HJAR May/Jun 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2023 47 Jennifer Dillaha, MD Director Arkansas Department of Health at healthy.arkansas.gov, then the healthcare provider should report it at this time. It is important for people to seek care as soon as possible so it can be determined if vaccina- tion is needed. This is especially important when it comes to bats. According to the CDC, unlike most other animals that carry rabies, many types of bats have very small teeth which may leave bite marks that disappear quickly. This means that a bat bite may not be easily identified. PEP is the only treatment available for rabies. Anyone who has not been previous- ly vaccinated will receive a dose of human rabies immune globulin and a first dose of rabies vaccine. Additional doses of vaccine are then given on Day 3, Day 7, and Day 14 after the first dose, which is Day 0. A dose will also be given on Day 28 for anyone who is immunocompromised. A tetanus shot is also needed if the patient has not received one within the past 10 years. People who have previously been vaccinated will only need two doses of rabies vaccine given three days apart and will not need rabies immune globulin. PEP is very expensive and can cost thousands of dollars for the entire series. That’s why it is helpful to be able to observe or test the animal involved to help deter- mine whether PEP is truly needed. In Arkansas, there also has been confu- sion about where a patient should go for treatment. The ADH does not provide PEP, and small healthcare facilities may not pro- vide it due to the cost. When PEP is needed, theADH recommends that patients, whose doctors are unable to provide it, visit their local emergency room (ER) to receive wound care and initial round of PEP. During that visit, healthcare workers should talk with the patient about what will happen next and where the patient should go to receive their next vaccine doses. It is important for healthcare workers to know their facilities’ procedure so they can pass the correct in- formation on to their patients. There have been no deaths in Arkansas due to rabies since 2005. However, in the United States, five people died last year alone due to rabies exposure from bats. There are ways to prevent the spread of ra- bies. Arkansas law requires all dogs and cats to be vaccinated against rabies. Vaccinations also exist for some other animals including horses and cattle. People are encouraged to leave wild animals alone and not let pets roamwhere they can be bitten or bite others. Dealing with animal bites and PEP can be scary and stressful. But good communica- tion and teamwork will help lower stress and keep the situation from being frustrat- ing for all involved. Visit cdc.gov/rabies/ or healthy.arkansas.gov to learn more about rabies and treatment. Reporting an Animal Bite • To report animal bites, call the near- est ADH local health unit between 8 a.m. and 4:30 p.m. or submit a report at healthy.arkansas.gov. • For questions about rabies PEP, call the ADH Zoonotic Disease Section at 501-280-4136 between 8 a.m. and 4:30 p.m. • Tomake a report or ask a question after hours, on weekends, or holidays, call the ADH at 800-633-1735. n problems swallowing, excessive drool or saliva, excessive aggression, or biting at imaginary objects. Wild animals may act tamer than expected or have trouble mov- ing around. Skunks out during the day or a bat not flying around are important warn- ing signs. Humans can become infected when ex- posed to rabid animals, usually through bites. Most human rabies cases in the United States are due to unrecognized or unreport- ed exposures to bats. Since only 2 to 3% of bats are infected, a laboratory test is needed to confirmwhether a bat is infected. If a per- son finds a bat in their home, they should contact animal control or a nuisance wild- life control company to capture the bat for testing. Anyone attempting to capture a bat by themselves should use leather gloves as well as a net or box to trap the bat without direct contact. If a person experiences an animal bite, they should not dispose of the animal that bites them. If it appears healthy and is vaccinated, it can be confined and observed for 10 days to evaluate potential illness. Livestock and other domestic ani- mals have longer observation periods, and there is no recognized quarantine period for wildlife. An animal that has died or been eu- thanized can be tested by the Public Health Lab to see if it has rabies. In 2021-2022, 1,194 animals were tested for rabies in Arkansas. There were 45 animals who tested positive. If someone is bitten or scratched by an animal, they should wash any wounds im- mediately with soap and water and then talk with a healthcare provider. If the person bitten has not reported the bite to the nearest ADH Local Health Unit or