Public health impact of reemergence of rabies, New York.This report summarizes the spread of a raccoon raccoon, nocturnal New World mammal of the genus Procyon. The common raccoon of North America, Procyon lotor, also called coon, is found from S Canada to South America, except in parts of the Rocky Mts. and in deserts. rabies rabies (rā`bēz, ră`–) or hydrophobia (hī'drəfō`bēə), acute viral infection of the central nervous system in dogs, foxes, raccoons, skunks, bats, and other animals, and in epizootic ep·i·zo·ot·ic adj. Affecting a large number of animals at the same time within a particular region or geographic area. Used of a disease. ep into New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of in the 1990s, the species of animals affected, and human postexposure treatments (PET). A total of 57,008 specimens were submitted to the state laboratory from 1993 to 1998; 8,858 (16%) animals were confirmed rabid, with raccoons the most common species (75%). After exposure to 11,769 animals, 18,238 (45%) persons received PET, mostly because of contact with saliva saliva Thick, colourless fluid constantly present in the mouth, composed of water, mucus, proteins, mineral salts, and amylase, an enzyme that breaks down starches. One to two litres are produced daily by the salivary glands. or nervous tissue. We analyzed an·a·lyze tr.v. an·a·lyzed, an·a·lyz·ing, an·a·lyz·es 1. To examine methodically by separating into parts and studying their interrelations. 2. Chemistry To make a chemical analysis of. 3. expenditure reports to estimate the cost of rabies prevention activities. An estimated $13.9 million was spent in New York State to prevent rabies from 1993 to 1998. Traditional prevention methods such as vaccinating pets, avoiding wildlife, and verifying an animal's rabies status must be continued to reduce costly PET. To reduce rabid animals, exposures, and costs, oral vaccination vaccination, means of producing immunity against pathogens, such as viruses and bacteria, by the introduction of live, killed, or altered antigens that stimulate the body to produce antibodies against more dangerous forms. of wildlife should also be considered. ********** The incidence of human rabies is high in developing countries, and most cases of the illness occur in humans with untreated dog bites dog bite Public health The clamping of skin and subjacent soft tissues between the upper and lower mandible of a canine, which may cause infections, acting as a disease vector or even death. See Dog. (1,2). In developing countries, rabies control in domestic canids has shifted the source of rabies exposures for most humans and domestic animals to wild terrestrial animals Terrestrial animals are animals that live predominantly or entirely on land, as compared with aquatic animals, which live predominantly or entirely in the water (e.g., fish, lobsters, octopuses), or amphibians, which rely on a combination of aquatic and terrestrial habitats (e.g. . Reported animal rabies cases in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. have increased dramatically since 1990 in association with the raccoon rabies epizootic in the mid-Atlantic and northeastern states. Before 1990, rabies infections in New York were attributed to red fox and bat variants of the virus. After 1993, rabies testing Rabies testing is a test generally done on animals (predominantly wild animals) when a person has been bitten. Since the 1960's, the standard test for rabies has been Direct fluorescent antibody test (dFA test). indicated that the red fox variant variant /var·i·ant/ (var´e-ant) 1. something that differs in some characteristic from the class to which it belongs. 2. exhibiting such variation. var·i·ant adj. no longer existed in the state (3); instead, a raccoon rabies variant had moved into New York State from Pennsylvania in 1990. Nationwide, the number of reported rabies cases in animals increased from 6,972 in 1991 to 9,495 in 1993, but decreased to 8,224 in 1994, 8,509 in 1997, and 7,961 in 1998 (4-11). Wild animals WILD ANIMALS. Animals in a state of nature; animals ferae naturae. Vide Animals; Ferae naturae. accounted for 92% of animal rabies cases in the United States, with raccoons reported most frequently, followed by skunks, bats, and foxes. The number of human cases remained low in the same time period, ranging from one case in 1998 to six cases in 1994 (4-11). In 1991, New York State accounted for 14% of reported rabid animals in the United States; this proportion increased to 28% in 1993 (12,13). The exposure of humans and domestic animals to rabid animals has resulted in an estimated 16,000-39,000 persons per year receiving postexposure prophylaxis Postexposure prophylaxis (PEP) Any treatment given after exposure to a disease to try to prevent the disease from occurring. In the case of rabies, PEP involves a series of vaccines given to an individual who has been bitten by an unknown animal or one that is treatment (PET) in the United States (14). The estimated cost for human post-exposure treatment ranges from $1,039 to $4,447 per person (15). Including pet animal vaccinations, the