On November 7, 1986, rabies was diagnosed in a dog euthanized
November 4th in a Westchester County, New York, animal hospital.
For
years, Westchester County has reported rabies only in bats.
The dog, a mixed Rhodesian Ridgeback, was acquired in December
1983 in Bamenda, Cameroon, by the owners, Americans living in West
Africa. The dog had been regularly vaccinated against rabies. It
had
received its first inactivated rabies vaccine in February 1984,
when
it was 10 to 12 weeks old. A second dose was administered 1 year
later. The dog arrived in the United States on January 16, 1986,
and
received a third dose of inactivated rabies vaccine in early March.
The dog had not been bitten by any animal after its arrival in the
United States. The owner reported, however, that just before
leaving
Cameroon on January 14, 1986, the dog had been scratched by a stray
dog in a hotel lobby in Douala, Cameroon. The wound was cleaned
thoroughly, but no rabies vaccine was administered at that time.
On October 3l, l986, the owner, a school teacher in Yonkers,
New
York, brought the dog to school with her. Two students were
exposed
to the dog's saliva, and fifteen other students and a teacher had
minor contact with the dog. That afternoon, the dog was noted to
have
paralysis of the lower jaw and was taken to a local animal
hospital.
The dog was ambulant, remained docile, and did not exhibit any
furious
signs. It was discharged with a diagnosis of a "viral infection",
and
instructions were given to force-feed it. The dog was again seen
in
the clinic the morning of November l, but because of deteriorating
neurologic conditions was taken to a second animal clinic on
November
2. It was kept overnight and discharged November 3. That evening
the
dog was returned to the first animal hospital and was euthanized
the
next day. Direct flourescent antibody testing and isolation of the
virus in neuroblastoma cells at the New York State Health
Department
confirmed the diagnosis of rabies. Analysis by monoclonal
antibodies
(1,2) indicated that the virus differed from strains isolated from
bats or terrestrial wildlife in the United States. It was,
however,
identical to rabies strains isolated in West Africa, a finding that
suggested the dog had acquired rabies there.
A total of 37 individuals received post-exposure prophylaxis
for
possible exposure to the dog during its illness and the 2-week
period
prior to onset. This included the dog's owner, the veterinarians
and
their assistants, four neighbors, 17 students, and a teacher.
Reported by E Argentina, B Bowman, AS Curran, MD, K Farrell, F
Guido,
GN Haloukas, MM Landrigan, BO Mojica, MD, FR Morrissey, C Ryan, VO
Sousa, MD, F Virtuoso, Westchester County Dept of Health, C
Trimarchi,
R Gallo, B Rudd, D Morse, MD, State Epidemiologist, New York State
Dept of Health; Viral and Rickettsial Zoonoses Br, Div of Viral
Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Dog rabies is endemic in most of Africa, Asia, and
Latin America (3). In the United States, however, dog rabies has
decreased dramatically, from 5,688 cases in l953 to 113 in 1985.
Wildlife rabies, on the other hand, has increased considerably and
accounts for 91% of all reported cases; the main reservoirs are
skunks, raccoons, and bats (4). Epidemiologic studies (5) and
monoclonal antibody analysis (1,2) have shown that dogs in the
United
States are usually infected by rabid terrestrial wildlife species.
Current Public Health Service quarantine regulations (6,7)
require
that all dogs imported from countries with endemic rabies have a
valid
certificate of rabies vaccination and be vaccinated against rabies
at
least 30 days prior to entering the United States. These
requirements
were fulfilled for this dog since it was vaccinated twice with an
inactivated vaccine that normally gives a 3-year immunity.
Rabies must be suspected when dogs imported from rabies-endemic
areas develop unexplained neurological disease, even if the dogs
have
been vaccinated. The 9H-month incubation period reported here is
very
rare (8,9,10), although a few cases with incubation periods
6 months
have been reported in dogs released from quarantine in the United
Kingdom (8,9). In addition, vaccine failures such as the one
described here are uncommon (10) and represent only 4% to 6% of
reported cases in the United States for 1971-1973 (5). Failures
following the administration of inactivated rabies vaccines may
result
from an incomplete immunization schedule, poor handling of the
vaccine, or inadequate immunologic response (11). Regarding
vaccine
potency, the three vaccine lots from which this dog was vaccinated
had
been tested and shown potent by the manufacturers and national
testing
agencies.
References
Smith JS, Sumner JW, Roumillat LF, Baer GM, Winkler WG.
Antigenic
characteristics of isolates associated with a new epizootic of
raccoon rabies in the United States. J Infect Dis
1984;149:769-74.
Smith JS, Reid-Sanden FL, Roumillat LF, Trimarchi C, Clark K,
Baer
GM, Winkler WG. Demonstration of antigenic variation among
rabies
virus isolates by using monoclonal antibodies to nucleocapsid
proteins. J Clin Microbiol 1986;24:573-80.
Acha PN, Arambulo PV III. Rabies in the tropics: history and
current status. In: Kuwert E, ed. Rabies in the tropics.
Berlin: Springer-Verlag, 1985:343-59.
CDC. Rabies surveillance annual summary, 1985. Atlanta,
Georgia: US Department of Health and Human Services, Public
Health Service, 1986.
Kappus KD. Canine rabies in the United States, 1971-1973:
study
of reported cases with reference to vaccination history. Am J
Epidemiol 1976;103:242-9.
Public Health Service. Importations: dogs and cats. Federal
Register 1986;42(1):54-6.
CDC. Compendium of animal rabies control, 1987--prepared by:
the
National Association of State Public Health Veterinarians, Inc.
MMWR 1987;35:807-10, 815-8.
Kaplan MM. The epidemiology of a fickle virus. Proc Roy Soc
Med
1971;64:225-8.
Turner T. The risks and problems associated with the
importation
of dogs, cats and other mammals--I: rabies. Br Vet J
1984;140:96-106.
Clark KA, Kelly VP, et al. Rabies vaccination: field
observations during epizootics in dogs. Modern Vet Pract
1981;Dec:907-11.
Blaucou J, Firon JP, Rollin PE. Defaut de reaction immunitaire
du
chien apres vaccination contre la rage. Etude d'un cas --
consequences. Rec Med Vet 1983;159(10):789-93.
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