Rabies is Big Concern for Zoonotic Importance and Public Health Concern

Ban Dog Imported from Egypt

Because of uncertainty about the validity of documentation or efficacy of rabies vaccine administered in Egypt, KDHE required the remaining 25 dogs to be quarantined or euthanized. All 25 dogs were returned to the pet rescue, which was approved by the Kansas Department of Agriculture’s Animal Facilities Inspection Program, for quarantine by March 1. Length of quarantine was determined through prospective serologic monitoring, which is recognized by the National Association of State Public Health Veterinarians as a testing method to evaluate whether a healthy dog or cat without valid rabies vaccine documentation has been previously vaccinated [4]. Prospective serologic monitoring utilizes RFFIT on paired serum specimens collected on days 0 and 5–7. Rabies vaccine is administered after collection of the first specimen. If the first titer is ≥0.5 IU/mL or a statistically significant rise in titer (1.8-fold increase) occurs between collection of the first and second specimen, and the second titer is ≥0.5 IU/ mL, then the animal is considered to have been previously vaccinated.

The rabid dog in Virginia was determined to have an intentionally falsified rabies vaccination certificate [3, 4, 5, 6]. To prevent the importation of rabid dogs into the United States, CDC suspended dog importations from Egypt on May 10, 2019 [7]. Given the frequency and high cost associated with these investigations, this event highlights the importance of thorough review of vaccination and serology documents for dogs imported from countries lacking robust veterinary safeguards and consultation with public health officials upon suspicion of fraudulent or inconsistent records.

Each imported case of CRVV represents a risk of reintroduction of the virus into the United States canine population and exhausts public health resources. Each response to an imported dog with CRVV is estimated to consume 800 hours in resources and cost nearly $214,000 in personnel time and PEP [7]. During this investigation, an average of $9,290* was spent per person for PEP, excluding administration and exam charges, totaling $176,510 for 19 persons who were recommended to receive PEP or $408,760 for all 44 persons who received PEP. Federal regulation requires that dogs imported into the United States from CRVV high-risk countries have a valid rabies vaccination certificate documenting receipt of vaccine at least 28 days before travel [1]. Kansas regulation requires dogs to have a certificate of veterinary inspection issued 30 days before movement and proof of rabies vaccination in animals aged >3 months [8]. These documents were examined at the Canada– United States and Kansas borders for all dogs, and vaccine lot numbers were verified with manufacturers listed on the rabies certificates. Results from serologic testing performed in Egypt suggested that all dogs had mounted sufficient immune responses to a previous vaccination; however, prospective serologic monitoring results indicated that only seven of 25 dogs had evidence that they had responded to a prior rabies vaccination. Serology results were unable to be verified by the Egyptian laboratory because of invalid contact information. Each imported case of CRVV represents a risk of reintroduction of the virus into the United States canine population and exhausts public health resources. Each response to an imported dog with CRVV is estimated to consume 800 hours in resources and cost nearly $214,000 in personnel time and PEP [7]. During this investigation, an average of $9,290* was spent per person for PEP, excluding administration and exam charges, totaling $176,510 for 19 persons who were recommended to receive PEP or $408,760 for all 44 persons who received PEP. Federal regulation requires that dogs imported into the United States from CRVV high-risk countries have a valid rabies vaccination certificate documenting receipt of vaccine at least 28 days before travel [1]. Kansas regulation requires dogs to have a certificate of veterinary inspection issued 30 days before movement and proof of rabies vaccination in animals aged >3 months [8]. These documents were examined at the Canada– United States and Kansas borders for all dogs, and vaccine lot numbers were verified with manufacturers listed on the rabies certificates. Results from serologic testing performed in Egypt suggested that all dogs had mounted sufficient immune responses to a previous vaccination; however, prospective serologic monitoring results indicated that only seven of 25 dogs had evidence that they had responded to a prior rabies vaccination. Serology results were unable to be verified by the Egyptian laboratory because of invalid contact information. This is the third importation of a rabid dog from Egypt in 4 years; the other two dogs were imported into Connecticut [2] and Virginia [3], and all three were rescue dogs with rabies vaccination certificates upon U.S. entry. It is not known if the insufficiency of dog A’s rabies vaccination was a result of inadequate vaccine potency related to improper storage and handling, vaccination failure, or fraudulent documentation. Prospective serologic monitoring results of the remaining dogs confirm a systemic failure representing either the inability to appropriately deliver rabies vaccine or forgery of importations is the third importation of a rabid dog from Egypt in 4 years; the other two dogs were imported into Connecticut [2] and Virginia [3], and all three were rescue dogs with rabies vaccination certificates upon U.S. entry. It is not known if the insufficiency of dog A’s rabies vaccination was a result of inadequate vaccine potency related to improper storage and handling, vaccination failure, or fraudulent documentation. Prospective serologic monitoring results of the remaining dogs confirm a systemic failure representing either the inability to appropriately deliver rabies vaccine or forgery of importation.