Section 40. Model plan for localities

A. Localities are required to have a rabies exposure response plan by § 3.2-6562.1 of the Code of Virginia. Pursuant to the second enactment of Chapter 834 of the 2010 Acts of Assembly, the department has developed a model plan that localities may use in part or in total to fulfill this requirement. In addition, localities may want to consider including information that will assist the plan's users with assessing rabies exposure and making post-exposure prophylactic (PEP) recommendations, communication with local authorities involved in rabies exposure response, documenting information associated with rabies exposure, and any other duties associated with response.

B. Model plan.

Title: Human and Companion Animal Rabies Exposure Protocol.

Section I. Purpose. The purpose of this plan is to:

A. Ensure the prompt capture, confinement, isolation, or euthanasia of any animal that has exposed, or poses a risk of exposing, a person or companion animal to rabies by standardizing procedures associated with investigating such incidents.

B. Identify the authority and responsibility of the LHD, law-enforcement officers, animal control officers, and any other persons with a duty to control or respond to a risk of rabies exposure.

C. Establish consistent communication and reporting of possible rabies exposure incidents to ensure residents living in the locality receive appropriate guidance and residents and their animals receive protection against rabies infection by including them within the scope of the LHD epidemiology staff, LHD environmental health, LHD nursing staff, and locality animal control staff or any personnel acting in the capacity of a locality animal control officer and locality law enforcement. Officials who have entered into a memorandum of understanding with the LHD agree to employ standard written guidelines in response to possible human and animal rabies exposures.

D. Establish a plan to control the risk of rabies exposure and ensure prompt response to rabies-related incidents in order to minimize companion animal and human morbidity and mortality in the locality.

Section II. Locality Employees to Whom Policy Applies. This policy applies to positions assigned to the LHD environmental health staff, LHD nursing staff, LHD epidemiology staff, and any LHD or locality animal control staff employee who receives an initial report of an animal bite/possible rabies exposure. Further, this policy outlines the roles of locality animal control staff and any personnel who may be acting in the capacity of a locality animal control officer and any locality law-enforcement officials who have entered into a memorandum of understanding with the LHD for this purpose and shall herein be referred to as "locality animal control services."

Section III. Legal Authority. Authority for the local health director to develop a local authority and responsibility plan that shall provide for those within the locality with a duty to control or respond to a risk of rabies exposure and to be directed by the local health director for such purposes is articulated in § 3.2-6562.1 of the Code of Virginia (included below).

§ 3.2-6562.1. Rabies exposure; local authority and responsibility plan.

The local health director, in conjunction with the governing body of the locality, shall adopt a plan to control and respond to the risk of rabies exposure to persons and companion animals. Such plan shall set forth a procedure that promptly ensures the capture, confinement, isolation, or euthanasia of any animal that has exposed, or poses a risk of exposing, a person or companion animal to rabies. The plan shall identify the authority and responsibility of the local health department, law-enforcement officers, animal control officers, and any other persons with a duty to control or respond to a risk of rabies exposure. The plan shall provide for law-enforcement officers, animal control officers, and other persons to report to and be directed by the local health director for such purposes.

Section IV. Maintenance. This plan is a working document. In an effort to maintain a current rabies response plan, which addresses emergent issues and changing knowledge, the plan will be reviewed and supplemented as needed as a result of lessons learned during investigations or to comply with updated guidance and legislative requirements.

Section V. Disclaimer. This plan is meant to be used as a guide. No single set of guidelines applies to all situations involving rabies or can provide all of the information needed. The contents of the plan are meant to offer a framework for response as well as support and complement appropriate, practical public health knowledge and experience.

Section VI. Responsibility of Locality Animal Control Services. As directed by the local health director, it shall be the duty of locality animal control services to capture, confine, isolate, or euthanize any animal that has exposed, or poses a risk of exposing, a person or companion animal to rabies. If such personnel is unable to capture, confine, isolate, or euthanize a companion animal that (i) is reasonably suspected to be rabid and (ii) has exposed, or poses an immediate risk of exposing, a person or companion animal to rabies, such personnel shall ensure the humane destruction of such animal.

A. Companion Animal Response. Locality animal control services shall within 24 hours of receiving information about a companion animal exposure:

1. Investigate reports of susceptible companion animals exposed to rabies.

2. Determine if the companion animal has or may have been exposed to a rabid animal, and if the companion animal is currently vaccinated.

3. Evaluate the exposure of the companion animal and prescribe the appropriate action according to state and local regulations.

4. Ensure that exposed, currently vaccinated companion animals receive a booster vaccination.

5. Notify the LHD about any unvaccinated, exposed companion animals, or exposed companion animals with an expired vaccination status in order to relay details of the exposure, vaccination history if applicable, and discussion with the owner concerning the potential options.

6. Notify the LHD about any exposed companion animals that are not dogs, cats, or ferrets.

7. Immediately notify the LHD about any illness associated with any animal in confinement or isolation.

8. Facilitate the submission of the head of any animal that may have exposed a companion animal to rabies as directed by the LHD.

9. Carry out euthanasia or humane destruction of companion animals and suspected rabid animals that may have exposed companion animals as directed by the state agency with jurisdiction over that species.

10. Submit reports associated with any companion animal exposures to the LHD.

B. Human Exposure Response. In regard to situations involving human exposure, locality animal control services shall:

1. Upon receiving information about a human exposure immediately report the exposure to the LHD by the fastest means possible.

2. Not disclose the identity of any victim of an animal bite or rabies exposure except to a health care provider or official of the LHD.

3. If possible, secure any animal that may have exposed a person, pending advice from the LHD as to how to proceed with either observation or testing.

