APPENDIX 8 ANIMAL BITE PROTOCOL Proposed Changes to
APPENDIX 8. ANIMAL BITE PROTOCOL Proposed Changes to the Animal Bite Protocol How to deal with vaccination status, rabies suspects and bites in a CART Shelter Burlington County CART biosecurity protocol revision subcommittee: Elaine Sullivan, Director Burlington Co. CART Linda Frese, Principal Rabies Control Technician, NJ Dept. of Health Leslie Seraphin, DVM, MPH, Adjunct Veterinarian Burlington Co. CART; District Epidemiology Officer, USDA APHIS Veterinary Services
Current bite protocol �APPENDIX 8 Animal Bite Protocol �Covers animal bites to humans �Really only covers dog bites to humans (maybe cats) �What about animal to animal bites? �Is the reporting the same? �Any restrictions on the bitten animal? �What if the biting animal is incubating (and contagious) rabies but not yet showing signs? �What should CART personnel consider as proof of valid rabies vaccination?
Burlington County CART & the bite protocol �Add more specifics on animal rabies vaccination and what is proof of a valid vaccination �Add more specifics on valid human rabies vaccination in a bite situation �Increase biosecurity when handling animals of unknown vaccination status in a CART shelter �Develop SOP for animal to animal bites �Part 1. Animal to human bites �Part 2. Animal to animal bites �Format for different types of learners – written SOP, reference table, flow chart
Animal Bite Protocol • Take all bites seriously • Internal damage can be worse than what the wound appears from the outside
Appendix 8 Animal Bite Protocol Part 1. Animal to human bites 1. Animal bites must be reported to the Shelter Manager immediately. The Shelter Manager will report the bite to the local Health Department and Animal Control Officer (ACO) as soon as possible. By NJ statute, the bite must be reported within 12 hours of the occurrence.
Outside assistance The Shelter Manager in conjunction with Medical Reserve Corps or other on site first aid personnel will determine if outside assistance (i. e. an ambulance, emergency squad, etc. ) will be deployed to the shelter to assist the bite victim. A listing of local Health Departments in NJ: http: //www. state. nj. us/health/lh/directory/lhdselectcounty. shtml
Shelter Manager Actions Notify shelter manager also if animal shows signs of illness/rabies
Immediate actions a. Depending on the size and severity of the wound, the bite victim should be told to immediately wash the wound with soap and water. Regardless of apparent wound severity, the bite victim should be told to have the wound examined at the nearest hospital, doctor’s office, urgent care facility, or first aid facility.
Animal bite concerns �Damage to muscles, tendons, joints, internal organs, nerves, internal bleeding �Tetanus �Rabies �Bacterial infection �Cat scratch fever �Teeth can act like a needle, injecting bacteria into the wound.
Immediate animal actions 3. The animal should be immediately crated after the bite incident. The crate and animal should be placed in the Aggressive Animal Area designated at the shelter. Concern – at this point, if the biting animal is a mammal, the rabies vaccination status of the animal has not been determined. What if it is incubating rabies? Shedding virus?
Rabies signs �Rabies can affect ANY mammal �Furious rabies signs: �Classical “mad dog” syndrome �Alert, anxious facial expression �Dilated pupils �Noise may invite attack �Attack any moving object We recommend adding rabies signs to the bite protocol
Rabies signs �Paralytic or “Dumb” rabies signs: �Depression �Salivation and inability to swallow (hydrophobia) �Dropping of the lower jaw �Paralysis or weakness of legs Rabies virus can be shed in saliva 3 to 6 days before an infected animal shows clinical signs of disease
Immediate housing of the biting animal �Rabies can be transmitted by a bite, by saliva entering a wound, by saliva contacting a mucous membrane �Keep the biting animal’s saliva from reaching other animals and people �Physical barriers remind shelter workers there is something “different” about this aggressive animal
3. The animal should be immediately caged…Aggressive animal area. . . at the shelter If the animal is a mammal, as the rabies vaccination status has not yet been verified, keep the animal isolated from other animals. Prevent possible animal to animal contact via the biting animal’s saliva (such as drool flung during head shaking) until additional information on the animal can be obtained. This can be done by a sold wall, tarp, or leaving at least 15 feet between the biting animal’s crate and other animal crates. When using a tarp, leave the crate door end of the crate uncovered. Face the crate door away from other animals in the Aggressive Animal area. Be mindful of ambient temperature conditions when covering the crate. Note: Rabies virus can be shed in saliva 3 to 6 days before an infected animal shows clinical signs of disease.