total cost of treatment was recently estimated at $300 million per year in the United States (16). New York State has passed a legislative appropriation The designation by the government or an individual of the use to which a fund of money is to be applied. The selection and setting apart of privately owned land by the government for public use, such as a military reservation or public building. for rabies prevention and PET. Reimbursement Reimbursement Payment made to someone for out-of-pocket expenses has incurred. of PET costs not covered not covered Health care adjective Referring to a procedure, test or other health service to which a policy holder or insurance beneficiary is not entitled under the terms of the policy or payment system–eg, Medicare. Cf Covered. by third-party payers was first established more than 50 years ago, in response to concerns about potential human deaths from fox rabies in those who could not afford treatment. Since the New York State Department of Health (NYSDOH NYSDOH New York State Department of Health ) disburses these funds, this agency can provide accurate estimates of the cost of postexposure rabies treatments in the state. In addition, NYSDOH's active rabies laboratory conducts all diagnostic work in the state, excluding New York City New York City: see New York, city. New York City City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. , which has its own laboratory (although test result data from New York City are also reported). Initial analyses of rabies treatments for four New York counties in 1993 and 1994 have been previously published (13). In this study, we examine the reemergence of rabies in New York and summarize sum·ma·rize intr. & tr.v. sum·ma·rized, sum·ma·riz·ing, sum·ma·riz·es To make a summary or make a summary of. sum information on the spread of rabid animals, the type of animals involved, trends in human exposures to rabid animals, and the intervention strategies to reduce human exposures from 1993 to 1998. Materials and Methods In New York State, public health law requires health-care providers with knowledge of a person exposed to an animal suspected of having rabies infection to report the incident to the local health unit (LHU LHU Lock Haven University (Lock Haven, PA, USA) LHU Lord Help Us LHU Local Health Unit LHU Liverpool Hope University (UK) ). LHUs are required to have comprehensive rabies control protocols that provide 24-hour availability of county staff to manage possible exposures, including 10-day confinement con·fine·ment n. 1. The act of restricting or the state of being restricted in movement. 2. Lying-in. confinement and observation of apparently healthy dogs and cats responsible for exposures; collection, preparation, and submission of animal specimens to the rabies laboratory for prompt rabies examination; authorization The right or permission to use a system resource; the process of granting access. See access control. of human PET; and provision of pet vaccination clinics. Annually, LHUs must submit to NYSDOH a detailed expenditure report for state-reimbursed costs including PET, laboratory specimen A laboratory specimen is a sample of a species which is preserved and made available to Zoology students in educational institutions. The purpose is to educate the student about the structure, general appearance, various organs, and details related to the specimen's body. preparation, and pet vaccination clinics. We used fiscal year data (April-March) from 1993 to 1998 to estimate the overall cost of human PETs in New York. A rabies specimen SPECIMEN. A sample; a part of something by which the other may be known. 2. The act of congress of July 4, 1836, section 6, requires the inventor or discoverer of an invention or discovery to accompany his petition and specification for a patent with specimens history form accompanies each animal specimen submitted to the New York State Wadsworth Center rabies laboratory for testing. Using this form, we gathered information specific to the specimen regarding species, location of capture, nature of human and animal contacts, and rabies testing results. A rabies surveillance report form is completed by the LHU for each animal exposure that resulted in human postexposure treatment and for each rabid animal. These surveillance forms are forwarded to the NYSDOH Bureau of Communicable Disease communicable disease n. A disease that is transmitted through direct contact with an infected individual or indirectly through a vector. Also called contagious disease. Control for data entry and analysis. Data collected on these reports include animal species, location, type of exposure, and number of humans exposed to the suspected animal. We matched data from the surveillance reports with data from rabies laboratory specimen history reports. Positive test results with missing surveillance information were actively followed up with LHUs to assure the completeness of exposure and treatment data. The data from laboratory and human exposure reports have been computerized computerized adapted for analysis, storage and retrieval on a computer. computerized