Roadkill specimens are an important source of samples for enhanced rabies surveillance (ERS) in areas where other methods of sample collection may not be practical. However, the physical condition of roadkill specimens is unpredictable and, in many circumstances, unsatisfactory for rabies diagnostic testing by antigen detection methods. The high sensitivity of real-time reverse transcriptase PCR (RT-PCR) holds promise for rabies diagnostic testing of poor-quality samples. We conducted an evaluation of real-time RT-PCR to detect rabies virus RNA in roadkill samples. A total of 299 specimens were collected from raccoons (n = 232), skunks (n = 46), foxes (n = 17), coyotes (n = 2), a bobcat (n = 1), and a domestic cat (n = 1) across ten states during 2018 - 2021 in the United States. Eight samples (2.7%) were positive using the LN34 pan-lyssavirus real-time RT-PCR assay. These eight rabid animals in areas of high interest for wildlife rabies management would likely not have been identified otherwise. These findings support the use of real-time RT-PCR for samples that would typically be unsuitable for testing by widely used antigenic-based detection methods such as the direct fluorescent antibody test (DFA or FAT) and direct rapid immunohistochemistry test (DRIT).

Rabies is a fatal encephalitic disease affecting all mammals. This report describes identification of raccoon rabies virus variant isolated from a stray kitten in an urban Midwestern city that is nonendemic for this virus variant. The kitten originally presented with nonspecific neurologic abnormalities. Astute veterinary, wildlife, and public health professionals played a critical role in the identification of this fatal zoonotic disease and the extensive public health and wildlife management response that ensued. This case serves as an important reminder of the risk of rabies in unvaccinated animals or those without known vaccination status, including stray animals.

On September 28, 2023, a kitten aged approximately 6 weeks found in Omaha, Nebraska, had test results positive for rabies at the Nebraska Veterinary Diagnostic Center (NVDC) after dying with neurologic signs and having bitten and scratched its caretakers. Preliminary investigation identified 10 exposed persons for whom postexposure prophylaxis (PEP)(†) was recommended. Subsequent variant-typing by NVDC yielded a presumptive positive result for the Eastern raccoon rabies virus variant (RRVV), which CDC confirmed on October 6.

The raccoon (Procyon lotor) variant of the rabies virus (RRV) is enzootic in the eastern United States and oral rabies vaccination (ORV) is the primary strategy to prevent and control landscape spread. Breaches of ORV management zones occasionally occur, and emergency "contingency" actions may be implemented to enhance local control. Contingency actions are an integral part of landscape-scale wildlife rabies management but can be very costly and routinely involve enhanced rabies surveillance (ERS) around the index case. We investigated two contingency actions in Ohio (2017-2019 and 2018-2021) and one in Virginia (2017-2019) using a dynamic, multi-method occupancy approach to examine relationships between specific management actions and RRV occurrence, including whether ERS was sufficient around the index case. The RRV occupancy was assessed seasonally at 100-km(2) grids and we examined relationships across three spatial scales (regional management zone, RRV free regions, and local contingency areas). The location of a grid relative to the ORV management zone was the strongest predictor of RRV occupancy at the regional scale. In RRV free regions, the neighbor effect and temporal variability were most important in influencing RRV occupancy. Parenteral (hand) vaccination of raccoons was important across all three contingency action areas, but more influential in the Ohio contingency action areas where more raccoons were hand vaccinated. In the Virginia contingency action area, ORV strategies were as important in reducing RRV occupancy as a hand vaccination strategy. The management action to trap, euthanize, and test (TET) raccoons was an important method to increase ERS, yet the impacts of TET on RRV occupancy are not clear. The probability of detecting additional cases of RRV was exceptionally high (>0.95) during the season the index case occurred. The probability of detecting RRV through ERS declined in the seasons following initial TET efforts but remained higher after the contingency action compared to the ERS detection probabilities prior to index case incidence. Local RRV cases were contained within one year and eliminated within 2-3 years of each contingency action.

Rabies virus (RABV) is a deadly zoonosis that circulates in wild carnivore populations in North America. Intensive management within the USA and Canada has been conducted to control the spread of the raccoon (Procyon lotor) variant of RABV and work towards elimination. We examined RABV occurrence across the northeastern USA and southeastern Quebec, Canada during 2008-2018 using a multi-method, dynamic occupancy model. Using a 10 km x 10 km grid overlaid on the landscape, we examined the probability that a grid cell was occupied with RABV and relationships with management activities (oral rabies vaccination (ORV) and trap-vaccinate-release efforts), habitat, neighbour effects and temporal trends. We compared raccoon RABV detection probabilities between different surveillance samples (e.g. animals that are strange acting, road-kill, public health samples). The management of RABV through ORV was found to be the greatest driver in reducing the occurrence of rabies on the landscape. Additionally, RABV occupancy declined further with increasing duration of ORV baiting programmes. Grid cells north of ORV management were at or near elimination ([Image: see text] = 0.00, s.e. = 0.15), managed areas had low RABV occupancy ([Image: see text] = 0.20, s.e. = 0.29) and enzootic areas had the highest level of RABV occupancy ([Image: see text] = 0.83, s.e. = 0.06). These results provide evidence that past management actions have been being successful at the goals of reducing and controlling the raccoon variant of RABV. At a finer scale we also found that vaccine bait type and bait density impacted RABV occupancy. Detection probabilities varied; samples from strange acting animals and public health had the highest detection rates. Our results support the movement of the ORV zone south within the USA due to high elimination probabilities along the US border with Quebec. Additional enhanced rabies surveillance is still needed to ensure elimination is maintained.

