Rabies General Info

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Rabies

 

Background

Rabies is a disease that is caused by the rabies virus.  It affects the nervous system of humans and other mammals. People get rabies from the bite of an animal infected with the rabies virus (a rabid animal).

In the United States, human fatalities associated with rabies occur in people who fail to seek medical assistance, usually because they were unaware of their exposure. 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, hyper salivation (increase in saliva), difficulty swallowing, and hydrophobia (fear of water). Death usually occurs within days of the onset of these symptoms. The last human case of rabies in Illinois was reported in 1954.

The vast majority of rabies cases reported in the United States occur in wild animals, like a raccoon, skunk, fox, coyote and bats. Domestic animals such as cattle, cats and dogs account for less than 10% of the reported animal rabies cases.

 

Rabies positive animals by species and year in Illinois 2008-2018

Species 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018  
Bat 103 83 117 50 63 55 40 97 62 58 85
Cattle 0 0 0 1 0 0 0 0 0 0 0  
Cat 0 0 0 0 0 0 0 0 1 0 0  
Fox 0 0 0 0 0 0 0 0 0 0 0  
Skunk 0 0 0 0 0 0 0 0 0 0 0  
Total 103 83 117 51 63 55 40 97 63 58 85  

 

In Illinois, bats are the primary species identified with rabies. During summer in Chicago, the likelihood of human-bat contact increases because of bat migration and feeding patterns. Although not all bats carry rabies, bats in Chicago and the surrounding area test positive for the virus each year. For Chicago in 2018, the Illinois Department of Public Health tested 284 of bats out of which 14 rabies-positive bats were identified.  

 

Although there has not been a reported case of human rabies in Illinois since 1954, rabies in humans is almost always a fatal disease. Therefore, it is critical to provide prompt and appropriate rabies post-exposure prophylaxis (PEP) when bat exposures take place

Exposures of concern for rabies transmission by bats:

  • If any physical contact with a bat has occurred
  • If an individual awakens and finds a bat in a room or if a bat is seen in the room of a sleeping person
  • If a bat is found in the room of an unattended child
  • If a bat is seen near a mentally impaired or intoxicated person
  • If a bat is found near an unattended pet
  • NOTE:  Bats have very small teeth. Therefore, a bite from a bat may not be felt and may leave marks that are not easily seen.

Providers

The Chicago Department of Public Health has created an algorithm for providers who are evaluating potential human exposures to rabies for bats & wild animals and domestic animals to help determine whether an individual will require rabies post exposure prophylaxis.

Once the exposure scenario is verified to represent a risk of rabies transmission, the exposed
person should receive Rabies Immune Globulin (RIG) and rabies vaccine. The first dose of the 4-dose course should be administered as soon as possible after exposure (day 0). Additional rabies vaccine doses then should be administered on days 3, 7, and 14 after the first vaccination.

Please alert the pharmacy in your facility if you have a potential exposed person to ensure availability if RIG and vaccine.

All individuals receiving post exposure prophylaxis must receive RIG. If your organization does not have access to RIG please contact the health department at 312-743-9000.

Rabies Contact & Reporting

All individuals who have been potentially exposed to rabies must be reported to CDPH:

For immediate clinical questions please call 311 and ask to speak to a communicable disease physician on call or call the CDPH Disease Reporting Number 312-743-9000.

Reporting also can be done through INEDSS (Illinois Notifiable Electronic Disease Surveillance System) or a Rabies Case Report Form can be completed and faxed back to the Chicago Department of Public Health at 312-746-6388.

Rabies Vaccine Information

Summary and Action Items:
• Until further notice, use RabAvert vaccine for rabies vaccination for either pre or post-exposure administration. RabAvert can be purchased directly from the manufacturer on an as-needed basis.
• For rabies immune globulin (RIG), Kedrab and HyperRab are available. Imogam is only available directly from the manufacturer at this time.
• As always, please ensure that persons who are receiving rabies post-exposure prophylaxis (PEP) are recommended for rabies PEP per guidance in the “Human Rabies Prevention-United States, 2008, Recommendations of the ACIP”.
• Correctly administer rabies vaccine to avoid the need to re-do a rabies vaccination.
• Review information on the CDC website.

Background
Imovax (produced by Sanofi Pasteur) is experiencing a temporary supply shortage and is not available at this time. RabAvert vaccine (produced by GlaxoSmithKline) is experiencing a temporary limited supply but is still available for both pre-exposure prophylaxis and PEP. If vaccine is not available from the distributor, order directly from the manufacturer on an as-needed basis. Healthcare providers who are unable to obtain Imovax should use RabAvert during this time, even if Imovax was used to start a pre-exposure or PEP schedule that is in progress.

Both Kedrab (produced by Kedrion Biopharma) and HyperRab (produced by Grifols) are available with no restrictions for rabies immune globulin. Imogam (produced by Sanofi Pasteur) is currently experiencing a temporary shortage. Providers can obtain Imogam directly from the manufacturer.

The CDC continues to work with partners to monitor the status of rabies biologic supplies. The current situation is not expected to impact overall availability of PEP nationally. Healthcare providers should continue to administer PEP when indicated.

For more information please see the IDPH Health Alert issued October 7, 2019.