Exotic notifiable animal diseases contingency plans - Scottish Regional Resilience Partnerships' framework: August 2022

Appendix M: Rabies

Introduction

Rabies is a fatal viral disease of the nervous system caused by a [rhabdo] virus, which can affect all mammals, including humans, and affect bats as well as terrestrial animals. The disease is usually spread by saliva from the bite of an infected animal. It is invariably fatal once signs of the disease have appeared.

The disease is absent from land mammals in the UK. However, two strains of European Bat Lyssavirus (EBLV 1 and EBLV2) have been detected in certain species of bats in the UK, and there was a fatal human case of rabies caused by EBLV 2 in Scotland in December 2002.

The Scottish Government's control structures that would be set up in response to a rabies outbreak are outlined in the Scottish Government's Exotic Diseases of Animal Contingency Framework Plan. However, the disease response to rabies is different to most other exotic notifiable diseases. The GB Rabies Control Strategy contains a more detailed response and can be found at www.gov.scot/publications/rabies. The operational response to a rabies outbreak is generally local authority led. It is expected that the CDCC would be stood up by APHA to help coordinate the response and, given the potential implications for human health, the Scottish Government Resilience Room (SGoR) would, at minimum, monitor the situation and provide briefing to Scottish Ministers. During an outbreak of rabies in Scotland or elsewhere in GB, the rabies web pages on gov.scot will be supplemented with additional information specific to the disease outbreak.

Legislation and National Contingency Plan

Year: 1974

Disease Orders: The Rabies (Importation of Dogs, Cats and Other Mammals) Order (as amended)

Statutory Instrument number: 1974/2211

Year: 1974

Disease Orders: The Rabies (Control) Order

Statutory Instrument number: 1974/2212

Year: 1976

Disease Orders: The Rabies (Compensation) Order

Statutory Instrument number: 1976/2195

Year: 1981

Disease Orders: The Animal Health Act (as amended)

Statutory Instrument number: 1981/22

Year: 1993

Disease Orders: The Channel Tunnel (International Arrangements) Order (as amended)

Statutory Instrument number: 1993/1813

Year: 2011

Disease Orders: The Non-Commercial Movement of Pet Animals Order

Statutory Instrument number: 2011/2883

Year: 2018

Disease Orders: GB Rabies Control Strategy

Possible impact

Sector: Domestic agricultural industry

Impact: Moderate

Detail: Rabies is not primarily a livestock disease, but may infect livestock, which are unlikely to transmit disease further.

Movement restrictions would be placed on the affected premises. Food Standard Scotland (FSS) guidance on dairy and meat products would need to be followed where livestock have been in contact with suspect/contact animals. If infection became established, there would be increased risk to agricultural workers.

Sector: International agricultural trade

Impact: Moderate

Detail: Trade restrictions on affected holdings. Some countries may be unwilling to import dairy and meat products if disease is suspected/confirmed in livestock.

Sector: General public

Impact: High

Detail: In the event of an outbreak, there would be a high level of concern amongst the public. Pet owners would be particularly concerned about their own pet's health. They would be required to take measures such as muzzling and leashing, as well as keeping pet dogs and cats under control, and may be required to vaccinate their pets against rabies. Non-pet owning general public might perceive pets and potentially wildlife reservoirs such as foxes, bats, or (to a limited extent) badgers, as a risk.

Sector: Government

Impact: High

Detail: High public concern would require urgent decisions regarding control and eradication, as well as joined-up working with the public health colleagues and local authorities. Outbreaks can occur in urban as well as rural areas.

Sector: Rural industry

Impact: High

Detail: In the event of an outbreak, movement restrictions would apply to specific animals within an Infected Area, including livestock, zoo animals and companion animals. Some activities in an Infected Area, such as animal gatherings and hunting, would be banned, except under licence.

If outbreaks in wildlife required vaccination and/or destruction, a reaction from Animal Rights groups is to be expected. Possible impact on rural tourism if wildlife controls are required.

Sector: Public health

Impact: Very high

Detail: Rabies is fatal in humans. People bitten or scratched by a confirmed or suspect animal will require urgent post-exposure treatment. The costs to the National Health Service could be high, and resources would be needed to investigate all possible contacts with rabid animals.

The last human death in the UK from classical rabies (genotype 1) contracted in the country was in 1902. A bat handler died in 2002 from a bat strain of the virus (EBLV 2). Any infected animal that has started to excrete the virus, which may be several days before clinical signs are seen, poses a hazard.

The UK is currently free from classical rabies, although there is a low prevalence of EBLV-2 and EBLV-1 has recently been identified for the first time in the UK.

However, due to the small likelihood of contact between people and bats (apart from bat handlers), the risk of a human case of rabies caused by a bat remains 'very low'.