axial tomography see computed tomography. for the years 1993-1998 and are analyzed in this report. To map New York's counties and the year raccoon rabies was first confirmed in each county, we included data from 1991 to 1997. Results From 1993 to 1998, a total of 56,947 animal and 61 human specimens were submitted for rabies testing, with the highest number of tested animals in 1993 (11,896) and the lowest in 1995 (8,032) (Figure 1). The overall proportion of tested animal specimens with laboratory-confirmed rabies virus rabies virus n. A rather large, bullet-shaped virus of the genus Lyssavirus that causes rabies. was 16%, and the number of rabid animals declined from a high of 2,688 (23%) in 1993 to 1,097 (11%) in 1998. However, we did not observe a similar decline in the 18,238 humans who received PET during this period, with the highest number in 1997 (3,373) and the lowest in 1995 (2,422). [FIGURE 1 OMITTED] The geographic movement of raccoon variant of rabies is shown in Figure 2, which indicates when the variant was first confirmed in each county from 1991 to 1997. By 1998, only three counties reported no rabid raccoons or other animals infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. with the raccoon variant of rabies. Although the raccoon rabies variant continued to spread throughout the state in the 1990s, the annual number of raccoons testing positive for rabies decreased from 2,318 in 1993 to 691 in 1998. [FIGURE 2 OMITTED] From 1993 to 1998, a total of 18,071 animal rabies surveillance reports were received from local health departments (Figure 3). Of these, 8,437 (47%) were for exposures to animals not submitted for rabies testing. The annual number of surveillance reports without an animal submitted for rabies testing increased from 1,194 in 1993 to 1,714 in 1998. [FIGURE 3 OMITTED] A total of 8,858 rabies surveillance reports were received on animal specimens with laboratory-confirmed rabies (Figure 3), with 6,302 representing rabid animals in which no human exposure was reporter. Of the number of rabid animals associated with human exposures, the species most frequently involved were raccoons (65.2%), skunks (10.4%)., bats (7.2%), cats (6.5%), and foxes (5%) (Table 1). For some domestic species, a large proportion of the rabid animals were reported to have exposures resulting in human PET, such as goats (100%), horses (96%), cats (90%), dogs (87%), and cows (82%). High numbers of PETs (>10) for single incidents of rabid animals were documented for many animal species, including raccoons, bats, foxes, cats, cows, deer, dogs, horses, and ferrets. In 1996, 465 persons who attended a county fair received PET because of contact with one rabid goat. A total of 11,552 persons received PET for exposure to 8,762 animals with specimens unavailable for testing or not testable because of specimen condition (Table 2). In addition, 547 persons received PET for exposure to 451 animals that had negative rabies virus tests (Table 2). Cats, bats, and dogs each accounted for approximately 25% of the exposures requiring treatment when the suspect animal was unavailable for testing, with raccoons accounting for more than 10% of the exposures. Similarly, these species also accounted for most of the PETs when laboratory testing confirmed that the animal was not rabid, although more than 40% of the unnecessary treatments resulted from cat exposures. Across all categories of rabies status for the animal, most postexposure treatments were provided because of possible contact with saliva or nervous tissue (44.5%), followed by bite (34.9%) and scratch (5.8%) exposures (Table 3). When the animal tested positive for rabies, a larger proportion of the PETs (82.9%) were for saliva or nervous tissue contact, particularly from raccoons. In contrast, for the suspect or nonrabid animals, most of the PETs were for bite exposures (47.6% and 60%, respectively). Two fatal human rabies cases related to bat exposure occurred in New York in 1993 and 1995 (the 1995 case was in a Connecticut resident hospitalized in New York) resulting in treatment of 55 and 48 persons, respectively, who had contact with the cases either at home or in the hospital. Although bats represented only 4.6% of the rabid animals in New York, exposure to bats accounted for 25.8% of the PETs, with a total of 4,706 persons receiving PET after exposure to bats in the state. Fifty-one percent of the bat-related PETs were classified as "unknown" in regard to exposure, and 28% were provided because of reported contact with saliva or nervous tissue. The total expenditure for PETs, laboratory specimen preparation, and pet vaccination clinics increased in New York from $1.8 million in the 1993-1994 fiscal year to $2.9 million in the 1998-1999 fiscal year (Table 4). The estimated average annual statewide cost for the biologics and administration of the PETs was $1.8 million; the average cost per person for PET was $927, increasing from $769 in the 1993 fiscal year to $1,136 in the 1998 fiscal year. Discussion The public health impact of the reemergence of rabies in New York resulting from the spread of