OBJECTIVE: To evaluate rabies virus (RABV) characterization data obtained from animal specimens submitted to the US public health rabies surveillance system and propose a standardized approach to sample selection for RABV characterization that could enhance early detection of important rabies epizootic events in the United States. SAMPLE: United States public health rabies surveillance system data collected from January 1, 2010, through December 31, 2015. PROCEDURES: Data were reviewed to identify RABV-positive specimens for which virus characterization would likely provide information regarding any of 4 overarching events (discovery of novel variants, translocation of RABV variants, host-shift events, and any unusual rabies-related event) that could substantially alter animal rabies epizootiology in the United States. These specimens were designated as specimens of epizootiological importance (SEIs). Estimates of the additional number of specimens that public health laboratories could expect to process each year if all SEIs underwent RABV characterization were calculated. RESULTS: During the 6-year period, the mean annual number of SEIs was 855 (95% CI, 739 to 971); the mean number of SEIs that underwent virus characterization was 270 (95% CI, 187 to 353). Virus characterization of all SEIs would be expected to increase the public health laboratories' test load by approximately 585 (95% CI, 543 to 625) specimens/y. CONCLUSIONS AND CLINICAL RELEVANCE: Prioritization of RABV characterization of SEIs may improve early detection of rabies events associated with RABV host shifts, variant translocations, and importation. Characterization of SEIs may help refine wildlife rabies management practices. Each public health laboratory should evaluate testing of SEIs to ensure diagnostic laboratory capacity is not overstretched.

Intensive efforts are being made to eliminate the raccoon variant of rabies virus (RABV) from the eastern United States and Canada. The United States Department of Agriculture (USDA) Wildlife Services National Rabies Management Program has implemented enhanced rabies surveillance (ERS) to improve case detection across the extent of the raccoon oral rabies vaccination (ORV) management area. We evaluated ERS and public health surveillance data from 2006 to 2017 in three northeastern USA states using a dynamic occupancy modeling approach. Our objectives were to examine potential risk corridors for RABV incursion from the U.S. into Canada, evaluate the effectiveness of ORV management strategies, and identify surveillance gaps. ORV management has resulted in a decrease in RABV cases over time within vaccination zones (from occupancy ( psi ) of 0.60 standard error (SE) = 0.03 in the spring of 2006 to psi of 0.33 SE = 0.10 in the spring 2017). RABV cases also reduced in the enzootic area (from psi of 0.60 SE = 0.03 in the spring of 2006 to psi of 0.45 SE = 0.05 in the spring 2017). Although RABV occurrence was related to habitat type, greater impacts were associated with ORV and trap-vaccinate-release (TVR) campaigns, in addition to seasonal and yearly trends. Reductions in RABV occupancy were more pronounced in areas treated with Ontario Rabies Vaccine Bait (ONRAB) compared to RABORAL V-RG((R)). Our approach tracked changes in RABV occurrence across space and time, identified risk corridors for potential incursions into Canada, and highlighted surveillance gaps, while evaluating the impacts of management actions. Using this approach, we are able to provide guidance for future RABV management.

A necessary component of elimination programmes for wildlife disease is effective surveillance. The ability to distinguish between disease freedom and non-detection can mean the difference between a successful elimination campaign and new epizootics. Understanding the contribution of different surveillance methods helps to optimize and better allocate effort and develop more effective surveillance programmes. We evaluated the probability of rabies virus elimination (disease freedom) in an enzootic area with active management using dynamic occupancy modelling of 10 years of raccoon rabies virus (RABV) surveillance data (2006–2015) collected from three states in the eastern United States. We estimated detection probability of RABV cases for each surveillance method (e.g. strange acting reports, roadkill, surveillance-trapped animals, nuisance animals and public health samples) used by the USDA National Rabies Management Program. Strange acting, found dead and public health animals were the most likely to detect RABV when it was present, and generally detectability was higher in fall–winter compared to spring–summer. Found dead animals in fall–winter had the highest detection at 0.33 (95% CI: 0.20, 0.48). Nuisance animals had the lowest detection probabilities (~0.02). Areas with oral rabies vaccination (ORV) management had reduced occurrence probability compared to enzootic areas without ORV management. RABV occurrence was positively associated with deciduous and mixed forests and medium to high developed areas, which are also areas with higher raccoon (Procyon lotor) densities. By combining occupancy and detection estimates we can create a probability of elimination surface that can be updated seasonally to provide guidance on areas managed for wildlife disease. Synthesis and applications. Wildlife disease surveillance is often comprised of a combination of targeted and convenience-based methods. Using a multi-method analytical approach allows us to compare the relative strengths of these methods, providing guidance on resource allocation for surveillance actions. Applying this multi-method approach in conjunction with dynamic occupancy analyses better informs management decisions by understanding ecological drivers of disease occurrence.

Delayed HIV diagnosis among men who have sex with men (MSM) in the United States continues to be a significant personal and public health issue. Using qualitative and quantitative data from 75 recently tested, HIV-sero-positive MSM (38 delayed and 37 nondelayed testers), the authors sought to further elucidate potential personal and contextual factors that may contribute to delayed HIV diagnosis among MSM. Findings indicate that MSM who experience multiple life stressors, whether personal or contextual, have an increased likelihood of delaying HIV diagnosis. Furthermore, MSM who experience multiple life stressors without the scaffolding of social support, stable mental health, and self-efficacy to engage in protective health behaviors may be particularly vulnerable to delaying diagnosis. Interventions targeting these factors as well as structural interventions targeting physiological and safety concerns are needed to help MSM handle their life stressors more effectively and seek HIV testing in a timelier manner.