April 3, 2019

One Health Inquiry
G reetings from the One Health Commission Bat Rabies Education Team (BRET):
BRET needs your help!
We are reaching directly to U.S. State Public Health Veterinarians and State Veterinarians to ask if your state has in place a real time Rabies Alert System for local Veterinary Practices.
 
You may be aware of the One Health Commission's Bat Rabies Education Team (BRET). BRET has been working for several years to educate children and parents and increase public awareness about bat rabies and bat/human interactions in the Americas (and beyond).
BRET was created because a gap was identified; there seemed to be no concerted, focused, preventive, nationwide efforts in the US to actively teach children and parents not to touch a bat or to seek medical guidance if they do have contact with a bat/bats. The death late in 2018 of a 6 year old boy in Florida ( https://fxn.ws/2tsyIHE ) who was scratched by a bat is just one example of our need for this education. Nor is there an active, concerted effort to assure that nurses, teachers, and the general public are aware of rabies in general and bat rabies in particular. BRET seeks to educate about the ecological 'need' for bats: don’t harm them...we need them for pollination and to eat mosquitoes and crop damaging insects. Just be aware and do not touch them; and do seek medical advice if you have contact with a bat.
 
One reason this gap in education exists is that the US does not have hundreds of deaths to rabies every year as in so many countries that have endemic canine rabies. So here in the US, this needed education about bats and about rabies in general easily slips through the cracks. BRET believes strongly that if one life can be saved via education, it will be worth every ounce of energy that we can commit to this education.

One Action that the team is working on is preparing a call (published Commentary) for states across the US to establish a real time alert system to notify practicing veterinarians when rabies has been diagnosed in wild or domestic animals in their neighborhoods. As a former practicing veterinarian, I know that the only way veterinary clinicians learn about such events is via news media and/or their clients. It's humbling to be standing in an exam room with your client asking...'Hey Doc, did you hear about that rabid fox that attacked that lady and her kids up the road?" ...and have to say, no. 
 
But practicing veterinarians and their staff are a first line of defense against rabies spillover into domestic animals and humans. Veterinary practices must be alert. And I can tell you, in the US, because of our success with rabies vaccination of dogs and cats, rabies does not jump to the top of the rule-out list for most veterinarians when presented with a sick pet who has not been vaccinated against rabies or is overdue for its rabies vaccines.
 
We realize that rabies incidence information is often posted on State Health Department websites. But I promise you, busy Veterinary Clinicians do not come into their practice every morning and think, “I better log onto the State Public Health Dept website first thing this morning to see if there are any cases of rabies in my neighborhood so I will be on the lookout and so I can warn my staff to take precautions with unvaccinated, sick pets being brought in.”
 
You may have seen a survey that BRET did in 2017 trying to discern what is being done to actively educate about bats and rabies. While local educational efforts may be temporarily mounted after an incident or death, over 50% of survey respondents indicated that nothing specifically on bats and rabies was in place in their locale for this kind of preventive public education. Some states may alert human hospital emergency departments. But that might be too little too late. It is Veterinarians who provide the first line of defense to rabies spillover from wildlife.
 
We are reaching now directly to U.S. State Public Health Veterinarians and to State Veterinarians to ask if your state has in place a real time Rabies Alert System for Veterinary Practices or if you know of any states/agencies that do have such a system. We have become aware of such alerts in Los Angeles County, CA and in New Mexico. We believe that such an alert system would not be very difficult to establish in most states, especially if the State Veterinary Medical Board and/or State Veterinary Medical Associations were willing and able to partner on this important One Health action. We are not suggesting that every rabid animal be broadcast to every practice, or that any privacy laws be broken. Just that when rabies is diagnosed in wild or domestic animals that the Veterinary Practices in that region be notified:
 
“A rabid bat/cat/dog/fox/coyote/bobcat/horse/racoon/skunk/other in your practice area was diagnosed
with rabies on X date. Please be aware. You may wish to call the State or local Public Health Department
for more information.”
 
We urge State Public Health Veterinarians to work with their local health departments to develop their state’s notification system and protocols. Whether the notice came from the state or from the local health department, this alert could go to practice manager’s as well as clinical Veterinarians on staff. Or it could go by snail mail. Veterinary Practitioners could also be asked to place free educational bat rabies posters in their lobbies and exam rooms around the U.S.
 
In the U.S. we do a pretty good job of identifying cases of rabies. But this does not necessarily mean that the data gets back to a community in a "planned and timely" manner. In the larger / longer range picture, it would be ideal to merge veterinary and human health surveillance systems and not have to duplicate efforts. This suggested Veterinary Practice Rabies Alert System could be a useful step towards such collaborations and would create beneficial relationships and lines of communication between local veterinary clinicians and Public Health Departments, moving us toward true One Health surveillance collaborations.
 
Would you please respond, by April 15 if possible, if your state has (or you know of any) such alert systems in place and if you have any thoughts about our planned Commentary c alling for states to establish a Rabies Alert System for Veterinary Practices. Please send your comments to [email protected] .
 
Thank you so much, in advance, for your time to read this message and respond.
Sincerely,
Cheryl Stroud, DVM, Ph D in support of BRET
Executive Director, One Health Commission
D irect Phone: 224-622-1839

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