1...a suspect rabid animal is at large
Suspected rabid animals include raccoons, skunks, foxes, bats and any other mammal which is exhibiting any of the signs of rabies described above.

If there is a significant exposure to a human from a wild or stray animal and that animal can be unequivocally identified by the person, the appropriate police department/animal control officer (ACO) should be contacted to catch the animal and hold it for rabies testing. The Westchester County Department of Health should be called immediately if such an incident should occur.

2...bitten by or exposed to rabies suspect animals
A person bitten or scratched by an animal should immediately wash the wound vigorously with soap and water and seek medical attention. If the biting animal is a stray or a wild animal the local police department or a nuisance control person should be called for help in capturing the animal. An attempt should be made to capture the animal, without damaging the head.

3...reporting animal bites and other exposures (including scratches)
All animal bites are required by law to be reported to the local or county health officer as soon as possible (NYS Sanitary Code Chapter 1, and Westchester County Sanitary Code Article 17). Every physician must report to the county health department the name, address, and telephone number of any person under his or her care or observation who has been bitten by or exposed to any animal that is rabid or suspected of having rabies. Every physician who provides post-exposure rabies treatment must report the initiation of such treatment, as well as all pertinent facts relative to the treatment and bite or exposure, to the county health department.

If no physician is in attendance, the person that was bitten or exposed, or the parent or legal guardian of a minor who was bitten or exposed or, if the person is incapacitated, the person caring for the victim must report the person's name, age, address and telephone number to the county health department.

Health care providers and the public are urged to report any bites or other exposures to the Westchester County Department of Health as soon as possible by calling 914-813-5000 (24 hours/day, 7 days/week).

4...assessing an animal bite incident
The ultimate decision as to the necessity for post-exposure treatment rests with the attending physician and the patient or the patient's family. A thorough assessment of the circumstances will be done for every animal bite, or potential exposure, incident received.

Medical consultation, during business hours, is provided by the public health nurses in the Disease Control in conjunction with the Deputy Commissioner (MD) for Disease Control. In the evening and on weekends, the physician on-call provides the medical consultation to patients, private physicians and emergency departments.

Although each animal bite incident requires individual evaluation, the following general principles apply:

A bite or scratch from bats, large rodents (woodchuck) and carnivores (raccoon, fox, skunk) constitutes an exposure to rabies and post-exposure rabies treatment must be administered if the animal is not available for rabies diagnosis.

Small rodents, such as squirrels, hamsters, guinea pigs, gerbils, chipmunks, rats, mice, and rabbits and hares, are almost never infected with rabies and do not normally serve as a reservoir or vector for transmission of rabies to humans in nature. Very rarely, an "unprovoked" aggressive attack by one of these animals may constitute a risk for rabies transmission.

Transmission of rabies by indirect exposure to potentially infectious materials when humans handle pets immediately after the pet had a fight with a rabid or potentially rabid animal, has not been documented as a route of rabies transmission but may warrant rabies post-exposure treatment under select circumstances.

5...a dog, cat or ferret bites or scratches
A bite or scratch from a dog, cat, or ferret should be thoroughly investigated. A bite or scratch from a stray dog, cat or ferret which is not available for daily observation or rabies testing may constitute an exposure to rabies and post-exposure rabies treatment should be considered.

The victim or the victim's guardian should contact the local animal control officer (police department or animal shelter) so that an attempt may be made, by the animal control officer, to capture the animal. The dog or cat may be held at an animal shelter for the 10-day confinement period. The Westchester County Department of Health must be immediately notified of the incident.

If a bite or scratch by an owned dog, cat or ferret occurs, the owner of the offending animal must provide proof of vaccination against rabies. All offending animals, regardless of vaccination status, will be confined for 10 days and observed daily for signs of rabies. The owner is to confine the animal in the home or at a veterinarian's office. At the end of the confinement period the owner must provide the Westchester County Department of Health with a completed biting/scratching animal affidavit, including information on the health and rabies vaccination history of the animal. If the animal is unvaccinated the owner must have the animal vaccinated immediately after the 10-day confinement is completed and submit a completed biting/scratching animal affidavit to the Westchester County Department of Health. If the necessary information is not obtained by the department in a timely fashion, either through letters or phone calls, a site visit will be conducted to determine the status of the biting animal.

If the animal is still healthy after 10 days, there is no danger of rabies from that bite.

If the animal dies or shows signs of rabies during the 10-day period the owner must immediately call the Westchester County Department of Health. In the event that this occurs the animal must be transported to a county veterinarian where the animal will be sacrificed and the specimen for rabies testing prepared at the county's expense. The specimen will then be transported to the Westchester County Department of Health at 145 Huguenot St., New Rochelle New York. If it is after- hours or on a weekend or holiday the owner must call the Westchester County Department of Health's Emergency number (914-813-5000) and speak to the administrator on-call to make the necessary arrangements for transport of the animal to the New York State Rabies Lab, if it is deemed necessary.

