Todd,
 
RE: the interpretation of the Compendium is a problem, whichis why we are
trying in NH to get a quarantine into the state law.
 
I have been told (not read or verified) that at the hearing on the recent MD
ferret bite case, that Dr. Grigor admitted that they routinely quarantine
horses, cattle, etc. for 10 days even though they are kept outside (therefore
more likely exposed to rabies vectors) and there  have been no shedding
studies done on them - anywhere.
 
In hearing from knowledgable medical people, if the doctor of a bite victim
suspects the likelyhood of rabies, treatment should be started immediately.
The testing of the animal is to be used only to confirm, not deny, the
application of the treatment.  The example is, a raccoon acting strangely and
 attacking a person during the daylight hours (raccoons are usually
nocturnal), the doctor should start treatment imediately, and have the
raccoon killed and tested.  If the test comes back negative, continue the
treatment since there is about a 14% chance that the test would come back a
"false negative" . (Natural History of Rabies, 2nd Edition; shows the results
of an evaluation exercise performed by the U.S. Public Health Services in
1983, on 129 participating laboratories.  The evaluations showed that on true
negative samples, 5% of the labs returned a positive finding; on weak
positive samples, 14% returned a negative finding.). In other words, the
treatment should be started because of the diagnosis of a high probablily of
rabies in the animal species, the circumstances of the bite, and the presence
of rabies in the population.  You don't wait for the test results.  They
could be in error anyway.
 
The fact that MD did not start treatment on the 12 year old girl, shows me
that Public Health has no concern for rabies in this case.  Besides which,
treatment started 30 days after the bite of a truely rabid animal would be
useless anyway.
 
Dick Bossart
[Posted in FML issue 1083]