12VAC5-105 Rabies Regulations

REGULATIONS

Vol. 30 Iss. 7 - December 02, 2013

TITLE 12. HEALTH

STATE BOARD OF HEALTH

Chapter 105

Proposed Regulation

Title of Regulation: 12VAC5-105. Rabies Regulations (adding 12VAC5-105-10 through 12VAC5-105-40).

Statutory Authority: §§ 32.1-12 and 3.2-6521 of the Code of Virginia; Chapter 834 of the 2010 Acts of Assembly.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: January 31, 2014.

Agency Contact: Julia Murphy, DVM, State Epidemiological Veterinarian, Department of Health, 109 Governor Street, 5th Floor, Richmond, VA 23219, telephone [phone], FAX [phone], or email [e-mail].

Basis: Section 32.1-12 of the Code of Virginia authorizes the State Board of Health to make, adopt, promulgate, and enforce such regulations as may be necessary to carry out the provisions of Title 32.1 of the Code of Virginia and other laws of the Commonwealth administered by it, the Commissioner of Health, or the Department of Health. Chapter 834 of the 2010 Acts of Assembly clarifies the procedures and responsibilities among the Department of Health, localities, and other entities to prevent and control rabies and the second enactment of Chapter 834 requires the Board of Health to adopt regulations to implement the provisions of the act. Section 3.2-6521 of the Code of Virginia requires the Board of Health to provide, by regulation, an exemption to the requirement that an owner of a dog or cat must have his animal vaccinated for rabies if the veterinarian determines that the dog or cat has an underlying medical condition that is likely to result in a life-threatening condition in response to the vaccination.

Purpose: These regulations are necessary for the protection of public health. Rabies is nearly 100% fatal in mammals and is highly endemic in the Commonwealth. It is very important that human and animal exposures are addressed promptly and correctly. Greater detail than is appropriate for the Code of Virginia is articulated in these regulations to support the implementation of rabies-related sections of the Code of Virginia modified and introduced during the 2010 Session of the General Assembly. In addition, the Board of Health has been specifically instructed to develop regulations addressing rabies exemptions and a model rabies response plan. Goals of the proposed language include (i) defining commonly used terms in the rabies-related sections of the Code of Virginia to increase the likelihood that these terms are interpreted and applied in a consistent way, (ii) improving the recordkeeping associated with rabies clinics to increase the likelihood that an animal's vaccinations status can be verified in response to a rabies exposure, (iii) outlining the procedure a veterinarian must use to apply for a rabies vaccination exemption and the role of local authorities in that process, and (iv) offering a model rabies response plan that localities may use to comply with § 3.2-6562.1 of the Code of Virginia. The proposed language has been developed in cooperation with stakeholders from potentially affected groups such as local health departments, animal control agencies, veterinary associations, humane groups, wildlife agencies, agriculture agencies, the Board of Veterinary Medicine, and local government associations. These stakeholders have been engaged to discuss issues such as the entity that grants rabies exemptions and restrictions placed on animals that are exempt as well as the authority local health directors now have to direct animal control officers in the pursuit of their duties in certain circumstances. This participatory approach was intended to result in proposed language that is clearly written, understandable, and functional for all those involved in rabies prevention, control, and response efforts.

Substance: The provisions in these new regulations address commonly used terms in the rabies-related sections of the Code of Virginia, the health department's recordkeeping responsibilities associated with rabies clinics, a mechanism whereby dogs and cats may be granted a rabies vaccination exemption, and fulfill the requirement, as put forward by the 2010 General Assembly, for the Board of Health to develop a model plan that may be used by localities to comply with the requirements of § 3.2-6562.1 of the Code of Virginia.

Issues: The main issues associated with the proposed regulatory action include defining common terms used in the Code of Virginia, rabies vaccination exemptions, recordkeeping associated with rabies clinics, and the development of a model rabies response plan. The primary advantages of these regulations for individual private citizens, veterinarians in private practice, and the Commonwealth include (i) increasing the likelihood that the terms used in the rabies-related sections of the Code of Virginia will be applied and interpreted in a consistent way in all health districts; (ii) increasing the likelihood that the rabies vaccination status of an animal that was vaccinated as part of a rabies clinic can be verified; (iii) providing a mechanism for granting rabies vaccination exemptions that will allow for a dog or cat owner whose animal is likely to have a life-threatening reaction in response to vaccination to be in compliance with local licensing laws, but also contains provisions that will assist local authorities with protecting public health; and (iv) improving coordination and communication among local government authorities in response to a rabies exposure event to ensure that residents living in a locality and their animals receive timely and accurate guidance about rabies by creating a model rabies response plan that can be used by local health departments. A potential disadvantage of these regulations includes the time and effort veterinarians in private practice may need to complete the application for vaccination exemption.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. Pursuant to Chapters 182 and 834 of the 2010 Acts of Assembly, the proposed regulations 1) establish a procedure for issuing exemptions for rabies vaccination, and 2) require localities to have a response plan to rabies exposure.

Result of Analysis. There is insufficient data to accurately compare the magnitude of the benefits versus the costs. Detailed analysis of the benefits and costs can be found in the next section.