4. Carry out euthanasia or humane destruction of companion animals and suspected rabid animals that may have exposed a person as directed by the state agency with jurisdiction over that species.

5. Facilitate the submission of the head of any animal that may have exposed a person to rabies as directed by the LHD.

Section VII. Responsibility of the LHD. As directed by the local health director, it shall be the duty of LHD environmental health staff, LHD nursing staff, and LHD epidemiology staff to respond to human and companion animal rabies exposures as detailed below. Any LHD employee who receives a report associated with a companion animal or human rabies exposure shall notify a member of the LHD environmental health staff, LHD nursing staff, or LHD epidemiology staff within 24 hours of receiving the report.

A. LHD Environmental Health Staff. LHD environmental health staff members are primarily responsible for the following activities in regard to companion animal and human rabies exposure response:

1. Interfacing with locality animal control services and ensuring that any animals involved in a possible rabies exposure incident are appropriately managed to control the spread of rabies viral infection.

2. Initiating contact with a human exposure victim and coordinating contact with a companion animal owner with locality animal control services when necessary by phone or site visit within two hours of receiving an exposure report.

3. Conducting a site visit to investigate a human exposure and coordinating a site visit with a companion animal owner with locality animal control services when necessary within 24 hours of the report.

4. Notifying the LHD nursing staff and the local health director within 24 hours of receiving a report of a human exposure victim.

5. Coordinating with locality animal control services to locate, and contain or retrieve animals, and collect clinical animal specimens as necessary.

6. Coordinating the submission of rabies samples to a laboratory that has been designated by the Commonwealth for rabies testing.

7. Maintaining a record of human and companion animal exposures as well as test results associated with rabies sample submissions.

8. Immediately notifying LHD nursing staff and the local health director of any positive results associated with human exposures.

9. Notifying any human exposure victims of positive results within two hours of receiving the result and referring the victim to the LHD nursing staff in regard to PEP treatment options.

10. Coordinating with locality animal control services the notification of owners of positive results associated with exposed companion animals within 24 hours of receiving the result.

11. Coordinating with locality animal control services the response to exposed companion animals and owner follow up to evaluate the situation for any human exposures.

12. Notifying the local health director, LHD nursing staff, and LHD epidemiology staff within 24 hours of any negative results associated with rabies sample submissions.

13. Notifying the LHD epidemiology staff with 24 hours of any positive results associated with rabies sample submissions.

14. Notifying the local health director, LHD nursing staff, and locality animal control services within 24 hours of any companion animal that has been placed in isolation or confinement that is manifesting clinical signs that could be compatible with rabies.

15. Notifying locality animal control services within 24 hours of a companion animal for which rabies vaccination is required that is not vaccinated or has an expired status.

16. Developing and maintaining a human and companion animal rabies exposure communication plan that is shared with locality animal control services.

17. In coordination with the local health director, LHD nursing staff, and LHD epidemiology staff, developing and maintaining a training program that can be used to review locality rabies control and response procedures with locality animal control services on an as needed basis and/or as new staff are hired.

B. LHD Nursing Staff. LHD nursing staff members are primarily responsible for the following activities in regard to companion animal and human rabies exposure response:

1. Ensuring that any humans involved in a possible rabies exposure incident are appropriately counseled/treated to control the risk of rabies viral infection.

2. Notifying the environmental health staff of a human or companion animal exposure within two hours of receiving a report if the report did not originate with environmental health staff.

3. Coordinating human exposure follow up with environmental health staff and assisting with human exposure assessment interviews within 24 hours of receiving a report of an exposure.

4. Coordinating the notifying of human exposure victims with environmental health staff immediately after receiving a positive test result.

5. Coordinating the notifying of human exposure victims with environmental health staff within 24 hours of receiving a negative test result.

6. Discussing PEP treatment options within the locality with human exposure victim(s).

7. Discussing medical conditions and history with human exposure victims that may affect PEP treatment.

8. Maintaining a record of medical information associated with all human exposure victims interviewed and counseled, including the exposure victim's decision concerning PEP treatment and if treatment was completed.

9. Notifying the LHD epidemiology staff when a human exposure victim initiates PEP treatment and providing any information about the situation necessary for statistical purposes.

10. Coordinating follow up with exposure victims if PEP treatment recommendations are not followed.

11. Coordinating the notification of human exposure victims with environmental health staff in regard to confinement release results within 24 hours after the confinement period.

C. LHD Epidemiology Staff. LHD epidemiology staff members are primarily responsible for collecting and maintaining the following data in coordination/consultation with the environmental health staff and nursing staff for animal exposures/bites, animal bites to humans, and other human exposures:

1. Demographics of person exposed;

2. Information about the animal and its owner;

3. Details of exposure;

4. PEP recommendations and actions;

5. Animal euthanasia secondary to suspect rabies; and

6. Animal quarantine or confinement.

D. Local Health Director. The local health director is primarily responsible for the following activities in regard to companion animal and human rabies exposure response:

1. Developing memoranda of understanding with locality animal control services for the purpose of organizing an integrated response to human and companion animal exposures within the locality and acknowledging the need for locality animal control services to be directed by the local health director in certain rabies related situations.

2. Overseeing companion animal and human exposure response within the locality.

3. Providing medical advice and consultation in regard to human exposure victims to environmental health staff, nursing staff, and human exposure victims within the locality.

4. Providing medical advice and consultation about rabies and rabies PEP treatment with health care providers within the locality.

5. Developing a guidance document for locality animal control services that contains examples of rabies response and control situations requiring locality animal control services staff to be specifically directed by the local health director.

§§ 3.2-6521 and 32.1-12 of the Code of Volume 31, Issue 22, eff. July 31, 2015.