raccoon variant in the 1990s was profound in terms of the number of rabid animals diagnosed, humans exposed and treated, and PET costs. Despite the decreasing number of rabid animals during the study period, the increasing number of humans receiving treatment for rabies from 1993 to 1998 appeared to be a result of the high number of suspected rabid animals (untested) and the high number of reported bat exposures following publicity surrounding two bat rabies-related human deaths. The high proportion of PETs associated with exposures other than bites (9,165/18,238 [50%]) in our review indicates the degree of human fear about possible rabies and the difficulties in interpreting definitions of exposure (17,18). This concern is also indicated by the PET administered to 465 persons exposed to a rabid goat in 1996 and 547 persons exposed to animals that tested negative for rabies from 1993 to 1998. With 41% of 11,552 treated persons exposed to dogs and cats without testable specimens (because of specimen condition), efforts to find these pets to verify their rabies status may be helpful in reducing unnecessary treatments (19). The annual reviews and recommendations on animal rabies control from the National Association of State Public Health Veterinarians The National Association of State Public Health Veterinarians, or NASPHV, is a U.S. organization whose purpose is to draft uniform public health procedures involving animal-borne disease. It works in close cooperation with the Centers for Disease Control. (20) should be applied to reduce human exposures to rabid animals and unnecessary rabies PETs. A few studies suggest that >$1 billion per year has been spent recently to prevent rabies in the United States (14), with the vaccination of pet animals accounting for 82% of the expenditures (the cost associated with pet vaccination given by private providers was not available for our study). Our study estimated that $13.9 million was spent to prevent rabies in New York, where $10.7 million (77%) was used on PET from 1993 to 1998. The use of PET for 547 persons exposed to non-rabid animals supports the need for better education of healthcare providers to determine whether PET is really necessary pending laboratory test results and the need for public education to reduce exposure to rabid animals and minimize contact to exposed pets. Seventy-five percent (24/32) of the human rabies cases in the United States since 1990 have been attributed to bat variants (21-23). The two bat-variant deaths in New York exemplify ex·em·pli·fy tr.v. ex·em·pli·fied, ex·em·pli·fy·ing, ex·em·pli·fies 1. a. To illustrate by example: exemplify an argument. b. the new realization that human rabies may result from encounters with bats when bites are unreported or unrecognized. In July 1993, a child without a history of a known bite or other exposure to a suspected rabid animal died from rabies that was identified as a bat variant (24). In October 1995, a Connecticut resident without history of animal bites but possible exposure to a bat died from rabies in a N. Y. hospital and resulted in 48 state residents receiving PET (25). Bat exposures accounted for 25% of New York's PETs from 1993 to 1998, underscoring the importance of avoiding contact with bats and the need to test bats for rabies when human contact may have occurred (26). The persistence (1) In a CRT, the time a phosphor dot remains illuminated after being energized. Long-persistence phosphors reduce flicker, but generate ghost-like images that linger on screen for a fraction of a second. and spread of rabies in raccoons and domestic animal exposure to this variant continue to be an important issue for public health officials. The reemergence of wildlife rabies in areas like New York (after the fox variant had moved out of the state) as a result of the unimpeded unimpeded Adjective not stopped or disrupted by anything Adj. 1. unimpeded - not slowed or prevented; "a time of unimpeded growth"; "an unimpeded sweep of meadows and hills afforded a peaceful setting" northward north·ward adv. & adj. Toward, to, or in the north. n. A northern direction, point, or region. north spread of the raccoon variant into the state and increased recognition of the importance of bat variants has led to a large number of rabies cases both in domestic and wildlife species and a corresponding number of human rabies PETs. Traditional public health methods of surveillance, public and provider education to avoid exposure to potentially rabid animals, appropriate postexposure prophylaxis, and emphasis on verifying the negative rabies status of suspect animals to avoid unnecessary treatments will remain important methods for rabies control. However, the major impact of raccoon rabies in human exposure and treatments may also need to be addressed with new wildlife rabies control methods such as oral rabies vaccine rabies vaccine n. 1. A vaccine introduced by Pasteur as a method of treatment for the bite of a rabid animal, consisting of 23 daily injections of virus that are increased serially from noninfective doses to doses containing fully infective (27-29).
