Use of a Modified Preexposure Prophylaxis Vaccination Schedule to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

The Guidelines for Standards of Care in Animal Shelters. Second Edition

“…Random cohousing of animals in shelters is an unacceptable practice� 25 Cohousing requires careful selection of animals by trained personnel to balance the benefits and risks for individual animals and the group� Unrelated or unfamiliar animals must not be cohoused until health and behavior are assessed� 27 When cohoused, animals need to be intentionally matched for age, sex, health, and behavioral compat-ibility� Monitoring after introduction is essential to recognize signs of stress or negative interactions (e�g� guarding food or other resources) that may necessitate separation� Given their increased welfare needs, animals predicted to have longer lengths of stay may benefit most from cohousing, particularly when foster care is not available� Regardless of the size of the enclosure, no more than six adult cats should be cohoused in a primary enclosure� 5 When cohousing is indicated, pairs are preferred for dogs to maximize safety and biosecurity, and no more than two to four adult dogs should be cohoused in a primary enclosure� 3 Larger groups of any species are challenging to monitor and increase the risk of conflict and infectious disease transmission� It is preferable to cohouse the minimum number of adult animals together needed to achieve a social benefit� Housing young puppies and kittens with their mother and littermates is important for physical and emotional development, as well as the establishment of species-specific behaviors� Because of their susceptibility to infectious disease, puppies and kittens under 20 weeks of age must not be cohoused with unfamiliar animals except when the benefits outweigh the risks for all animals involved� 38 For example, after a careful medical and behavioral assessment, a single orphaned kitten or puppy may be paired with another orphan or a surrogate mother (see Behavior)� Introducing new animals can result in stress for individuals and the group� Dogs should be introduced outside of their primary enclosures in pairs or groups to determine compatibility prior to cohousing� 3,27 In addition, turnover within groups must be minimized to reduce stress and social conflicts as well as the risk of infectious disease exposure and transmission� 22,39,40 The use of smaller enclosures with fewer animals, rather than large rooms with large groups of animals, minimizes the need for frequent introductions, group reorganization, and allows for more effective monitoring� 41,42 Smaller cohousing spaces facilitate an 'all-in/all-out' approach, where all animals leave before more are added� This strategy allows enclosures to be completely sanitized before a new group of animals moves in and eliminates the risks associated with new introductions�…”

“…Individual animals and group dynamics must be monitored to recognize signs of stress and social conflicts in cohousing enclosures� 24,43 Monitoring, especially after a new animal is introduced into a group and during feeding time, is critical to ensure that all animals are benefitting� In addition to daily monitoring for resource guarding and other signs of social conflict, regular physical examinations including measurement of body weight can ensure that cohoused animals are not suffering due to unrecognized social conflicts� Not all animals are well suited to cohousing� Individual enriched housing must be provided for animals who are fearful or behave aggressively toward other animals, are stressed by the presence of other animals, require individual monitoring, or are ill and require treatment that cannot be provided in cohousing� 22,41 Cohousing animals who fight with one another is unacceptable�…”

“…Hand sanitation is a key part of preventing disease trans-mission� 37,39 Hand hygiene stations should be available in or near every area where contact with animals occurs� 40 Ideally, hand hygiene stations are sinks that allow washing with soap and water, and drying with single use tow-els� At a minimum, hand hygiene stations provide hand sanitizer with at least 60% alcohol� 41 Because hand sanitizers are ineffective against some of the most concerning pathogens in shelters (e�g� parvovirus, calicivirus, and ringworm), hand sanitizers should not be relied on as the sole means of hand hygiene� 41,42 Proper handwashing technique includes wetting hands with clean, running water; applying and scrubbing with soap for at least 20 seconds; rinsing with clean water; and drying thoroughly with a fresh towel or forced air� 43 Proper hand sanitizer techniques include applying 1-2 pumps of gel product to one hand and then rubbing hands together until all surfaces are covered and dry (approximately 20 seconds)� Hand sanitizer should only be used on hands that are visibly clean� 41 Sanitation protocols must address hand hygiene for shelter staff, volunteers, and visitors� 3,4,37 Although all people can move pathogens around, shelter personnel are significantly more likely to do this while they complete daily care tasks compared to shelter visitors� 44…”

“…A core vaccine is one given to all eligible animals and is withheld only in extraordinary circumstances� 26 For all core vaccines except rabies, shelters should use modified live virus or recombinant vaccines (MLV) rather than killed products because they provide a faster immune response� [32][33][34] This includes vaccines for puppies, kittens, animals with FeLV or FIV, and pregnant and nursing animals� 29,35 Cerebellar hypoplasia is a theoretical complication of MLV panleukopenia vaccination of pregnant cats; however, the risk of abortion, maternal, and kitten death due to panleukopenia generally outweighs this concern in shelters� 36,37 MLV vaccines create effective, long-lasting immunity to distemper-, parvo-, adeno-, and panleukopenia viruses in dogs and cats with competent immune systems within days of initial vaccination and may provide partial protection sooner� 32,38,39 MLV vaccines also decrease symptoms and duration of herpes-, calici-, and parainfluenza virus and Bordetella infections� 24,33,34,40,41 Dogs A subcutaneous MLV vaccine for canine distemper-, adeno-, parvo-, and parainfluenza viruses (DAPP) is core for shelter puppies and dogs� 20 An intranasal vaccine containing both Bordetella and parainfluenza virus (Bord/ PI), with or without adenovirus, is also core for shelter puppies and dogs� 20 The intranasal route is important to maximize efficacy and activate respiratory immune cells, which can provide additional protection against other infectious respiratory diseases� 42,43 Cats A subcutaneous MLV vaccine for feline viral rhinotracheitis, calicivirus, and panleukopenia viruses (FVRCP) is core for shelter cats and kittens� Feline intranasal vaccination for herpes and calicivirus has a similar efficacy to the injectable, but there is questionable reliability of intranasal vaccination against panleukopenia virus� 22,38 Using both subcutaneous and intranasal vaccines together is safe but has not been shown to increase immunity over either product alone� The intranasal vaccine may provide protection against herpes and calicivirus to young kittens through reduced maternal antibody interference� 22 Rabies Eligible dogs and cats should be vaccinated against rabies before leaving shelter care� 11 Rabies vaccines must be administered following state and local guidelines and the most recent Compendium for Animal Rabies Prevention and Control� 44-47 Specific regulations for how rabies vaccination is to be documented and who can administer the vaccine vary by state� Puppies and kittens that are too young for rabies vaccination may be adopted or transported with the recommendation that new caretakers provide vaccination when old enough� Rabies vaccination of animals under 12 weeks of age, althoug...…”

Biosafety Practices When Working with Bats: A Guide to Field Research Considerations

“…In May 2022, the ACIP published modifications to pre-exposure rabies prophylaxis (PrEP) ( Table 2 ). 39 The modifications, which were accepted by the Director of the CDC, include:…”