a. International. Present Public Health Service regulations (42 CFR No. 71.51) governing the importation of domestic felines and canines are minimal for preventing the introduction of rabid animals into the United States. All dogs and cats imported from countries with endemic rabies should be vaccinated against rabies at least 30 days before entry into the United States.* CDC is responsible for animals imported into the United States, and their requirements should be coordinated with interstate shipment requirements. The health authority of the state of destination should be notified of any animal conditionally admitted into its jurisdiction within 72 hours. The conditional admission into the United States of such animals must be subject to state and local laws governing rabies. Failure to comply with these requirements should be promptly reported to the director of CDC. b. Interstate. Prior to interstate shipment, dogs and cats should be vaccinated against rabies according to the compendium's recommendations and, preferably, should be vaccinated at least 30 days prior to shipment. While in shipment, they should be accompanied by a currently valid NASPHV Form #50, "Rabies Vaccination Certificate." One copy of the certificate should be mailed to the appropriate Public Health Veterinarian or State Veterinarian of the state of destination. c. Health Certificates. If a certificate is required for dogs and cats in transit, it must not replace the NASPHV rabies vaccination certificate. 4. Adjunct Procedures. Methods or procedures that enhance rabies control include: a. Licensure. Registration or licensure of all dogs and cats controls the number of stray animals and may, thus, be used as a means of rabies control. Frequently a fee is charged for such licensure, and revenues collected are used to maintain a rabies or animal control program. Vaccination is usually recommended as a prerequisite to licensure. b. Canvassing of Area. Canvassing includes house-to-house calls by members of the animal control program to enforce vaccination and licensure requirements. c. Citations. Citations are legal summonses issued to owners for violations, including the failure to vaccinate or license their animals. d. Leash Laws. All communities should adopt leash laws that can be incorporated into their animal control ordinances. 5. Postexposure Management. ANY DOMESTIC ANIMAL THAT IS BITTEN OR SCRATCHED BY A BAT OR BY A WILD, CARNIVOROUS MAMMAL THAT IS NOT AVAILABLE FOR TESTING SHOULD BE REGARDED AS HAVING BEEN EXPOSED TO A RABID ANIMAL. a. Dogs and Cats. When bitten by a rabid animal, unvaccinated dogs and cats should be destroyed immediately. If the owner is unwilling to have this done, the unvaccinated animal should be placed in strict isolation for 6 months and vaccinated 1 month before being released. Dogs and cats that are currently *In regard to cats, these recommendations do not conform to the official recommendations of CDC and the Public Health Service. Although domestic feline rabies has increased, there has been no evidence of increased risk of imported rabies in cats. U.S. Foreign Quarantine regulations do not require rabies vaccinations for imported cats. vaccinated should be revaccinated immediately and observed by the owner for 90 days. b. Livestock. All species of livestock are susceptible to rabies infection; cattle appear to be among the most susceptible of all domestic animal species. Livestock known to have been bitten by rabid animals should be destroyed (slaughtered) immediately. If the owner is unwilling to have this done, the animal should be kept under very close observation for 6 months. Following are recommendations for owners of livestock exposed to rabid animals: (1) If the animal is slaughtered within 7 days of being bitten, its tissues may be eaten without risk of infection, provided liberal portions of the exposed area are discarded. Federal meat inspectors will reject for slaughter any animal that has been exposed to rabies within 8 months. (2) No tissues or secretions from a clinically rabid animal should be used for human or animal consumption. However, since pasteurization temperatures will inactivate rabies virus, the drinking of pasteurized milk or eating of completely cooked meat does not constitute a rabies exposure. 