Isolating the biting animal
Bites to humans - Tagging the aggressive animal’s crate/cage 4. The crate of the animal should be clearly tagged and information placed in the animal’s paperwork as soon as the incident is noted or suspected. a. Tag the crate: a. b. “This crate contains an animal that has been involved in a bite. ” Write the time and date the bite occurred on the tag.
Information for the animal’s paperwork b. Put the following information in the animal’s paperwork �The date and time of the bite �The personal identification of the bitten person including: �Permanent address and contact information �Current location and contact information �Emergency contact names (e. g. friends, relatives) and phone numbers �If the biting animal is a mammal, determine the rabies vaccination status of the person bitten including date of last pre-exposure vaccination and date of last rabies titer showing adequate protection
Information for the animal’s paperwork cont’d �Identify any person who observed the bite and get his/her account of the incident and contact information. �Notify the animal’s owner of the bite incident and detail the time/date of the notification of the owner �Note any special circumstances associated with the bite.
Notice of Bite and Confinement 5) For all animal bites, fill out the Notice of Bite and Confinement Form up to the information regarding the confinement. Although this form will be completed by the local Health Department, gathering the information as soon as possible is critical in a CART sheltering situation. Place the form in the biting animal’s records for future reference. Write “DRAFT” on the top corner of the form to distinguish this from the official confinement form issued by the local Health Department.
Notice of Bite & Confinement form DRAFT
Bite protocol step 6 6. If the biting animal is a mammal and displaying clinical signs of rabies, put the animal in entry controlled, strict isolation (solid wall, only animal in the room is best). Contact the Shelter Manager and Shelter Veterinarian immediately. The animal must be examined by a veterinarian and evaluated for rabies. The Shelter Manager or Shelter Veterinarian will contact the local Health Department immediately regarding any mammal suspected of having clinical signs consistent with rabies. (for reference, clinical signs of rabies are listed after this section)
Step 6 –report to local HD �No changes to this section
Step 7 Local HD actions 7. If the animal is a cat, dog or ferret, the local health department staff will usually order the animal to be confined and observed for clinical signs of rabies for 10 days (observation site will be determined by the local health department). a. If there is no rabies vaccination history, the animal should NOT be vaccinated 1 until after the 10 -day observation period. 1 Reference to rabies vaccination applies only to species listed on the vaccine insert. Rabies vaccination must be used only according to the manufacturer recommendations. For example, rabies vaccine is usually not listed for use in pigs (including pot bellied pigs).
Local HD actions – other animals b. If the animal is not a dog, cat or ferret, the local Health Department will investigate further to determine what actions are needed as the viral shedding period is undetermined for most mammals.
Local HD actions section cont’d The following information applies only to mammals b. Housing of the biting animals (when no clinical rabies signs are present)at the CART shelter (i. e. if the animal is not relocated to a permanent shelter or confinement area by the local Health Department) 1. If there is no rabies vaccination history, the animal should be housed in the aggressive animal area, isolated from other animals by a solid wall, tarp, or at least 15 feet (as in #3, above) during the 10 day observation period.
Local HD – housing a mammal which has bitten a human 2. If there is a history and documentation of current, valid rabies vaccination 1 , the animal may be housed as an aggressive animal with appropriate tag on the cage/crate.