The most likely scenario for rabies entering GB is through an infected animal imported into the country illegally. At highest risk would be workers in quarantine kennels or those dealing with animals imported illegally, and/or owners of those animals who may be exposed to infection brought in from abroad.

History, risk introduction and spread of disease

Classical rabies was eradicated from GB in 1922, but is widely distributed across the globe, present on all continents and endemic in most African and Asian countries. Our island status makes it unlikely that rabies will be introduced through natural wildlife spread.

There are strict legal controls on the entry of animals into GB, aimed at preventing the introduction of rabies. Pet cats, dogs and ferrets entering GB are subject to the rules relating to the movement (commercial and non-commercial) of pets. Pets that do not meet these rules may be put into quarantine or refused entry if they have travelled by sea. Other rabies susceptible animals can also be imported into GB but they must be licenced directly to a quarantine facility. The maximum quarantine period for all animals is four months.

The largest risk for rabies entering GB is through an infected animal imported into the country illegally. Experts have assessed that by far the most likely scenario the GB might face is that a single pet with rabies (re)enters the country from abroad without meeting all legal border controls, and subsequently is diagnosed as having rabies, and thus being the initial source of the infection. In virtually all cases of rabies brought into Europe in the last decade by illegal pet movements, the initial pet that brought in the rabies virus was identified. This makes control of the disease spread easier and quicker than a scenario where a series of infected animals are found, and none have recently been abroad.

Rabies affects bats as well as terrestrial mammals. In Europe, there are two commonly reported strains of EBVL 1 and EBVL 2. EBLV 1 is commonly associated with the Serotine bat, and although isolated in GB for the first time in 2018, is still only confirmed in a small population of GB bats in a restricted area. Therefore, it is not considered endemic in GB. EBLV 2 is commonly associated with the Daubenton's bat and can be considered as endemic in GB. Research has indicated that the risk of cross species transmission of lyssaviruses from bats to other animals should be considered very low, but is not negligible. There have been incidents worldwide where humans and other animals have contracted rabies and died following infection with bat lyssaviruses. In 2002, a Scottish bat worker died following contact with infected bats.

Transmission depends upon close contact with a live, infected animal. People become infected mainly from bites from animals showing clinical signs of disease. Dogs are the most common source of human infection. If the disease became established in the country, urban foxes could also pose a significant risk.

Transmission of the virus can occur through mucous membranes, but not intact skin. Airborne transmission is believed to have occurred in two laboratory workers in the USA; however, airborne transmission of rabies virus is considered a rare event.

If infection becomes established in the country, infected wildlife (particularly the red fox) or infected companion animals would be the most likely source. Worldwide, dogs account for around 99% of human infections and infected livestock are regarded as "dead-end" hosts for the disease. Since farm animals tend to get paralytic disease rather than the furious form, they do not generally attack other animals or people, and do not pose a significant threat to the general public. However, on occasions they may transmit the disease to their handlers.

The majority of human cases in France during the epidemic of sylvatic rabies were attributed to livestock contact. Infected meat or milk from affected animals could in principle be a source if they were consumed, but this is unlikely. The risk from this source is believed to be very low and would be reduced even further by cooking.

Currently the greatest risk is to people who illegally import mammals from countries where rabies is endemic, or who accidentally come into contact with animals imported inadvertently in freight etc. Those who work in quarantine kennels and those who work with bats are at risk of exposure and are normally vaccinated to mitigate the risk. People who may otherwise come into contact with bats may be at risk, such as builders working in roof spaces where bats roost.

In the event of an outbreak, anyone who handles suspect animals in the infected area is potentially at risk.

Control Measures

Overview of control measures currently in place

• Prevention of introduction by import controls, including GB pet travel rules, quarantine and post import checks.
• Statutory notification of suspicion of disease in any animal, followed by investigation.

Statutory powers to control outbreaks including those to impose restrictions on:

• Movement of animals
• Confinement and control of pets
• Seizure and detention or destruction of animals not properly controlled
• Compulsory vaccination of animals
• Prohibition of gatherings of animals or activities likely to disperse wildlife
• Vaccination or destruction of wildlife in defined areas
• Payment of compensation at market value for animals compulsorily culled (except for animals in quarantine)
• Observation of suspect cases: rabid terrestrial mammals are generally only capable of transmitting disease during a limited period of a few days just before they die of rabies. If a terrestrial mammal is still healthy 15 days after the biting/scratching incident, then it can be assumed that it did not transmit disease at or before the incident. This is a guiding control principle for both human and animal contacts.

Other options for control

Out with a disease outbreak, vaccination for domestic animals is available through veterinary surgeons and there are no restrictions on pet owners who want to vaccinate their pets against rabies pre-emptively. Whilst its use tends to be limited to pets travelling abroad or animals in quarantine, vaccination could be extended to other animals in the face of an outbreak.

