Hello everyone,
I have not yet received word on the test results of the Grand Rapids, MI
ferret that was killed and tested but I did receive a reply to some of my
previous inquiries.  I thought that I would share this with you so that you
could see what we are up against!!!  It is hard for me to believe that this
"doctor" is in such a position.  I always thought that scientists dealt
occasionally with facts (SKUNKS?????).  Thanks to all for writing to
Michigan.  Keep those letters coming.  Please copy this "doctor" as it
appears that he is (could anything be clear when dealing with the
government?) assuming the lead for this matter.
 
His email is EXACTLY (note upper case) this:
[log in to unmask]
 
In order to keep the FML clear, please email me directly if you have
comments.  I am obviously upset with this, but we are making a dent.
 
===========================================================================
June 18, 1996
Dear Mr. & Mrs. Les: ([log in to unmask])
 
Director Haveman has asked me to respond to your E-mail of June 7, 1996,
regarding ferrets.  Dr. Stobierski also has forwarded the E-mail messages
you directed towards her recently as well.  She related to me that she spoke
by telephone to you on May 22, 1996, shortly after you sent your original
message and hoped she had answered your questions.  It appears that you have
misinterpreted the role that Dr. Stobierski has in Department policy.  She
does not set policy regarding ferrets, but does carry out Department policy.
In other words, the Michigan Department of Community Health has a policy
regarding ferrets that she and others in this department follow.
 
Rabies consultations are always based on an assessment of risk.  The mission
of our Department is to protect human health by preventing disease and
injury.  Because of this responsibility, state public health officials must
take seriously any potential exposure to an essentially fatal disease such
as rabies.  Michigan did have a rabid ferret in 1985 in Ontonagon county
that involved human bite exposure.  Rabies positive bats and other animals
are reported throughout the state every year, thus no area of Michigan is
considered to be free of rabies.  These facts are taken into account
whenever we are consulted about an animal bite, regardless of the species
involved.
 
Our state's rabies policy on ferrets, other animal species, and people, are
derived from national documents that deal with rabies and public health.
These documents are the Compendium of Animal Rabies Control, published by
the National Association of State Public Health Veterinarians on an annual
basis, and a document titled 'Rabies Prevention - United States, 1991,
Recommendations of the Immunization Practices Advisory Committee (ACIP)'
published by the Centers for Disease Control in Morbidity and Mortality
Weekly Report, March 22, 1991.  We understand that the ACIP group plans to
meet this year and review their rabies recommendations.  Both these
documents are the products of advisory committees and represent a consensus
view of experts from the Centers for Disease Control, academia, other
government agencies and clinical practice.  In the public health community,
national policy is often developed this way.  Another reference document is
the 'Statement on Ferrets' issued jointly by The Council of State and
Territorial Epidemiologists and The National Association of State Public
Health Veterinarians.  In a concise fashion, it expresses the concerns of
the public health community about ferrets.
 
You point out that some states have a policy on biting ferrets that may not
call for euthanizing them as often.  The state of Michigan has chosen to
adopt the national recommendations because everything we know about rabies
in our state implies that these recommendations are appropriate for
Michigan.  Most other states follow the same national guidelines that we do.
You may wish to ask the states that have chosen to deviate form the national
guidelines why they have done so.
 
Rabies vaccine is required for ferrets because, it seems likely to greatly
increase the probability that an animal is protected against rabies.
However, even if a vaccine is 95% effective, it is still ineffective 5% of
the time.  In the one published study we have seen on Imrab (Rupprecht et.
al.  1990), only 36 ferrets were studied.  When challenged with rabies
virus, 32 survived, but 4 died of rabies, thus demonstrating a vaccine
efficacy of 89%.
 