Documentation of rabies vaccination may be: �Current rabies vaccination certificate which matches the animal and is issued by a veterinarian or municipal rabies vaccination clinic �Medical records from a veterinary clinic documenting rabies vaccination date, vaccine used, and animal information �Vaccine booklet from a veterinary clinic noting the rabies vaccination �Current rabies vaccination tag on the animal’s collar �Current municipal license tag on the animal’s collar
Example of vaccination certificate matching the animal
Other example proofs of rabies vaccination
Rabies tag on collar – vaccine validity In general for dogs �~ 16 weeks 1 st rabies vaccination. �All 1 st rabies vaccines are good for 1 year � 2 nd rabies vaccine given at 1+ year of age � 2 nd rabies vaccine good for 3 years However � 1 st rabies vaccines are good for 1 year – could get first vaccine at 2 years, or 3 years, or… �In CART situation, history from owner + rabies tag year = best estimate of rabies vaccine validity
Local HD - housing animal which has bitten cont. 3. If there is no documentation of rabies vaccination, or if the period of validity has expired, the animal must be considered unvaccinated and housed as an unvaccinated, aggressive animal (house as in #3, above).
Illness in the 10 day observation period c. Any illness noted in the animal (dog, cat or ferret) during the 10 day observation period must be reported to the local health department and the animal should be evaluated by a veterinarian. If determined to be a rabies suspect, the animal shall be euthanized by a veterinarian after approval from the local Health Officer. The veterinarian will promptly prepare the rabies specimen and will, with the local Health Department, arrange for delivery of the sample to the State Rabies Laboratory for testing.
Local HD 7. cont’d d) If the animal (dog cat or ferret) remains health for 10 days, the local health department will release the animal, and it may be returned to the owner. e) If the animal has a lengthy bite history or the bite incident is severe, the local ACO will investigate the incident further. The ACO, in conjunction with the local Health Department, will determine if and where the animal will be impounded. f) The Shelter Manager may discuss alternate site housing for any animal involved in an animal to human bite incident with the ACO, Shelter Veterinarian, local Health Officer, or Incident Commander.
Housing the biting animal cont’d g) Animals which have bitten a person should only be handled by a professional with experience handling aggressive animals. 1) For mammals, preferably, the handler should have a current pre-exposure rabies vaccination or have a demonstrated protective titer done within the past 2 years. 2) For mammals, if the rabies vaccination status of the animal is unknown, animal handlers should wear appropriate personal protective equipment including eye or face protection.
Appendix 8 Animal Bite Protocol Part 2. Animal to animal bites Part 2 essentially the same as Part 1 in many areas: Housing the biting animal Signs of rabies and housing the biting or bitten animal Determining rabies vaccination status (of both animals) Animal to animal bites are NOT handled the same as animal to human bites under NJDH and local HD rules
Part 2. Animal to animal bites 1. All animal bites must be reported to the Shelter Manager immediately. The Shelter Manager will report the bite to the Shelter Veterinarian immediately and will advise the Animal Control Officer (ACO) of the incident. The Shelter Veterinarian will determine if either animal needs to be transferred to a veterinary hospital for further treatment.
Immediate actions 2. Depending on the size and severity of the wound, the bitten animal should have the wound immediately washed with soap and water. The bite victim should be immediately examined by the shelter veterinarian. If this is not possible, the owner should be advised to have the animal examined at the nearest veterinary facility no matter the outward appearance of wound severity as more damage may have occurred than is visible. The biting animal should also be examined by the shelter veterinarian even if there are no immediately visible injuries.
Reporting to HD 6. Animal to animal bites do not have to be reported to the local health department. a. Exception: if either animal (biting or bitten) is displaying signs consistent with rabies. Rabies itself is a reportable disease. If either animal has signs of rabies, no matter the vaccination status of the animal, the Shelter Manager or Shelter Veterinarian shall immediately report the bite incident to the local health department with jurisdiction where the shelter is located.
Crating the biting animal Use same language as suggested for animal to human bites as transmission of rabies to other animals is still a concern.
