Apparently isolated cases, but both rabies outbreaks came where they should not have
OMAHA, Nebraska; CHENNAI, India––Recent discoveries of a rabid kitten in east-central Omaha, Nebraska, and a rabid dog in Royapuram, a northern suburb of Chennai, India, indicate threats to two of the most influential rabies eradication success stories anywhere, ever.
The rabid kitten, discovered on September 28, 2023, died from the raccoon rabies strain, 850 miles west of anywhere raccoon rabies had ever before been detected.
The 1992 introduction of Raboral anti-rabies vaccine bait pellets had for 31 years kept raccoon rabies from spreading westward out of the Appalachian mountains, after it had already infected raccoons along the east coast of the U.S. from Florida to Vermont.
The rabid dog bit 29 people barely seven miles north of the Chennai headquarters of the Blue Cross of India, whose Animal Birth Control and anti-rabies vaccination programs had since 1966 all but eliminated rabies from the greater Chennai metropolitan area.
Health officials in Douglas County, Nebraska, warned the public about the possible raccoon rabies threat on October 10, 2023, after all ten people believed to have had contact with the kitten were located and began prophylactic treatment to prevent rabies infection.
“No history was available for the kitten, believed to have been from one to two months old,” reported Julie Anderson for the Omaha World-Herald.
“Sixteen cases of rabies in animals have been reported in the state so far this year , according to the Nebraska Department of Health & Human Services,” Anderson continued.
“All but two of those animals have been bats. Between 21 and 30 animals a year have tested positive for the disease in each of the preceding three years,” Anderson said.
A dozen USDA Wildlife Services trappers deployed throughout Douglass County in search of other rabid animals, especially raccoons.
No other rabid animals found
Meanwhile, wrote Anderson, “experts from the Centers for Disease Control & Prevention have been testing dead animals, mostly roadkill, collected by the Nebraska Humane Society and others.”
Two hundred road-killed raccoons all tested negative for rabies.
In addition, 665 raccoons, 35 skunks, three cats, and a red fox were live-trapped for observation. None appeared to be rabid.
Three raccoons were euthanized due to exhibiting lesions, wounds, or unusual behavior, potentially indicative of rabies. Among three raccoons transferred to the local organization Nebraska Wildlife Rehab for possible treatment of non-rabid conditions, one died, one was euthanized, and another, a juvenile, was kept at the facility.
“Vaccinated & released”
The remaining live-trapped animals “were vaccinated and released,” Anderson reported.
Beginning on November 1, 2023, the USDA Wildlife Services personnel and local assistants began distributing 18,000 Raboral baits over a 62-square-mile area surrounding where the rabid kitten was found, hoping to create a “wall of immunity” that will keep raccoon rabies from spreading.
USDA Wildlife Services is currently conducting similar efforts to contain recent raccoon rabies occurrences in Ohio and around Burlington, Vermont.
Wrote Anderson, “The concern, said Matthew Donahue, Nebraska’s state epidemiologist, is that the raccoon variant could become established in Nebraska’s abundant raccoon population,” estimated at about 50 per square mile in the Omaha area.
Failure to find any rabid raccoons, or other rabid animals, does not necessarily mean the outbreak has already been contained, because the raccoon rabies strain can have a latency interval, in raccoons, of several months before a victim raccoon displays symptoms.
“Evidence from the eastern United States,” Anderson explained, “indicates raccoon rabies could spread quickly here because local raccoons haven’t been exposed before.
“Because raccoons frequent backyards and parks, that could lead to a large number of exposures among pets––and the people with whom they share homes––requiring a series of costly vaccinations [in people], to ward off an infection which is nearly always fatal.”
Kitten found near St. Cecilia Cathedral
Even after more than a month of effort, Anderson added, “No one has been able to trace where the unfortunate kitten came from or how she became infected.”
The kitten was found near the St. Cecilia Cathedral, an Omaha landmark, built in 1959 as one of the ten largest Catholic churches in the U.S.
The family who found the kitten gave her to another family, who took the kitten to a veterinarian to be treated for suspected ringworm.
VCA Animal Medical Center of Omaha veterinarian Sharon Mix said that “a family member brought the kitten to her because she appeared to be getting sicker,” Anderson wrote, possibly due to a bad reaction to the ringworm medication.
“Mix stopped the medication and provided supportive care,” Anderson recounted. “The owner took the kitten back home.”
But the kitten stopped eating. Returned to Mix, the kitten began “exhibiting neurological signs.”
After the kitten died, Mix sent the kitten’s remains to the Nebraska Veterinary Diagnostic Center, part of the School of Veterinary Medicine and Biomedical Sciences at the University of Nebraska-Lincoln, for testing.
The test came back positive, reportedly the first case of rabies identified in a cat in Douglas County in almost 20 years. The Centers for Disease Control & Prevention confirmed the local test result and identified the raccoon rabies strain on October 6, 2023.
What is raccoon rabies?
The raccoon rabies strain was first identified as distinct from canine rabies, skunk rabies, fox rabies, and bat rabies circa 1950. A rabies strain unique to mongooses and Taiwanese ferret badgers was discovered more recently.
The chief difference among the different strains is the time the host animal can carry the infection before exhibiting symptoms and, soon afterward, dying from it.
Any mammal can become infected with rabies, and any infected mammal can transmit rabies to other mammals via saliva, usually delivered with a bite, but animals other than the host species––dogs, skunks, foxes, raccoons, ferret badgers, mongooses, and bats––typically die so soon after infection that they have little or no chance to infect others.
