A Rabid Rescue Dog From Egypt: Connecticut, 2017

The United States eliminated the canine rabies virus variant in 2007, after about five decades and hundreds of millions of dollars of effort. Worldwide, though, dogs remain the main source of human rabies, and imported dogs can bring the variant back. Yonette Hercules of CDC and colleagues described one such case.

A shipment from Cairo

On December 20, 2017, four rescue dogs arrived at New York's John F. Kennedy International Airport (JFK) from Cairo, Egypt. An Egyptian animal rescue group had handed them to a "flight parent" — someone recruited through social media, often unconnected to the rescue group and usually paid with a plane ticket — who flew with them. Transporters, who shuttle dogs between states, and one owner collected them for foster homes and adopters in Connecticut, Maryland and Virginia. A fifth dog, with a different flight parent, shared the cargo hold on its way to Washington State via New Jersey and West Virginia.

One of the four, "dog A," a 6-month-old male Chihuahua mix, was visibly agitated and bit the flight parent before boarding in Egypt. He arrived with fractured teeth and exposed jawbone, reportedly from being hit by a car that autumn.

Diagnosis

It was the second rabid dog from Egypt in three years. Since 2007, canine-variant rabies had been found in dogs imported from India (2007), Iraq (2008) and Egypt (2015). This was the sixth rabid dog imported in 15 years, the third from the Middle East — and all six were rescue dogs.

Tracing exposures

CDC's New York Quarantine Station led a contact investigation covering dog A's infectious period, December 9–21, working with health departments along the chain of all five dogs, U.S. Customs and Border Protection (CBP), the USDA's Animal and Plant Health Inspection Service, the airline and the cargo company.

• Rabies post-exposure prophylaxis (PEP) was recommended for the flight parent bitten in Cairo, dog A's caretakers and the bitten veterinary technician.
• Transporters and foster volunteers had no direct contact with dog A and needed no PEP.
• At JFK, video and interviews identified 13 cargo and baggage handlers and four CBP officers; the handlers wore gloves and none touched the dogs, and officers handled only paperwork, so no PEP was recommended.
• All dogs rode in separate crates and were never let out, so the other four dogs weren't considered exposed. Dog A was isolated at the clinic.

How did he get in?

All five dogs had certificates showing rabies vaccination at least 3 months old and at least 30 days before arrival. Dog A's protection may have failed because of vaccine failure, improperly stored vaccine or falsified documents — and investigators found the documentation may have been falsified. Vaccine failure is rare when vaccine is stored and given properly, and the manufacturer reported no other problems with the lot. Dog A also apparently wasn't part of the shipment the flight parent had agreed to carry, and the flight parent knew nothing of his medical history.

Keeping canine rabies out

The United States has one of the world's strongest rabies networks — about 120 diagnostic labs testing about 100,000 animals a year — and high vaccination coverage among dogs; none of the six imported cases led to spread among U.S. dogs. But rabies in dogs may be underreported, since its variable course doesn't always prompt owners to seek testing, and at ports of entry, rabies signs — agitation, barking, aggression, altered behavior — look a lot like the stress of a long trip.

The authors call for continued vigilance at ports of entry, strong domestic surveillance, high dog vaccination rates, and better education of rescue organizations at home and abroad, especially about dogs from countries where the canine variant circulates. Accepting animals without knowing their history or the accuracy of their papers can expose people and animals to a deadly disease.

Sources

Based on Hercules Y, Bryant NJ, Wallace RM, et al., "Rabies in a Dog Imported from Egypt — Connecticut, 2017," MMWR, Centers for Disease Control and Prevention; in the public domain.