Table 1. Rabid animals by species, human exposure, and
postexposure treatment, New York, 1993-1998 (a)
No. (%) of rabid animals No. (range) (b) of
Animal without with humans receiving
species human exposure human exposure PET
Raccoon 4,983 (79.1) 1,666 (65.2) 2,944 (1-25)
Skunk 895 (14.2) 266 (10.4) 470 (1-8)
Bat 221 (3.5) 184 (7.2) 377 (1-12)
Fox 101 (1.6) 127 (5.0) 229 (1-10)
Cat 18 (0.3) 166 (6.5) 844 (1-36)
Cow 12 (0.8) 54 (2.1) 246 (1-30)
Woodchuck 44 (0.7) 21 (0.8) 32 (1-5)
Deer 14 (0.2) 10 (0.4) 42 (1-13)
Dog 3 (<0.1) 20 (0.8) 286 (1-37)
Horse 1 (<0.1) 22 (0.9) 139 (1-14)
Beaver 2 (<0.1) 4 (0.2) 9 (1-3)
Goat 0 4 (0.2) 476 (1-465)
Bobcat 0 3 (<0.1) 7 (1-4)
Coyote 1 (<0.1) 2 (<0.1) 2 (1)
Rabbit 1 (<0.1) 2 (<0.1) 12 (5-7)
Sheep 0 2 (<0.1) 7 (2-5)
Ferret 0 2 (<0.1) 16 (3-13)
Other (c) 6 (<0.1) 1 (<0.1) 1 (1)
Total 6,302 (100) 2,556 (100) 6,139 (1-465)
(a) PET, postexposure treatment.
(b) Range of number of PETs for a single exposure incident for a rabid
animal.
(c) Other species included one rabid opossum resulting in human PET,
three rabid opossums, one fisher, one pig, and one otter without
consequent human PET.
Table 2. Nonrabid or suspected rabid animals and the number of
humans receiving, postexposure treatment, by animal species, New
York, 1993-1998 (a)
No. (%) of No. (range (c)) No. (%) of
Animal suspected of humans nonrabid
species rabid animals (b) receiving PET animals
Cat 2,373 (27.1) 2,620 (1-11) 183 (40.6)
Bat 2,289 (26.1) 4,181 (1-40) 116 (25.7)
Dog 2,000 (22.8) 2,067 (1-15) 49 (10.9)
Raccoon 952 (10.9) 1,247 (1-21) 51 (11.3)
Skunk 160 (1.8) 211 (1-6) 10 (2.2)
Fox 104 (1.2) 125 (1-3) 6 (1.3)
Woodchuck 92 (1.1) 99 (1-3) 9 (2.0)
Squirrel 73 (0.8) 75 (1-2) 6 (1.3)
Opossum 48 (0.5) 51 (1-2) 2 (0.4)
Deer 26 (0.3) 32 (1-4) 3 (0.7)
Muskrat 15 (0.2) 15 (1) 5 (1.1)
Cow 18 (0.2) 37 (1-2) 1 (0.2)
Rabbit 17 (0.2) 18 (1-2) 1 (0.2)
Rat 16 (0.2) 16 (1) 2 (0.4)
Ferret 12 (0.1) 16 (1-3) 3 (0.7)
Chipmunk 12 (0.2) 13 (1-2) 1 (0.2)
Other 104 (1.2) 133 (1-7) 3 (1.2)
Unknown 450 (5.1) 596 (1-7) 0
Total 8762 (100) 11552 (1-40) 451 (100)
No. (range (c))
Animal of humans
species receiving PET
Cat 220 (1-5)
Bat 148 (1-4)
Dog 53 (1-3)
Raccoon 67 (1-5)
Skunk 12 (1-3)
Fox 6 (1)
Woodchuck 9 (1)
Squirrel 6 (1)
Opossum 1 (1)
Deer 5 (1-2)
Muskrat 6 (1-2)
Cow 1 (1)
Rabbit 1 (1)
Rat 2 (1)
Ferret 3 (1)
Chipmunk 1 (1)
Other 5 (1)
Unknown 0
Total 547 (1-5)
(a) PET; postexposure treatment.
(b) Rabies status of animals could not be determined by testing (animal
not submitted for rabies testing or specimen not testable because of
specimen condition).
(c) Range of number of PETs for a single exposure incident to a
potentially rabid animal.
Table 3. Number of humans receiving postexposure treatment, by animal
status and type of exposure, New York, 1993-1998
No. (%) of humans receiving PET (a)
Type of Suspect rabid Nonrabid
exposure Rabid animal animal (b) animal (c) Total
Bite 538 (0.8) 5,503 (47.6) 328 (60.0) 6,369 (34.9)
Scratch 224 (3.6) 773 (6.7) 56 (10.2) 1,053 (5.8)
Contact with
saliva 5,090 (82.9) 2,891 (25.0) 131 (23.9) 8,112 (44.5)
Unknown
exposure 287 (4.8) 2,385 (20.6) 32 (5.9) 2,704 (14.8)
Total 6,139 (10) 11,552 (100) 547 (100) 18,238 (100)
(a) PET, postexposure treatment.