Bites to other animals – Tagging the aggressive animal’s crate/cage �Clearly tag the crate/cage Tag info: �“This cage/crate contains an animal that has been involved in an animal to animal bite” �Write the time and date the bite occurred on the cage tag
Animal to animal bite information to collect (still under 4. ) b. Put the following information in BOTH animals paperwork �The date and time of the bite �The identification of the biting animal including: �Owner’s usual contact and address information �Owner’s current location and contact information �Owner’s emergency contact phone numbers and names (e. g. friends, relatives) �The identification of the bitten animal including: �Owner’s usual contact and address information �Owner’s current location and contact information �Owner’s emergency contact phone numbers and names (e. g. friends, relatives)
Information to collect cont’d �If the biting animal is a mammal, determine the rabies vaccination status of both animals �Clearly note the rabies vaccination information of both the bitten and the biting animals and how it was determined (e. g. vaccination certificate, vaccination tag, etc. ) �Identify any person who observed the bite and get his/her account of the incident c. Notify both animals’ owners of the incident and detail the time/date of the notification in the animal’s paperwork.
Rabies vaccination status 7. Assess the vaccination status of the biting animal and the animal bitten. The biting animal: • If there is no vaccine history, the biting animal should not be vaccinated 1 until after a recommended 10 day observation period. • For animal to animal bites, there is no state/county required 10 day observation and confinement. • The Shelter Veterinarian can recommend the biting animal be observed for 10 days for signs of rabies (at the CART shelter, at a veterinarian’s office, or at the owner’s home if suitable. )
Rabies vaccination status (7 cont’d) The bitten animal: If there is no proof of valid rabies vaccination, the Shelter Veterinarian should examine the animal to determine if it is healthy enough for vaccination. 1 Per American Veterinary Medical Association recommendations, the bitten animal should be immediately vaccinated for rabies if it is fit.
Proof of valid rabies vaccination of the animals Same as in the animal bites human section, but now for BOTH animals �Rabies vaccination certificate showing the vaccine is still valid �Rabies vaccination tag on animal’s collar � 1 year vaccine � 3 year vaccine �Current town dog license tag on animal’s collar
Housing the biting animal 2) Housing an animal (mammal) which has bitten another animal: a) If there is no proof of valid rabies vaccination, the animal should be housed in the aggressive animal area, isolated from other animals by a solid wall, tarp, or at least 15 feet. b) If there is proof of valid rabies vaccination, the animal may be housed as an aggressive animal with the appropriate tag on the cage/crate. c) If there is no proof of valid rabies vaccination, the animal must be considered unvaccinated and housed as an unvaccinated, aggressive animal (as in the animal to human bite protocol).
Housing the bitten animal The bitten animal should be housed according to the situation of the bite. Options include: �Bitten animal also aggressor – house in aggressive animal area �Bitten animal not aggressor – house in regular area �Bitten animal with injuries – �If injuries require no further treatment, house as above �If injuries require treatments which are able to be done in the shelter by CART staff and/or the Shelter Veterinarian, house in a quiet area at the shelter (not the infectious disease isolation area) �If injuries require more than simple treatments which can be handled at the shelter, the animal should be transferred to a veterinary hospital. �Decisions on keeping an injured animal at the shelter or transferring it to a veterinary hospital should be made by the Shelter Manager and Shelter Veterinarian.
Signs of illness in biting animal �Any illness noted in the biting animal during the 10 day observation period must be reported to the Shelter Manager and Shelter Veterinarian. The Veterinarian will examine the animal to determine if it is a rabies suspect. �Animals deemed rabies suspect by the Shelter Veterinarian must be promptly reported to the local health department. �After obtaining local health department and the animal’s owner’s approval, rabies suspect animals should be euthanized, a sample promptly prepared and delivered to the State Rabies Laboratory for testing.
Future plans: update the CART shelter biosecurity protocol �Add detail and update the Biosecurity Protocol. �Compendium of Veterinary Standard Precautions for Zoonotic Disease Prevention in Veterinary Personnel; JAVMA, Dec 1, 2015 (National Association of State Public Health Veterinarians). Burlington County CART biosecurity protocol revision subcommittee: Elaine Sullivan, Director Burlington Co. CART Linda Frese, Principal Rabies Control Technician, NJ Dept. of Health Leslie Seraphin, DVM, MPH, Adjunct Veterinarian Burlington Co. CART; District Epidemiology Officer, USDA APHIS Veterinary Services
Questions? For a copy of the draft bite protocol, including rabies vaccination validation or to comment on the draft protocol please email Leslie. L. Seraphin@aphis. usda. gov
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