Mid-Atlantic states raccoon rabies pandemic
Raccoon rabies was initially known only in Georgia and Florida. It spread up and down the entire east coast of the U.S. in an episode remembered as the Mid-Atlantic states raccoon rabies pandemic of 1976-1992.
The pandemic began when a group of West Virginia raccoon hunters and trappers, trying to rebuild the hunted-out local population, translocated 3,500 raccoons from Florida.
The translocation, believed to have included many raccoons in the latent phase of rabies, touched off a 15-year series of raccoon rabies outbreaks that spread as far west as Ohio and as far north as Maine, New Hampshire, and Vermont before being stopped by deployments of Raboral, an oral rabies vaccine developed by Charles Rupprecht of the Wistar Institute.
As well as stopping the mid-Atlantic raccoon rabies pandemic, air drops of Raboral stopped a rabies outbreak among coyotes in Texas in 1998.
Raboral has been used ever since both to contain raccoon rabies outbreaks and to keep fox rabies outbreaks from crossing into the U.S. from the Canadian northeast.
Rupprecht later directed the CDC programs that helped to eradicate canine rabies from the U.S. by 2004.
The two most recent human deaths from canine rabies contracted within the U.S. were a seven-year-old girl, bitten by a rabid dog in Texas in June 1979, and a 13-year-old boy who was bitten by a rabid dog in Kansas in 1968.
“A sea of rabies” but canine rabies “has been eliminated”
Since 2004 all known canine rabies cases in the U.S. have occurred in “rescue” dogs imported from rabies-endemic nations.
“We don’t want to misconstrue that rabies has been eliminated, but dog rabies virus has been,” Rupprecht warned in 2004.
“Even though we still live in a sea of rabies and even though we have rabies viruses circulating among raccoons and foxes and bats,” Rupprecht emphasized, “the dog rabies virus, which is the most responsible for dog-to-dog transmission and which is still the greatest burden to humans, has been eliminated.”
Chennai case hit near the home of national Animal Birth Control program
India, struggling since 1911 to eradicate canine rabies through a combination of dog purges and post-exposure treatment of bite victims, at last began to make progress after chemical engineer Chinny Krishna, whose parents founded the Blue Cross of India in 1959, initiated the first pilot program to sterilize street dogs in Chennai in 1966, two years after Krishna succeeded to the Blue Cross of India presidency.
The Blue Cross of India extended the pilot “Animal Birth Control” program, ABC for short, to the whole of Chennai in 1996.
At that time the Chennai city government discontinued electrocuting impounded dogs, a practice introduced by the former British government of India in 1936, using equipment removed from pounds in England in 1925 after having been found to be inhumane.
The Animal Welfare Board of India recommended that ABC become national policy in 1997. ABC did at last become national policy, with partial federal funding, in 2001.
Verified human rabies deaths in India had by then dropped from tens of thousands per year to the low hundreds.
A decade later Mission Rabies, a program of World Veterinary Services, founded by British veterinarian Luke Gamble, began a concerted effort to eradicate the last canine rabies hotspots in India.
The combined efforts of ABC programs and Mission Rabies have been eminently successful.
“Pelted the dog with stones”
But the Royapuram rabid dog attacks represented a shocking setback right where ABC coupled with vaccination had been practiced longest, with apparently the best results.
The dog “bit 29 people within an hour before the locals pelted the dog with stones and then thrashed it to death,” the Chennai-based national newspaper and news website The Hindu reported.
“The dog bite victims included 10 schoolchildren and some elderly people who fell and hurt their heads in the impact. At least 24 of them suffered deep cuts due to the dog bite,” The Times of India added.
The Madras Veterinary College in Chennai confirmed from fluoroscopic examination of brain tissue samples that the dog was in fact rabid.
“We are vaccinating all dogs”
“The victims were admitted overnight to the Stanley Medical College & Hospital,” a government-operated facility, “and were given anti-rabies vaccine shots. They will have to return for four more shots,” The Hindu said.
Greater Chennai Corporation Commissioner J. Radhakrishnan told media that civic officials caught 52 dogs from the vicinity of the attacks, who are in quarantine for observation to detect rabid symptom..
Radhakrishnan pledged to do “a full-fledged dog census from November 27, 2023” until completed.
“We are vaccinating all dogs,” Radhakrishnan said. “We do 15,000-17,000 sterilizations every year. In Royapuram, we’re doing ring vaccination surrounding” the location of the attacks.
“Beating the dog to death is not the right approach”
The Royapuram incident was reportedly the first time a rabid dog had bitten anyone in Greater Chennai since 2020, and was the first time a rabid dog had attacked multiple people in Greater Chennai since 2016, when a rabid pack bit 16 people in Virugambakkam, about two miles north of the Blue Cross of India main campus in Guindy.
The rabid dog in Royapuram was reportedly the fifth found in Greater Chennai in 2023, the others having occurred in the Tiruvottiyur, Perungudi, and Madhavaram outlying suburbs.
Radhakrishnan anticipated that about 100,000 dogs would have to be vaccinated to prevent further rabid incidents.
“Beating the dog to death is not the right approach,” Radhakrishnan emphasized. “Even if it is a rabid dog, it is better to catch and observe it.”
Chennai Corporation Veterinary Officer J. Kamal Hussain said that the city logs about 30,000 non-rabid dog bites per year.
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