Estimated Economic Impact. Chapter 182 of the 2010 Acts of Assembly requires the Board of Health to provide an exemption for rabies vaccination if the vaccination would endanger the animal's life. According to the Virginia Department of Health (VDH), some animals may develop life threatening allergic reaction to the rabies vaccination. The proposed regulations will allow a veterinarian to apply to the local health director for an exemption if the animal has a history of severe allergic reaction to the vaccination.¹ Based on data from a neighboring state, on an annual basis, approximately 130 applications may be expected and approximately 100 exemptions may be issued in Virginia.

The main benefit of the proposed change is avoidance of a potentially life threatening allergic reaction the animal may develop. The main cost is the added chances of animal being infected with rabies because it is not vaccinated.

In addition, if an exemption is issued, the owner would not have to incur the cost of the vaccination and realize some savings. Each vaccination is estimated to cost approximately $15 - $20. However, VDH estimates a veterinarian would have to spend approximately 1 to 2 hours to gather necessary information to complete an exemption application. If a veterinarian chooses to charge for his or her additional time, the owners compliance costs may increase.

Finally, the local health director would be required to spend some time in reviewing exemption applications.

Another proposed change, pursuant to Chapter 834 of the 2010 Acts of Assembly, requires localities to have a response plan to rabies exposure. VDH estimates that most localities already have a plan to respond to rabies exposure. Nonetheless, the proposed regulations also provide a model plan localities may choose to use in part or in total. This proposed change is expected mainly to improve coordination and communication among local government authorities in responding to rabies exposure.

All of the remaining changes appear to be clarifications of current requirements and are not anticipated to create any significant economic impact.

Businesses and Entities Affected. There are 134 local governments, approximately 130 dog or cat owners who are estimated to apply for an exemption, and over 700 full service veterinary hospitals in Virginia.

Localities Particularly Affected. The proposed regulations apply throughout the Commonwealth.

Projected Impact on Employment. Approximately 1 to 2 hours may be required to gather necessary information to complete an exemption application. Also, the local health director would be required to spend some time in reviewing exemption applications. Thus, a small increase in demand for labor may be expected.

Effects on the Use and Value of Private Property. The proposed regulations are not anticipated to have a direct impact on the use and value of private property.

Small Businesses: Costs and Other Effects. The vast majority, if not all, of over 700 full-service veterinary hospitals are believed to be small businesses. As discussed, the proposed exemption may require veterinarians to spend approximately 1 to 2 hours of their time to gather information. Veterinarians will choose whether or not to charge for this additional time.

Small Businesses: Alternative Method that Minimizes Adverse Impact. There is no known alternative that has no effect on veterinarians while accomplishing the same goals.

Real Estate Development Costs. The proposed regulations have no effect on real estate development costs.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPB's best estimate of these economic impacts.

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¹ The proposed exemption is for licensing purposes only in that if the animal is exposed to rabies, euthanasia or 6-month strict isolation will still be required.

Agency's Response to Economic Impact Analysis: The Virginia Department of Health has reviewed and agrees with the Virginia Department of Planning and Budget's economic impact analysis.

Summary:

The proposed regulations (i) establish a procedure for issuing exemptions for rabies vaccination, (ii) require localities to have a response plan to rabies exposure, and (iii) establish requirements for recordkeeping associated with rabies clinics.

CHAPTER 105
RABIES REGULATIONS

12VAC5-105-10. Definitions.

The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Currently vaccinated" means the animal was (i) vaccinated by a licensed veterinarian or a licensed veterinary technician under the direct supervision of a licensed veterinarian on the premises and (ii) the animal was vaccinated and revaccinated in accordance with the current National Association of State Public Health Veterinarian's Compendium of Animal Rabies Prevention and Control or as described on the U.S. Department of Agriculture approved vaccine label. For the purposes of rabies exposure response and § 3.2-6522 of the Code of Virginia, an animal will not be considered currently vaccinated until it has been at least 28 days since the initial vaccination and then immediately after every subsequent vaccination.

"Department" means the Virginia Department of Health.

"Rabid animal" means an animal that has had the diagnosis of rabies confirmed by the Virginia Division of Consolidated Laboratory Services, Fairfax Health Department Laboratory, Centers for Disease Control and Prevention Rabies Laboratory, or a laboratory in any state that is recognized by that state to perform rabies testing for public health purposes. Any suspected rabid animal that has exposed a companion or agricultural animal or a person and is not available for laboratory testing should be presumed to be rabid.

"Rabies exposure" or "exposed to rabies" means any circumstance where saliva or central nervous system tissue from a rabid or suspected rabid animal entered or could have entered a fresh, open wound or come in contact with a mucous membrane of a person or susceptible species of companion or agricultural animal. For the purposes of companion and agricultural animal exposure, the actual witnessing of a bite or attack by a rabid or suspected rabid animal is not necessary to define an exposure; however, a rabid or suspected rabid animal needs to have been witnessed in close proximity to the exposed animal and where, in the judgment of the local health director or his designee, it is reasonable to assume that the rabid or suspected rabid animal could have exposed the susceptible companion or agricultural animal. The department should notify the Virginia Department of Agriculture and Consumer Services when agricultural animals meet exposure criteria and coordinate exposure response with that agency. This definition notwithstanding, decisions regarding the disposition of animals housed or maintained with an agricultural animal that is diagnosed with rabies shall be at the discretion of the local health director.