(b) PETs due to exposure to animals not submitted for rabies testing or
specimen was not testable because of specimen condition.
(c) PETs due to exposure to animals that tested negative for rabies.
Table 4. Rabies expenditures for postexposure treatments, laboratory
specimen preparation, and pet vaccination clinics, by fiscal year, (a)
New York, 1993-1998
Type of expenditure 1993-1994 1994-1995 1995-1996
PET (b) $1,222,125 $1,919,606 $1,257,621
State $669,564 $1,006,471 $679,902
Local $138,415 $170,284 $116,368
Other $414,146 $742,851 $461,351
Average per person (c) $769 $822 $824
Specimens (d) $265,037 $256,518 $251,796
State $200,702 $234,097 $231,917
Local $64,335 $22,421 $19,879
Clinics (e) $271,062 $328,532 $294,251
State $84,671 $167,763 $139,456
Local $186,391 $160,769 $154,795
Type of expenditure 1996-1997 1997-1998 1998-1999
PET (b) $1,835,058 $2,092,572 $2,347,555
State $311,356 $974,079 $959,362
Local $787,500 $84,630 $188,723
Other $736,202 $1,033,863 $1,199,470
Average per person (c) $944 $1,020 $1,136
Specimens (d) $246,794 $276,219 $270,184
State $226,224 $254,888 $250,762
Local $20,570 $21,331 $19,422
Clinics (e) $289,729 $244,254 $262,351
State $117,840 $110,145 $118,002
Local $171,889 $134,109 $144,349
(a) Fiscal year is April--March.
(b) PET, postexposure treatment; PET costs incurred by the New York
State Department of Health ([less than or equal to] $1,000 per PET),
the local health departments, and others (third-party payers).
(c) Calculated by dividing total treatment costs by number of persons
treated.
(d) Laboratory specimen preparation costs incurred by the New York
State Department of Health (limits of $60 per small animal specimen and
$75 per livestock specimen) and the local health departments, for
animal euthanasia, head removal, and specimen shipment.
(e) Pet vaccination clinic costs incurred by the New York State
Department of Health (limits of five clinics per year and $1,000 per
clinic) and local health departments.
Acknowledgments We thank Amy Schrom, Stephanie Anderson, and staff of the Statistical Unit for data entry and coordination, and Lgbal Poshni and Richard Raczkowski for specimen processing and data management. Ms. Chang is director of the statistical unit, Division of Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , New York State Department of Health. Her research focuses on the epidemiology of infectious diseases infectious diseases: see communicable diseases. . References (1.) Orihuela TA, Solano VJ. Rabies in the state of Morelos, Mexico. Trop Anim Health Prod 1995;27:164-6. (2.) Hemachudha T. 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Mass human exposure to rabies in New Hampshire New Hampshire, one of the New England states of the NE United States. It is bordered by Massachusetts (S), Vermont, with the Connecticut R. forming the boundary (W), the Canadian province of Quebec (NW), and Maine and a short strip of the Atlantic Ocean (E). : exposure, treatment, and cost. Am J Public Health 1996;86:1149-51. (17.) Afshar A. A review of non-bite transmission of rabies virus infection. Br Vet J 1979;135:142-8. (18.) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Human rabies prevention--United States, 1999. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, Morb Mortal mortal /mor·tal/ (mor´t'l) 1. subject to death, or destined to die. 2. fatal. mor·tal adj. 1. Liable or subject to death. 2. Wkly Rep 1999;48:1-21. (19.) Moran Moran equitable councillor to King Feredach. [Irish Hist.: Brewer Dictionary, 728] See : Justice GJ, Talan DV, Mower mower, farm machine used for cutting grasses and other hay crops. Mowers, drawn by or attached to tractors, or self-propelled, have superseded scythes. The mower is essentially an adaptation of the much earlier reaper. The first commercial mower was patented in 1847. W, Newdov M, Ong S, Nakase JY, et al. Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. JAMA JAMA abbr. Journal of the American Medical Association 2000;284:1001-7. (20.) Centers for Disease Control and Prevention. Compendium com·pen·di·um n. pl. com·pen·di·ums or com·pen·di·a 1. A short, complete summary; an abstract. 