In response to the ongoing rabies outbreak in wild animals in Taiwan, the seventh meeting convened by the inter-ministerial working group was held on July 31, 2013. The meeting was presided by the Director-General of the Bureau of Animal and Plant Health Inspection and Quarantine (BAPHIQ), Council of Agriculture (COA), Dr. Su-San Chang, and the Director-General of the Taiwan Centers for Disease Control (Taiwan CDC), Dr. Feng-Yee Chang. Vice Premier Chi-Kuo Mao specifically instructed in writing that relevant ministries and all local governments to reinforce the implementation of the following rabies prevention and control policies:

1. Since there is a sudden increase in the current demand for animal rabies vaccine, the Consumer Protection Committee of the Executive Yuan has been asked to monitor the market conditions to prevent hoarding by vaccine sellers or animal hospitals through appropriate interventions.

2. The Ministry of Transportation and Communication has been asked to assist in locating all possible media channels around commercial transportation modes to facilitate the implementation of rabies awareness campaigns.

3. The first wave of 300 pre-exposure human rabies vaccinations started on July 29, 2013. According to the statistics collected by Taiwan CDC during the past two days, the vaccination rate is rather low. To ensure the health and wellbeing of the frontline health workers, local health bureaus are urged to notify recommended target groups to receive the vaccine as soon as possible.

4. Although the ongoing rabies outbreak is only limited to wild animals, the number of species the outbreak affected has expanded. All ministries are advised to stay vigilant, pool resources for prevention efforts together, and reinforce relevant cooperation activities. In addition, to effectively prevent the transmission of rabies virus and ensure the health and wellbeing of the people in Taiwan, a number of prevention efforts have been strengthened, including the capture of stray animals in townships where the incidence of rabies in wild animals has been detected for rabies vaccination.

The World Health Organization (WHO) has not recommended the members of the general public to receive pre-exposure rabies vaccination. As the cross-species transmission of rabies has occurred, Taiwan CDC has amended the list of recommended target groups for post-exposure rabies prophylaxis, which might be adjusted according to the latest test results conducted by COA and the development of the outbreak situation, as follows:

1. When bitten or scratched by wild mammals, including house shrews, and stray cats and dogs, please seek immediate medical attention and receive the human rabies vaccine. If the test result for rabies is negative or the biting animal does not any rabies symptoms during the observation period, the patient may stop receiving the vaccine. When bitten or scratched by domestic cats and dogs, the patient will not be given the rabies vaccine. However, if the biting cat or dog develops rabies symptoms during the observation period and BAPHIQ suspects the patient’s likelihood of rabies infection to be high, the patient will be given the vaccine.

2. When bitten or scratched by ferret-badgers and animals with abnormal behavior such as aggression or lack of fear of people anywhere in the nation or house shrews in Taitung City, the biting animal has been suspected of rabies infection by the central agriculture authority, and the type of contact is determined to be category III contact, which includes single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, with the suspected rabid animal, administration of human rabies immune globulin (HRIG) will be recommended.

According to statistics compiled by Taiwan CDC, between 4pm on July 29 and 4pm on July 30, 2013, a total of 117 new animal bite cases applying for rabies vaccine were received. Of the applications, 52 have been approved, including 2 applications from Taipei, 4 applications from northern Taiwan, 13 applications from central Taiwan, 22 applications from southern Taiwan, 6 applications from Kaohsiung and Pingtung, and 5 applications from eastern Taiwan. At the time of writing, an accumulative total of 362 animal bite cases applying for rabies vaccine were received. Of the applications, 167 have been approved, including 9 applications from Taipei, 13 applications from northern Taiwan, 46 applications from central Taiwan, 47 applications from southern Taiwan, 20 applications from Kaohsiung and Pingtung, 25 applications from eastern Taiwan, and 7 applications from out of the country. 10 applications were approved for the use of HRIG and 7 of them have received the prophylaxis.

Taiwan CDC reminds clinicians who encounter wild animal bite cases to remember to record the location where the bite occurred, the animal species that made the bite, and whether the animal has been retained for observation. If a patient is qualified for post-exposure vaccination, please contact a Taiwan CDC Regional Center to facilitate the application for rabies vaccines. For more information on rabies prevention, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-024582 if calling from a cell phone. For more information on outbreaks of animal diseases, please call the COA’s hotline, 0800-761-590.