County near top in confirmed rabies cases [The Frederick News-Post, Md.]

Nov. 11--Liam Goodnough toddled around the living room of his family's Frederick home on a warm August evening, seemingly oblivious to his scrape with a potentially lethal virus.

Just two days earlier, the 2-year-old with red curly hair finished the last in a series of rabies shots as a preventive measure after he was scratched in the face by a stray kitten during a visit to a Frederick farm in late July.

The kitten disappeared from the farm before it could be quarantined and watched for signs of rabies infection.

Without any additional information about the kitten's health, the family decided not to risk the unknown. While there's no protocol for scratches from an animal, the Goodnoughs decided it was better to err on the side of caution.

"It was more like, there just wasn't certainty to make a decision one way or another," Brian Goodnough said. "We didn't have enough information to go on because we couldn't find the cat."

By the numbers

Frederick has routinely been near the top across the state for laboratory confirmed rabies cases in animals in recent years. A total of 34 cases were confirmed in animals in Frederick County this year through Sept. 28, including 17 in raccoons, according to the state Department of Health and Mental Hygiene. That number ranked the county No. 2 for the year so far, ranking only behind Worcester County, which had 39 cases, including 34 in raccoons.

Since 2010, more than 139 laboratory confirmed rabies cases in animals in Frederick County have been reported, ranking it No. 2. Only Montgomery County had more cases, with 149 reported. After Montgomery and Frederick, the number of reported cases per county drops, with a total of 117 reported by Baltimore City since 2010, according to DHMH data.

Rabies is transmitted only through saliva and brain or nervous system tissue, according to the Centers for Disease Control and Prevention. Petting an animal or contact with its blood, urine or feces is not considered exposure.

"It is a deadly disease," said Darlene Armacost, manager of the county's communicable disease and preparedness program. "Prevention is really the key."

Maryland law requires all dogs, cats and ferrets to be vaccinated against the virus. Armacost said one of the most common examples in which a human is exposed is a fight between a dog and wild animal, often a raccoon. She recommends when pet owners come to the aid of an injured pet, they should cover his or her hands to prevent possible exposure to infected fluids.

The last reported case of rabies infection in a human in the state was in March, the first in Maryland since 1976. The CDC confirmed the infection resulted from an organ transplant. Kimberly Mitchell, chief of rabies and vector-borne diseases at the state Health and Mental Hygiene Department, would not give the county of origin in that case but said it was not Frederick County. Health laws prevent officials from disclosing the identity of someone who sought treatment for post-rabies exposure.

Rabies cases tend to re-enter the public consciousness in the warm months because that's when people spend more time outdoors, but county health officials said they see cases year-round.

"You're more likely to be outside and more likely to be one with nature," said George Keller, director of environmental health services for the county health department. "And your animals are more likely to be outside."

County officials attribute the county's large number of cases to many different reasons. Frederick is the state's largest county in land area and has a number of large parks. While largely rural, the county is developing rapidly, dislodging some animal habitats, Keller said.

"As you get more growth, more people infringe on habitats," Keller said.

Geographically, confirmed rabies cases in 2013 appear to be spread out through the county fairly evenly. There was a spike in May with eight confirmed cases of rabies in animals, but there was only one confirmed case in June and none in August. There were also five confirmed cases in February.

Alicia Evangelista, a program manager in environmental health at the health department, added that there are likely a number of cases they never learn about. Farmers, homeowners or animal control officials may euthanize an animal they suspect of rabies infection, but if it did not knowingly expose a human or another animal, it won't be sent for testing.

Evangelista and Keller also credited the department's emphasis on education and raising awareness about the virus. While each county handles animal control differently, Frederick has someone available to handle animal emergencies 24 hours a day, Evangelista said, and the health department works with other agencies to raise rabies awareness. In some cases, awareness may be driving the numbers, they said.

"In Frederick, we pride ourselves on having a very robust program," Keller said.

No illness

The Goodnoughs took Liam to Frederick Memorial Hospital, where the first of four visits during a two-week span began.

Liam was one of 65 patients that sought post-exposure treatment for rabies at FMH so far this fiscal year, which began July 1. The hospital has handled treatment on behalf of the county health department since February, when it was transferred mostly for the purpose of patients being able to use insurance to cover treatment, county health officer Barbara Brookmyer said. That number does not include people who may have sought treatment outside the county.

The hospital started 39 patients on the vaccine in fiscal 2013 and the county started another 63 people on it during that same time period for a total of 102, Armacost said. During fiscal 2012, 108 people were started on the vaccine.

Postexposure treatment does not come cheaply, FMH Clinical Pharmacy Manager Patricia Grunwald said in an email that was sent through hospital spokeswoman Amanda Changuris. The first day of treatment includes shots of globulin of rabies antibodies as well as vaccine. The vaccine is again administered by injection three, seven and fourteen days after the first round. The entire course of treatment can cost more than $1,000. Some insurance companies may cover treatment, Grunwald said.

For Liam, the cost of treatment meant six different needles, five shots and four visits to the hospital, but months after his scratch, he's doing fine, Brian Goodnough said. The insurance company was billed for about $4,700 for the incident, he said.

For now, the family asks that pet owners vaccinate their animals.

"You never really think about it until you're on the other end of it," Brian Goodnough said. "I guess the biggest thing is, like, it doesn't take that much time and it isn't that expensive to take your animal to the vet and give it a rabies shot."

Follow Courtney Mabeus on Twitter: @courtmabeus.

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