2. A list or collection of various items. of animal rabies prevention and control, 2001. MMWR Morb Mortal Wkly Rep 2001 ;50:1-9. (21.) Fishbein DB, Robinson LE. Rabies. N Engl J Med 1993;329:1632-8. (22.) Centers for Disease Control and Prevention. Human rabies--Alabama, Tennessee, and Texas, 1994. MMWR Morb Mortal Wkly Rep 1995;44:269-72. (23.) Centers for Disease Control and Prevention. Human rabies--California, Georgia, Minnesota, New York, and Wisconsin, 2000. MMWR Morb Mortal Wkly Rep 2000;49:1111-5. (24.) Centers for Disease Control and Prevention. Human rabies--New York, 1993. MMWR Morb Mortal Wkly Rep 1993;42:799-806. (25.) Centers for Disease Control and Prevention. Human rabies--Connecticut, 1995. MMWR Morb Mortal Wkly Rep 1996;45:207-9. (26.) Debbie JG, Trimarchi CV. Prophylaxis prophylaxis (prō'fĭlăk`sĭs), measures designed to prevent the occurrence of disease or its dissemination. Some examples of prophylaxis are immunization against serious diseases such as smallpox or diphtheria; quarantine to confine for suspected exposure to bat rabies. Lancet lancet /lan·cet/ (lan´set) a small, pointed, two-edged surgical knife. lan·cet n. 1997;350:1790-1. (27.) Robbins AH, Borden MD, Windmiller BS, Niezgoda M, Marcus LC, O'Brien SM, et al. Prevention of the spread of rabies to wildlife by oral vaccination of raccoons in Massachusetts. J Am Vet Med Assoc 1998;213:1407-12. (28.) Roscoe DE, Holste WC, Sorhage FE, Campbell C, Niezgoda M, Buchannan R, et al. Efficacy of an oral vaccinia-rabies glycoprotein glycoprotein (glī'kōprō`tēn), organic compound composed of both a protein and a carbohydrate joined together in covalent chemical linkage. recombinant recombinant /re·com·bi·nant/ (re-kom´bi-nant) 1. the new entity (e.g., gene, protein, cell, individual) that results from genetic recombination. 2. pertaining or relating to such an entity. See also under DNA. vaccine vaccine Preparation containing either killed or weakened live microorganisms or their toxins, introduced by mouth, by injection, or by nasal spray to stimulate production of antibodies against an infectious agent. in controlling epidemic raccoon rabies in New Jersey. J Wildl Dis 1998;34:752-63. (29.) Hanlon CA, Rupprecht CE. The reemergence of rabies. In: Scheld WM, Armstrong D, Hughes JB, editors. Emerg Intact 1. Washington: American Society for Microbiology The American Society for Microbiology (ASM) is a scientific organization, based in the United States although with over 43,000 members throughout the world. It is the largest single life science professional organization and its members include those whose interests encompass basic 1998. p. 59-80. Address for correspondence: Hwa-Gan Chang, New York State Department of Health, Coming Tower Building Room 1143, Empire State Plaza The Governor Nelson A. Rockefeller Empire State Plaza (commonly known as simply the Empire State Plaza and less formally as The South Mall) is a complex of several state government buildings in downtown Albany, New York. , Albany, NY 12237, USA; fax: 518-474-4880; e-mail: hgc04@health.state.ny.us Hwa-Gan H. Chang, * Millicent Eidson, * ([dagger]) Candace Noonan-Toly, * Charles V Charles V, duke of Lorraine Charles V (Charles Leopold), 1643–90, duke of Lorraine; nephew of Duke Charles IV. Deprived of the rights of succession to the duchy, he was forced to leave France and entered the service of the Holy Roman emperor. . Trimarchi, * Robert Rudd, * Barbara J. Wallace, * ([dagger]) Perry F. Smith, * ([dagger]) and Dale L. Morse * ([dagger]) * New York State Department of Health, Albany, New York For other uses, see Albany. Albany is the capital of the State of New York and the county seat of Albany County. Albany lies 136 miles (219 km) north of New York City, and slightly to the south of the juncture of the Mohawk and Hudson Rivers. , USA; and ([dagger]) School of Public Health, University at Albany, Albany, New York, USA |
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