Rabies in a Dog Imported From Egypt — Connecticut, 2017

Yonette Hercules, MHSc; Nelva J. Bryant, DVM; Ryan M. Wallace, DVM; Randall Nelson, DVM; Gabriel Palumbo, MPH; Jemeila N. Williams, MPH; J. Miguel Ocana, MD; Sheryl Shapiro, MHA; Hilaire Leavitt; Sally Slavinsk, DVM; Alexandra Newman, DVM; David A. Crum, DVM; Brian E. Joseph, DVM; Lillian A. Orciari, MS; Yu Li, PhD; Pamela Yager; Rene E. Condori, MS; Kendra E. Stauffer, DVM; Clive Brown, MBBS


Morbidity and Mortality Weekly Report. 2018;67(50):1388-1391. 

In This Article

Public Health Investigation

After CDPHL's notification of confirmed rabies, CDC's New York Quarantine Station initiated a contact investigation to identify animals or persons potentially exposed to dog A during its infectious period (10 days before symptom onset until death [December 9–21]). CDC contacted health departments in the chain of distribution of all five dogs in the cargo hold to initiate rabies exposure assessments; these health departments included the Maryland Department of Health, Virginia Department of Health, New York City Department of Health and Mental Hygiene, New York State Department of Health and Mental Hygiene, and Washington State Department of Health. The investigation also included U.S. Customs and Border Protection (CBP), the U.S. Department of Agriculture's Animal and Plant Health Inspection Service, the airline that transported the animals, and the domestic cargo offloading company at JFK.

State health department staff members interviewed dog A's caretakers, volunteers, and employees associated with the involved rescue groups and veterinary hospital staff members for potential exposure. Public health investigators for Maryland, New Jersey, New York, Washington, and West Virginia determined that the animal transporters and foster home volunteers had no direct contact with dog A; therefore, no postexposure prophylaxis (PEP) was recommended for those persons. Connecticut public health officials, in accordance with national guidelines,[4] recommended PEP for the flight parent bitten in Cairo, the caretakers of dog A, and the veterinary technician who was bitten. CDC and CBP conducted a contact investigation to identify potentially exposed persons and animals at JFK. CBP interviewed the airline's U.S.-based cargo staff members and reviewed surveillance video to identify transporters and CBP staff members who had potential exposure to dog A. CBP identified 13 cargo and baggage handlers and four CBP officers; New York City Department of Health and Mental Hygiene conducted risk assessments and determined that PEP was not recommended. All handlers reportedly wore gloves while handing the crates and had no direct contact with the dogs. CBP reviewed the importation paperwork and cleared the animals but had no physical contact with the dogs or the crates.

The domestic animal exposure investigations determined that all four dogs in the Egyptian shipment (dogs A, B, C, and D) were individually crated within the airplane cargo hold. A fifth dog (dog E, also in an individual crate), that was not part of the rescue organization shipment, shared the same cargo hold space. The animals were never removed from the crates during shipment, so they could not have had direct contact with dog A. Therefore, dogs B, C, D, and E were not considered exposed to dog A during transport. Dog A had no contact with any dogs after exiting the airport and was placed in isolation at the veterinary clinic. All five dogs had certificates indicating rabies vaccination both at ≥3 months and ≥30 days before arrival at a U.S. port of entry (Table), as required by CDC dog importation regulations.[5] However, because dog A's infection raised uncertainty about the validity of rabies vaccination for the five dogs, investigators determined that the four remaining dogs from the shipment should receive a rabies booster vaccination followed by confinement, as recommended by the Compendium of Animal Rabies Prevention and Control.[6] In light of this uncertainty and the potential for unreported exposure before shipment, Maryland Department of Health elected to confine dogs B and C for 4 months; Virginia Department of Health and Washington State Department of Health elected to confine dogs D and E for 30 days (Table). Egyptian public health investigators instituted vaccination, confinement, and monitoring for four other dogs in the Egyptian rescuer's possession and indicated that persons exposed to dog A were given PEP. Clarification by Egyptian authorities of why an appropriately vaccinated dog (according to the documentation provided) developed rabies is pending.