6...a wild animal bites or scratches
If the animal is a wild animal, i.e. raccoon, skunk, fox, bat, coyote etc., the victim or the victim's guardian is advised to contact the local animal control officer (police department) or a nuisance wildlife trapper so that an attempt may be made to capture and destroy the animal. In the event that this occurs the animal is transported to a veterinarian where a specimen for rabies testing will be prepared. If the animal is brought to a veterinarian under contract with the county, and with PRIOR approval from the Westchester County Department of Health, the county will bear the expense. The specimen will then be transported to the Westchester County Department of Health 145 Huguenot St., New Rochelle New York. If it is after-hours or on a weekend or holiday the complainant must call the Westchester County Department of Health's Emergency number (914-813-5000) and speak to the administrator on-call to make the necessary arrangements for transport of the animal to the New York State Rabies Lab, if it is deemed necessary. Otherwise the specimen will be stored under refrigeration at an appropriate facility until picked up by the department on the next business day.

7...rabies post-exposure treatment is necessary
If the biting animal is an exotic mammalian pet the animal should be sacrificed and prepared for rabies testing. If upon review of the history of the animal in question with the NYS public health veterinarian this is not deemed necessary the Department of Health will notify the animal owner and the victim.

If the biting animal is a bat, raccoon, fox, skunk or other wild animal and the animal is unavailable for testing or it is a bite considered a high risk for rabies transmission, rabies post-exposure treatment should begin immediately. If the animal is available for testing, not considered high risk for rabies transmission and testing can be arranged in a timely fashion, initiation of rabies post-exposure treatment may be delayed pending test results.

If the bite is from some other animal the need for rabies post-exposure vaccination is to be determined by the nature of exposure, behavior of animal, and the species involved. This decision is made by the physician on-call or the public health nurses. If the Westchester County Department of Health recommends that rabies treatment be administered, the biologicals will be provided to an individual without requiring payment at the time. A claim to the individual's insurance company will be submitted and the department will pay for the cost of vaccine administration that is not covered by the individual's health insurance.

8..small rodents (mice, chipmunks, squirrels, etc.), rabbits, hares bite or scratch
Bites from small rodents, rabbits and hares, do not routinely indicate either rabies treatment to the victim or rabies testing of the animal in question; unless the circumstances are suspect. There have been very rare instances when rabbits and squirrels have tested positive for rabies. Bite victims will be called to determine if the circumstances of the bite are suspect. If the circumstances are suspect every attempt should be made to test the biting animal for rabies. If this is not possible recommendations will be made regarding the need for rabies post-exposure treatment.

9...domestic animals are exposed to rabies
The Animal Vector Unit is responsible for monitoring all domestic animals exposed to known or suspected rabid animals. This office is to be notified of all such incidents.

Domestic animals which are up-to-date on rabies vaccinations, in contact with a rabid or suspected rabid animal which is not available for testing, must receive a rabies booster injection within 5 days of the exposure. Owners of exposed domestic animals must provide proof of previous and booster vaccinations of the animal in question.

Unvaccinated animals or animals not up-to-date on rabies vaccinations, including livestock, in contact with a rabid or suspected rabid animal which is not available for testing must either be destroyed or quarantined for 6 months. Department of Health staff will make an initial inspection of the area where the animal is to be quarantined to ensure that it meets the requirements. The initial inspection will be conducted within 1 week of the department being notified of the incident. At the time of the initial inspection the animal owner will be given:

• A copy of the Westchester County Sanitary Code Article XVII and,
• The 6 month quarantine protocol.

The animal owner will also be required to sign the 6 month quarantine notification/agreement.

If the pet owner does not properly confine the animal, either voluntarily or by commissioner's order, arrangements for confinement at an appropriate facility will be made by the Animal Vector Unit. Such confinement is at the expense of the animal owner.

10...domestic animals are rabies suspect
Veterinarians, their staff, and animal owners in rabies enzootic areas must suspect rabies when animals become ill or demonstrate abnormal behavior. The animals should be isolated immediately. Protective rubber gloves should be worn when handling and medicating sick animals, especially animals suspected of choking, as this is frequently an early sign of rabies. A 10% solution of household bleach in water may be used to clean contaminated surfaces.

Veterinarians, veterinary technicians, nuisance wildlife trappers, animal control officers, animal shelter employees and others in intimate contact with animals in rabies enzootic areas should receive rabies pre-exposure immunization. Care must be taken while handling, treating and during necropsy of suspected rabid animals. Protective clothing should include rubber gloves, surgical mask and face shield or other eye protection.

11...wild animals are rabies suspect
Wild animals which are behaving abnormally, paralytic, vicious or injured should not be handled. Such animals should be reported to the local police department or if on county property the county police. Most police departments will send an officer to destroy the animal if it is deemed necessary. If the police will not respond or if the situation is only one of a nuisance animal then a New York State Department of Environmental Conservation licensed/registered nuisance wildlife trapper should be called. Every attempt should be made to test the animal if it has come in contact with a person or pet (regardless of the pet's vaccination status).