Control Zones that may be declared

Statutory Instrument: The Rabies Control Order (1974)

Zone: Infected Area

Stage declared: Minister believes or suspects existence of rabies in the previous 6 months

Area: The area where rabies is considered to exist or have existed in the previous 6 months, and any adjoining area that might spread to

Controls: Schedule 3

Lead responder control measures under Statutory and Regulatory powers and responsibilities

Local Authorities principal role

• Enforcement of EU Pet movement regime
• Enforcement of the Control Order
• Control of stray animals in an Infected Area
• Establishing a stray animal pound
• Humane destruction and disposal of unclaimed strays

Animal and Plant Health Agency (APHA) principal role

• Animal Health colleagues (rather than Public Health) will lead in the event of an outbreak of animal rabies.
• In view of the potential risk of spill over of disease to mankind, there will be close liaison with both national and local health boards.
• Stand up the CDCC.

NHS Boards principal role

• Provide pre-exposure immunisation to "at risk groups"
• Provide medical treatment and advice to persons presenting with potential rabies prone exposure (PRPE)
• Carry out a risk assessment for requirement of post exposure prophylaxis (PEP)
• Deploy a Competent Person in Public Health Medicine to the FOB
• Provide a representative to the National IMT
• Contribute to the Communications Strategy, risk communication and public facing messages in respect of matters affecting public health

Public Health Scotland (PHS) principal role

• Convene the National IMT to coordinate the public health response
• Provide expert public health advice to responding agencies
• Provide operational support to NHS boards in relation to the public health response to the incident

Police Scotland principal role

Police Scotland should be aware that under Article 4 of the Rabies (Control) Order 1974, there is a legal duty on any person who knows or suspects that an animal is suffering from rabies, or had died from the disease, to report this to the Local Authority (LA), the local Animal and Plant Health Agency (APHA) office or to the Police. In reality, reports are most likely to be made to APHA. If Police Scotland take a report call, they should contact the local APHA office in Scotland immediately for advice. Police Scotland's main roles would be:

• Assist local authorities to enforce restrictions
• Provide support for any public disturbance/public safety issues
• Local authorities and Police Scotland have the power to seize animals if the owner fails to comply with any rabies control provisions
• Deal with access issues to domestic dwellings
• Provide assistance to APHA through the provision of specialist knowledge in the area of management and co-ordination of major incidents
• Work in partnership with local authorities and APHA to consider local intelligence
• Ensure Corporate Communications are informed
• If required, execute and enforce Section 60(1) of the Animal Health Act 1981, e.g. powers of entry, search and arrest
• If required, execute and enforce Section 49 and Schedule 1 of the Animal Health and Welfare (Scotland) Act 2006, e.g. entry and search, stopping and detaining vehicles and arrest without warrant
• If required, provide representation at Amber Teleconference
• If required, attend DSG
• Maintain links between the resilience partnership and disease control centre response through liaison with the FOB and NDCC, ensuring representation at FOB/CDCC/NDCC bird table meetings
• Input to the OCG overnight reports

Scottish Government principal role

• Scottish Government Resilience Room will monitor the progress and brief Scottish Ministers
• Liaise with the CDCC and resilience partners and provide assistance where required
• Lead the communications to ensure consistency of message
• Laying, monitoring and uplift of baits (pre-bait, vaccines and/or poison bait) to control the spread in wildlife

First aid

Biting and scratching incident

If anyone is bitten or scratched by the suspect animal, immediate local treatment is of the paramount importance. The wound should be cleaned by thorough flushing under a running tap for several minutes and washing with soap or detergent and water. A virucidal agent, such as povidone-iodine solution or 40-70% alcohol, should be applied and the wound covered with a simple dressing. Primary suturing of the wound should be avoided as this may increase risk of introduction of rabies virus to the nerves.

A full and expert risk assessment must be promptly carried out and appropriate management agreed in consultation with the local ID Clinician. Management may include administration of rabies immunoglobulin and vaccine, or rabies vaccine alone.

Saliva contamination of broken skin or mucous membranes

Where the suspect animal has licked broken skin or where there has been saliva contact with mucous membranes (eyes, nose or mouth), there is a risk of infection. The area should be washed or irrigated thoroughly with clean water as soon as possible, and expert advice sought as above to assess risk and agree management

Rabies virus does not cross intact skin and so hands should be washed with soap (or detergent) and water. Clothes must be changed if contaminated with suspect animal discharges and subject to a thorough clean, preferably under the direction of APHA staff or the medical authorities.

Further information

Additional information on immunisation against infectious disease is available at:

• PHS Rabies: Guidance on Prophylaxis and Management in Humans in Scotland
• Immunisation Against Infectious Disease (Chapter 27 of this specifically includes information on rabies).