6. Management of Animals That Bite Humans. A healthy dog or cat that bites a person should be confined and observed for 10 days and evaluated by a veterinarian at the first sign of illness during confinement or before release. Any illness in the animal should be reported immediately to the local health department. If signs suggestive of rabies develop, the animal should be humanely killed, and its head should be removed and shipped, under refrigeration, for examination by a qualified laboratory designated by the local or state health department. Any stray or unwanted dog or cat that bites a person can be killed immediately; the head should be submitted, as described above, for rabies examination. C. Control Methods in Wild Animals Bats and wild carnivorous mammals (as well as wild animals crossbred with domestic dogs and cats) that bite people should be killed, and appropriate tissues should be sent to the laboratory for examination for rabies. A person bitten by a bat or any wild animal should immediately report the incident to a physician who can evaluate the need for antirabies treatment. (See current rabies prophylaxis recommendations of the ACIP [1,2].) 1. Terrestrial Mammals. Continuous and persistent government-funded programs for trapping or poisoning wildlife as a means of rabies control are not costeffective in reducing wildlife reservoirs or rabies incidence on a statewide basis. However, limited control in high-contact areas (picnic grounds, camps, suburban areas) may be indicated for the removal of selected high-risk species of wild animals. The public should be warned not to handle wild animals. The state wildlife agency should be consulted early to manage any elimination programs in coordination with the state health department. 2. Bats. Rabid bats have been reported from every state except Hawaii and have caused human rabies infections in the United States. It is neither feasible nor practical, however, to control rabies in bats by areawide programs to reduce bat populations. Bats should be eliminated from houses and surrounding structures to prevent direct association with people. Such structures should then be made bat proof by sealing routes of entrance with screen or by other means. Rabies Continued References 1. Immunization Practices Advisory Committee. Rabies prevention - United States, 1984. MMWR 1984;33:393-402,407-8. 2. Immunization Practices Advisory Committee. Rabies prevention: supplementary statement on the preexposure use of human diploid cell rabies vaccine by the intradermal route. MMWR 1986;35:767-8. Epidemiologic Notes and Reports Update: Influenza Activity United States Influenza A(H3N2) is the most frequently reported influenza virus so far this season (Figure 1). For the report week ending January 9, 1988, seven states reported regional outbreak activity.* Widespread activity has not yet been reported this season. Sporadically occurring cases of influenza B have been reported from five states.* Reported by: Participating State and Territorial Epidemiologists and State Laboratory Directors. WHO Collaborating Center for Influenza, Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC. *Kansas, Montana, Nebraska, South Dakota, Texas, Utah, and Wisconsin. *Arizona, Hawaii, New York, Ohio, and Tennessee. FIGURE 1. States reporting isolates of influenza A(H3N2) United States, Isolates reported The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238. The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333. Ha CENTERS FOR DISEASE CONTROL January 29, 1988 / Vol. 37 / No. 3 The first reported case of AIDS caused by human immunodeficiency virus type 2 (HIV-2) in the United States was diagnosed in December 1987. The patient, a West African, came to the United States in 1987. In December, the patient visited a physician because of a 3-year history of weight loss and recent onset of neurologic symptoms. A CAT scan of the head revealed mass lesions that biopsy showed to be caused by Toxoplasma gondii. Biopsy of a lymph node revealed acid-fast bacteria. The patient did not give a history of sexual intercourse, use of nonsterile needles, or donation of blood while in the United States. All family members and household contacts, both in the United States and abroad, are reported to be well. Because the diagnosis of cerebral toxoplasmosis without other underlying cause of immunodeficiency fits the CDC surveillance definition for AIDS, laboratory evidence of infection with HIV was sought. Testing of the patient's serum revealed a negative enzyme immunoassay (EIA) for antibody to HIV-1 with an indeterminate HIV-1 Western blot. However, EIA for antibodies to HIV-2 (Genetic Systems Corporation, Seattle, Washington [research test kit]) was repeatedly reactive and HIV-2 Western blot revealed bands for antibodies to gag (p26), pol (p34), and env (gp140) proteins. DNA amplification by the polymerase chain reaction technique with HIV-1specific and HIV-2-specific DNA probes (1) revealed HIV-2 DNA but not HIV-1 DNA in the patient's lymphocytes and confirmed the diagnosis of HIV-2 infection. Reported by: SH Weiss, MD, J Lombardo, MD, PhD, J Michaels, MD, LR Sharer, MD, M Tayyarah, Editorial Note: This patient represents the only documented case of HIV-2 infection U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES & PUBLIC HEALANDERVICE |