All bats, raccoons, and skunks in the county are considered positive for rabies unless proven otherwise through rabies testing at the NYS Rabies Lab. If a bat is found in a home and it cannot be determined how long the bat has been there or if there is a possibility that people were sleeping while the bat was in the house, the bat must be tested for rabies. If there is any possibility, no matter how remote, that a person might have had contact with a bat, the bat must be tested for rabies. It is imperative that the suspect animal be tested to avoid a 6 month quarantine for unvaccinated domestic animals and possible rabies treatment of exposed individuals.

If there has been no contact between the suspect animal and a person or pet the carcass may be disposed of. A carcass must be disposed of in the following manner: It must be put in a double plastic bag. The person doing this should wear gloves or use a large shovel and use the plastic bag as a barrier. All measures must be taken to avoid direct contact between the carcass and the person. The carcass must then either be incinerated or buried. If buried it must be three feet below the surface and 250 feet from any water source (i.e. pond, well, stream, etc.).

Tools, cages and other surfaces potentially contaminated with saliva, nervous tissue or blood can be disinfected with a 10% solution of household bleach in water.

12...pre-exposure immunization is indicated
Human diploid cell vaccine (HDCV) produced by the Merieux Institute has been used extensively for pre-exposure immunization in a regimen of three 1.0 ml doses intramuscularly (IM). The three doses are given one each on days 0, 7 and 21 or 28.

It is strongly recommended that those individuals with frequent exposure to wild animals (veterinarians, animal control officers, animal shelter employees, wildlife workers, etc.) receive pre-exposure immunization. Such persons may receive pre-exposure vaccination from their own physician.

Pre-exposure immunization of immunosuppressed persons is not recommended. The vaccine is not contraindicated in pregnant women exposed to a rabid animal. Chloroquine phosphate (administered for malaria chemoprophylaxis) and possibly other factors may interfere with antibody response to HDCV. An individual planning visits for one month or more to countries where canine rabies is endemic should complete the pre-exposure rabies immunization procedure at least one month prior to initiation of chloroquine prophylaxis. If chloroquine is already being taken, the 1.0 ml regimen on days 0, 7 and 21 or 28 should be utilized.

Hypersensitivity in individuals receiving booster doses of HDCV has occurred in up to 6% of those previously immunized and has included symptoms of generalized urticaria, arthralgia, arthritis, angioedema, nausea, vomiting, fever and malaise. Rarely have the illnesses been life threatening and no residual neuroparalytic sequelae have resulted.

If an individual's occupation is likely to lead to an inapparent exposure, a booster or serological evaluation should be considered every 2 years. Empirical data indicate, however, that should a previously immunized individual be exposed, two IM doses of HDCV will provide adequate antibody response even though several years have elapsed.

13...post-exposure treatment is necessary
The Human Diploid Cell Rabies Vaccine (HDCV) and Human Rabies Immune Globulin (HRIG) are stocked by the Westchester County Department of Health at the department's main office in New Rochelle and in local hospitals. These rabies biologicals may only be released with the approval of the Deputy Commissioner, of Disease Control or her staff (8:30 am to 4:30 pm, Monday through Friday) or the physician on-call after hours, weekends and holidays. The FDA has recently licensed a new chick embryo vaccine, Rabies Adsorbed, which may be ordered for those individuals who are allergic to the HDCV.

For rabies post-exposure treatment, persons who have had three 1.0 ml IM or three 0.1 ml ID doses of HDCV should receive two 1.0 ml IM doses, one on each of days 0 and 3. This also applies to individuals who have been treated previously with serum and > 3 doses of vaccine following an exposure.

Recommendations for persons potentially exposed to rabies who have not had pre-exposure immunization are: A single dose of HRIG based on weight (20 international units/kg or 9 I.U./lb.) and five 1.0 ml doses of HDCV - one each on days 0, 3, 7, 14 and 28 given IM. If anatomically feasible, the full dose of HRIG should be thoroughly infiltrated in the area around and into the wound(s). Any remaining HRIG should be given IM at a different location from the administration of the first dose of HDCV. The vaccine is administered on the lateral aspect of the upper arm. It should not be administered in the gluteal region due to decreased efficacy when given at this site.

All patient's receiving post-exposure treatment are case managed by a public health nurse to ensure that appropriate treatment is received. Prior to release of vaccine, the plan of treatment is reviewed with the patient's medical provider. This review includes the medication, route and site of administration, dose, and schedule. The of Disease Control follows-up with the healthcare provider and/or the patient to ensure that the immunization series is completed.

In the event the Westchester County Department of Health does not feel rabies post-exposure treatment is indicated, but the attending physician or client still wishes to receive post-exposure treatment, the following options are available:

• If a hospital maintains a supply of HRIG and rabies vaccine independent of that provided by the Westchester County Department of Health, this can be used at the hospital's or physician's discretion with any arrangements for reimbursement to be made directly between the involved parties.

• Physicians may order HRIG and rabies vaccine directly from the manufacturer, with submission of insurance claims or other arrangements for reimbursement to be made directly between the physician and patient as for any other situation. 

If the Westchester County Department of Health does not feel rabies post- exposure treatment is indicated, there should generally be no need for emergency initiation of treatment. Treatment can thus be initiated following receipt of HRIG and vaccine by a physician or hospital.

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