Addressing the Risk of Rabies Exposure in Veterinary Practice
Reprinted with permission form AVMA PLIT
Rabies virus infection is an invariably fatal disease of the central nervous system in mammals. Multiple cases are reported each year in wild and domestic animals, and it is a serious public health risk. Most states require current rabies vaccinations for dogs and many also require rabies vaccinations for cats and ferrets. Rabies exposure in a veterinary clinic can affect everyone, from the treating veterinarian to staff and even clients. This newsletter article will outline the importance of having appropriate insurance coverage in place not only for the veterinarian’s protection, but for everyone else that can be affected.
The Risk of Rabies
Rabies exposures can easily be overlooked in day-to-day practice when treating patients. Yet, they are not uncommon, especially in high-risk geographical areas. Additional concern from international exposure has also become a recent reality. Besides our own homeland exposure potential, the US experienced rabies cases from canine importation from high-risk countries due to fraudulent rabies vaccination certificates. In 2021, two canine rabies cases were found in the US stemming from importation from another country. Thankfully, importation guidelines have tightened recently. The risks of rabies go far beyond a single human exposure. One infected animal can potentially expose other animals, as well as humans who come into contact with it before, during, and after treatment. Beyond illness, the ripple effect of rabies can often involve financial and legal burdens: if a person is exposed to rabies, they will likely require exposure prophylaxis treatment. Additionally, legal reporting requirements for rabies exposure can be extensive.
The Liability Risks of Rabies
It is essential to consider rabies in your differential diagnosis when faced with neurologic or potential oral abnormalities in patients in areas with terrestrial rabies. As a veterinarian, you may be at risk of an allegation of negligence if you fail to recognize a potential rabies case and that patient exposes your team, clients, or the public to rabies. If you are presented with a patient that is a rabies suspect, team communications should include a clear discussion of risks with those handling the animal in question and the importance of appropriate personal protective equipment (PPE) should be highlighted.
Besides the professional obligations and responsibilities veterinarians carry regarding rabies exposures, veterinarians also carry legal obligations and responsibilities. Rabies control statutes exist in every state and can vary from region to region (or even among jurisdictions within a state). In many jurisdictions, rabies statutes include mandatory reporting of suspected and confirmed cases with potential human exposures. A veterinarian can be held legally responsible for a known or suspected exposure if appropriate action to notify those exposed was not taken according to the rabies laws in place.
Rabies as a Differential Diagnosis
How often do you consider rabies in your differential diagnosis when presented with a neurological patient, or a patient with hypersalivation? If a patient is presenting with clinical signs that could be associated with rabies and rabies is not part of your differential diagnosis and case management, you as the treating veterinarian can be held liable if exposure occurs.
When treating any patient presenting with signs that are suspicious for rabies, remember the following:
- Always include rabies on your differential diagnosis for neurological signs, fever of unknown origin, abnormal oral signs (hypersalivation), and unexplained lethargy.
- Stay up to date on your rabies vaccinations by checking your titers routinely and encourage your staff to do the same.
- Be familiar with tissue sample submission protocols for rabies testing. Know where, when, and how to send samples.
- Communicate the risk of rabies exposure and best practices to clients in an effort to limit human exposure risk.
- Be familiar with your local, regional, and state laws regarding rabies reporting.