"Rabies vaccination certificate" means a document provided by a licensed veterinarian or a licensed veterinary establishment indicating a specific animal has been vaccinated or revaccinated in accordance with the National Association of State Public Health Veterinarian's Compendium of Animal Rabies Prevention and Control or as described on the U.S. Department of Agriculture approved vaccine label and includes at least, but is not limited to, the following: signature of the veterinarian, the animal owner's name and address, the locality where the animal resides, the species of the animal, the sex, whether or not the animal is spayed or neutered, the age, the color, the primary breed, the certificate expiration date, and the vaccination number, also known as the serial lot number. In lieu of individual certificates, a herd certificate can be issued for livestock other than horses that includes at least the signature of the veterinarian, the owner's name and address, the species of animal, the sex, the approximate age, the primary breed, date of vaccination, the rabies vaccine product name, the vaccination number, identifying information for each animal such as ear tag number, tattoo or other permanent identification, and the name and contact information of the veterinarian who administered the vaccine. In lieu of individual certificates, a certificate of veterinary inspection for use in shipping equine may be generated for horses that includes at least the signature of the veterinarian, the owner's name and address, the sex, the approximate age, the date of vaccination, the rabies vaccine product name, the vaccination number, identifying information for each horse such as name, color, markings, tattoo or brand, and the name and contact information for the veterinarian who administered the vaccine.

"Suspected rabid animal" means any animal that has not been tested for rabies and that the department considers to be a species at high risk for acquiring or transmitting rabies whether or not the animal is exhibiting clinical signs compatible with rabies and any animal the department considers at low risk for acquiring or transmitting rabies that is exhibiting clinical signs compatible with rabies. At the discretion of the local health director, any animal to which an observation period will be applied that may have bitten a person shall be considered a suspected rabid animal until the end of the observation period. The status of animals for which an observation period will not be applied or that the department has not identified as either high or low risk for acquiring or transmitting rabies shall be at the discretion of the local health director.

12VAC5-105-20. Rabies clinics.

The local health department (LHD) will maintain and provide upon request the following information about rabies clinics that it and the local governing body have approved within the previous 48 months:

1. Date.

2. Clinic site.

3. Name of sponsoring organization.

4. Name, address, and phone number of attending veterinarian.

12VAC5-105-30. Rabies vaccine exemptions.

A. The local health director, in consultation with the state public health veterinarian, may grant an exemption to the requirement for rabies vaccination as articulated in § 3.2-6521 of the Code of Virginia if a vaccination would likely endanger the animal's life due to a previously diagnosed disease or other previously documented medical considerations as documented by a licensed veterinarian.

B. Such exemption may be granted for an individual animal only after the veterinarian has (i) consulted with the local health director and completed and submitted to the LHD an application for exemption from rabies vaccination on a form approved by the department and (ii) submitted other documents or medical records as may be requested by the LHD. After approval of such exemption, the LHD shall issue a rabies vaccination exemption certificate, copies of which shall be provided to the veterinarian, the owner of the dog or cat exempted from rabies vaccination, and the animal control office of the municipality in which the owner of the dog or cat resides. Certification that a dog or cat is exempt from rabies vaccination may be presented in lieu of a rabies vaccination certificate for the purposes of veterinary inspection by designated local authorities and for the purposes of licensing by the locality where the animal resides. Certification that a dog or cat is exempt from rabies vaccination shall be valid for one year, after which time the animal shall be vaccinated against rabies or the application for exemption shall be renewed.

C. The governing body of any locality may require that an exempted animal be confined on the owner's property or kept on a leash, or both, or otherwise restrained if it is thought necessary to protect public health and safety. The governing body of any locality may require that a form of unique identification is associated with an exempted animal. An exempted animal shall be considered unvaccinated by the department in the event of the animal's exposure to a confirmed or suspected rabid animal. Any requirement to vaccinate an exempted animal for rabies in the event of that animal's exposure to a confirmed or suspected rabid animal shall be at the discretion of the local health director.

12VAC5-105-40. 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. 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 refering 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. Locality Epidemiology Staff. Locality epidemiology staff members are primarily responsible for the following activities in regard to companion animal and human rabies exposure response:

1. 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:

2. Demographics of person exposed;

3. Information about the animal and its owner;

4. Details of exposure;

5. PEP recommendations and actions;

6. Animal euthanasia secondary to suspect rabies; and

7. 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.

NOTICE: The following forms used in administering the regulation were filed by the agency. The forms are not being published; however, online users of this issue of the Virginia Register of Regulations may click on the name of a form with a hyperlink to access it. The forms are also available from the agency contact or may be viewed at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, Virginia 23219.

FORMS (12VAC5-105)

Request for Rabies Vaccination Exemption for Licensing and Inspection Purposes (eff. 3/12)

VA.R. Doc. No. R11-2637; Filed November 5, 2013, 9:41 a.m.