnel, and other licensed rehabilitators. The decision to have
titers evaluated is up to the individual.
Important: Please contact your county health
department or health officer for guidance relating to post-exposure
CENTRES FOR DISEASE CONTROL (CDC) Atlanta
Rabies is a
preventable viral disease of mammals most often
transmitted through the bite of a rabid animal.
The vast majority of rabies cases reported to
the Centers for Disease Control and Prevention
(CDC) each year occur in wild animals like
raccoons, skunks, bats, and foxes.
The rabies virus
infects the central nervous system, ultimately
causing disease in the brain and death. The
early symptoms of rabies in people are similar
to that of many other illnesses, including
fever, headache, and general weakness or
discomfort. As the disease progresses, more
specific symptoms appear and may include
insomnia, anxiety, confusion, slight or partial
paralysis, excitation, hallucinations,
agitation, hypersalivation (increase in saliva),
difficulty swallowing, and hydrophobia (fear of
water). Death usually occurs within days of the
onset of these symptoms.
Compendium of animal rabies prevention and control, 2008
Parenteral animal rabies
vaccines should be administered only by or under the
direct supervision of a veterinarian. Rabies
vaccinations also may be administered under the
supervision of a veterinarian to animals held in
animal-control shelters before release. Any veterinarian
signing a rabies certificate must ensure that the person
administering vaccine is identified on the certificate
and is appropriately trained in vaccine storage,
handling, administration, and in the management of
adverse events. This practice ensures that a qualified
and responsible person can be held accountable for
properly vaccinating the animal.
Rabies Vaccines Licensed and Marketed in the U.S., 2008
Rabies Vaccination Recommendations
People who work with rabies
in laboratory settings and animal control and wildlife
officers are just a few of the people who should
consider rabies preexposure vaccinations.
If you are traveling to a
country where rabies is widespread, you should consult
your doctor about the possibility of receiving
preexposure vaccination against rabies.
Your planned activity
will bring you into contact with wild or domestic
animals, for example if you are a biologist,
veterinarian, or agriculture specialist working with
You will be visiting
remote areas where medical care is difficult to
obtain or may be delayed, for example, hiking
through remote villages where dogs are common.
Your stay is longer than
1 month in an area where dog rabies is common. The
longer your stay, the greater the chance of an
encounter with an animal.
vaccination does not eliminate the need for additional
therapy after a rabies exposure, it simplifies
management by eliminating the need for rabies immune
globulin and decreasing the number of doses of vaccine
needed. This is of particular importance for persons at
high risk for exposure to rabies in areas where
immunizing products might not be available or where
lesser quality biologics might be used which would place
the exposed person at increased risk for adverse events.
Preexposure prophylaxis may
also protect people whose postexposure therapy is
delayed and provide protection to people who are at risk
for unapparent exposures to rabies.
Rabies Preexposure Prophylaxis
Nature of Risk
continuously, often in high concentrations.
Specific exposures likely to go unrecognized.
Bite, nonbite, or aerosol exposure.
laboratory workers; rabies biologics production
Serologic testing every 6 months; booster
vaccination if antibody titer is below
episodic, with source recognized, but exposure
also might be unrecognized. Bite, nonbite, or
lab workers, spelunkers, veterinarians and
staff, and animal-control and wildlife workers
in rabies-enzootic areas. All persons who
frequently handle bats.
Serologic testing every 2 years; booster
vaccination if antibody titer is below
always episodic with source recognized. Bite or
terrestrial animal-control workers in areas
where rabies is uncommon to rare. Veterinary
students. Travelers visiting areas where rabies
is enzootic and immediate access to appropriate
medical care including biologics is limited.
Primary course. No
serologic testing or booster vaccination.
episodic with source recognized. Bite or nonbite
U.S. population at
large, including persons in rabies-epizootic
Three 1.0-mL injections of
HDCV or PCEC vaccine should be administered
intramuscularly (deltoid area) -- one injection per day
on days 0, 7, and 21 or 28. Vaccine preparations for
intradermal administration are no longer available in
the United States.
People who work with rabies
virus in research laboratories or vaccine production
facilities are at the highest risk for unapparent
exposures. Such persons should have a serum sample
tested for rabies antibody every six months.
Intramuscular booster doses of vaccine should be
administered to maintain a serum titer corresponding to
at least complete neutralization at a 1:5 serum dilution
by the RFFIT.
This group includes other
laboratory workers such as those performing rabies
diagnostic testing, spelunkers, veterinarians and staff,
and animal-control and wildlife officers in areas where
animal rabies is enzootic. The frequent-risk category
also includes persons who frequently handle bats,
regardless of location in the Unites States. Persons in
the frequent risk group should have a serum sample
tested for rabies antibody every 2 years; if the titer
is less than complete neutralization at a 1:5 serum
dilution by the RFFIT, the person also should receive a
single booster dose of vaccine.
students, and terrestrial animal-control and wildlife
officers working in areas where rabies is uncommon to
rare (infrequent exposure group) and at-risk
international travelers fall into this category and do
not routine preexposure booster doses of vaccine after
completion of primary preexposure vaccination.
Rabies vaccines and
immunoglobulin available in the United States
Human Diploid Cell
Embryo Cell Vaccine (PCEC)
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