Vaccination of any animal, even dogs and cats, with an approved rabies
vaccine is no guarantee that rabies will be prevented.  That is why, if a
dog or a cat bites a person, the animal is placed in ten days of confinement
and observation, whether or not it is vaccinated.  We know from scientific
studies and from many years of worldwide experience, that if a dog or cat is
capable of transmitting rabies virus when it bites a person, it will be
showing signs at that time or within a few days.  If signs of disease occur
in the dog or cat during confinement, there is time to administer the
lifesaving post-exposure treatment to the person who has been bitten.
 
In contrast to dogs and cats, the period between onset of viral shedding and
development of recognizable signs has not been established for ferrets.  If
this period is longer than ten days, it could delay the initiation of
post-exposure treatment for the bitten person and put that person at risk
for acquiring (and dying) from rabies.  We have neither scientific evidence,
nor lengthy experience, on which to base a confinement period for ferrets.
We do know that ferrets are in the same family as skunks and that these
animals have been known to shed virus for almost two weeks prior to onset of
signs of rabies.
 
Studies are presently underway to try and determine a virus shedding period
for ferrets and the relation to clinical signs of disease.  We are pleased
that Dr. Charles Rupprecht is one of the investigators.  Public health
officials encouraged the initiation of such studies and truly look forward
to results that may help them avoid the difficult decisions involved in
recommending euthanasia of beloved pets.  Once these studies are published
in a peer-reviewed scientific journal, the information will be able to be
assessed by those who determine rabies policy at the national and state
levels.
 
You may wish to consult with the National Association of State Public Health
Veterinarians, the Centers for Disease Control & Prevention, or the Advisory
Committee on Immunization Practices about the scientific data supporting
their recommendations relating to rabbits, rodents and livestock.  As we
understand it, their recommendations are based primarily upon the wealth of
experience the public health community has in dealing with potential
exposures from these animals that goes back to well before the turn of the
century.  Pet ferret exposures, on the other hand, are a relatively new
phenomenon.  Our experience is limited so we want to err on the side of
preventing human illness/death.  Scientific studies that are currently in
progress are the quickest way to get the needed data, as we do not have the
foundation to make any other recommendation besides euthanasia and testing
for biting ferrets.
 
In a bite situation, when an anxious bite victim and responsible attending
physician are contemplating the expensive, month-long rabies post-exposure
treatment, and there is no scientific data upon which to establish a
quarantine for a ferret, the public health official is put in the difficult
position of having to choose human health over the life of an animal.  These
are not pleasant decisions, and no one likes having to make such a choice.
Because rabies is essentially fatal for people once symptoms develop, public
health officials will always choose the safest option when making decisions
on animal versus human life.  Ferret owners and their organizations, as well
as veterinarians, animal welfare groups and animal control organizations can
all work toward the common goal of educating ferret owners to be responsible
in the care of their animals and in preventing bites to humans.
 
The figure that you cite for transportation and testing of biting ferrets
needs to be considered in light of the costs of post-exposure rabies
treatment that is recommended for all the reasons mentioned above.  Rabies
post-exposure treatments for people are conservatively estimated to cost
$1500.  - $2000., and we cannot place a dollar amount on the human pain
associated with receiving them, or the potential for loss of human life,
even if that risk is small.
 
Thank you for this additional opportunity to clarify the public health
position on ferret bites in Michigan.  Dr. Stobierski, in her role as state
public health veterinarian and infectious disease epidemiologist, does an
excellent job as the #front-line# person for rabies contact in our
Department.  She and the other scientists here who answer rabies questions
are consistent in their interpretation of Department policy.  We are sorry
you misinterpreted her role in policy-making.  It was inappropriate to
question her suitability for her position; indeed, she is very
well-qualified and performs exceptionally well in her job.
 
Any assistance that you can provide to help educate ferret owners and those
contemplating ferret ownership, and to support the collection of sound
scientific information on which to base public health decisions will be
appreciated.
 
Sincerely,
David R. Johnson, MD,MPH
Chief Medical Executive
[Posted in FML issue 1607]