R 131628Z OCT 11
UNCLASSIFIED//
MARADMIN 607/11
MSGID/GENADMIN/CMC WASHINGTON DC HS//
SUBJ/HUMAN RABIES RISK MITIGATION//
REF/A/MSGID:DOC/CENTCOM GENERAL ORDER NO 1B/YMD:2006MAR13//
REF/B/MSGID:DOC/MOD TEN TO USCENTCOM INDIVIDUAL PROTECTION AND INDIVIDUAL/UNIT DEPLOYMENT POLICY/YMD:2010MAR05//
REF/C/MSGID:DOC/BUMEDINST 6230.15A/YMD:2006SEP29//
REF/D/MSGID:DOC/BUMEDINST 6220.13/YMD:2004MAY28//
REF/E/MSGID:DOC/SECNAVINST 6401.1B/YMD:2006SEP29//
REF/F/MSGID:DOC/CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)/YMD:2010MAR19//
NARR/REF (A) IS CENTCOM GENERAL ORDER NUMBER 1B (GO-1B) PROHIBITING ADOPTION, CARING FOR, OR FEEDING ANY TYPE OF DOMESTIC OR WILD ANIMAL.  REF (B) IS MOD 10 TO CENTCOM PROTECTION AND DEPLOYMENT POLICY HIGHLIGHTING LOCAL ANIMAL DISEASE RISK AND ORDERING DEPLOYED PERSONNEL TO AVOID CONTACT WITH LOCAL ANIMALS.  REF (C) IS BUMEDINST 6230.15A, IMMUNIZATION AND CHEMOPROPHYLAXIS, PROVIDING POLICY ON PRE-EXPOSURE PROPHYLAXIS AS WELL AS POST EXPOSURE RABIES VACCINATION. REF (D) IS BUMEDINST 6220.13, RABIES PREVENTION AND CONTROL, PROVIDING POLICY ON ENSURING STANDARD PROCEDURES EXIST FOR THE INVESTIGATION, EVALUATION, TRACKING, FOLLOWUP, AND MANAGEMENT OF ANIMAL BITES.  REF (E) IS SECNAVINST 6401.1B, VETERINARY HEALTH SERVICES, PROVIDING POLICY ON RABIES CONTROL.  REF (F) IS CDC PUBLICATION MORBIDITY AND MORTALITY WEEKLY REPORT (MMWR), USE OF A REDUCED (4-DOSE) VACCINE SCHEDULE FOR POST-EXPOSURE PROPHYLAXIS TO PREVENT HUMAN RABIES, RECOMMENDATIONS OF THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES, VOL 59: NO RR-2, 19 MAR 2010//
POC/CDR W. S. PADGETT (USN), PREVENTIVE MEDICINE OFFICER, 703-614-4477 (DSN 224), WILLIAM.PADGETT(AT)USMC.MIL//
GENTEXT/REMARKS/1.  THIS MARADMIN REITERATES EXISTING FORCE HEALTH PROTECTION RABIES CONTROL POLICIES AND PROCEDURES.
2.  BACKGROUND
A.  IN AUGUST 2010, AN ARMY SOLDIER SUDDENLY DIED OF RABIES AFTER BEING BITTEN BY AN AFGHANI DOG 6-12 MONTHS EARLIER.  THIS TRAGIC LOSS IS A GRIM REMINDER THAT MARINES AND SAILORS GOING INTO HARMS WAY FACE DANGERS BEYOND KINETIC COMBAT.  THE SUBSEQUENT INVESTIGATION IDENTIFIED THAT SERVICE MEMBERS HAD ADOPTED LOCAL ANIMALS AS PETS, UNITS AND INSTALLATIONS HARBORED LOCAL ANIMALS, SERVICE MEMBERS FAILED TO COMPLETE POST-EXPOSURE RABIES VACCINE REQUIREMENTS, AND OTHER PERSONNEL SUFFERED INJURIES CAUSED BY ANIMALS THAT WERE NOT REPORTED OR DOCUMENTED.
B.  RABIES IS A REAL AND DEADLY THREAT TO PERSONNEL. ALL LOCAL ANIMALS, PARTICULARLY DOGS AND BATS, SHOULD BE VIEWED AS POTENTIALLY RABID. ANIMALS OFTEN APPEAR HEALTHY WHILE CARRYING THE RABIES VIRUS, ENABLING A SEEMINGLY LOYAL ANIMAL TO SPREAD THE DISEASE TO HUMANS.  ONCE SYMPTOMS OCCUR, RABIES IS FATAL, BUT TIMELY MEDICAL EVALUATION AND COMPLETE TREATMENT AFTER AN ANIMAL INJURY IS HIGHLY EFFECTIVE AT SAVING LIVES.
3.  FORCE HEALTH PROTECTION POLICY MUST BE EXECUTED CORRECTLY AND INJURIES CAUSED BY ANIMALS REPORTED IMMEDIATELY TO ENSURE THE SAFETY AND WELL-BEING OF PERSONNEL.  COMMANDERS MUST ENFORCE FORCE HEALTH PROTECTION POLICIES FOR THEIR AREAS OF RESPONSIBILITY (AOR), INCLUDING REFS (A) AND (B) WHEN OPERATING IN THE CENTRAL COMMAND (CENTCOM) AOR, MANDATING AVOIDANCE OF CONTACT WITH LOCAL ANIMALS AND IMMEDIATELY REPORTING INJURIES DUE TO ANIMALS. UNREPORTED INJURIES CAUSED BY ANIMALS THAT OCCURRED WITHIN THE PAST 18 MONTHS MUST BE IDENTIFIED AND EVALUATED BY PROPER MEDICAL OFFICIALS TO ENSURE PROPER TREATMENT IS PROVIDED, IF REQUIRED.
4.  EXECUTION
A.  PRE-EXPOSURE RABIES PROPHYLAXIS.  PER REF (C), PRE-EXPOSURE IMMUNIZATION IS REQUIRED FOR PERSONNEL OCCUPATIONALLY AT RISK OF EXPOSURE TO RABID ANIMALS AND PEOPLE ASSIGNED LONG-TERM TO REGIONS WITH ENDEMIC RABIES.  PERSONNEL THAT WILL REQUIRE PROPHYLAXIS INCLUDE:
(1) ALL ANIMAL HANDLERS SUCH AS MILITARY WORKING DOG, IMPROVISED EXPLOSIVE DEVICE DETECTOR DOG, AND TACTICAL EXPLOSIVE DETECTOR DOG HANDLERS.
(2) VETERINARY WORKERS AND CERTAIN LABORATORY PERSONNEL.
(3) WILDLIFE MANAGEMENT PROFESSIONALS AS WELL AS PERSONNEL RESPONSIBLE FOR ANIMAL CONTROL PROGRAMS WHILE DEPLOYED SUCH AS PREVENTIVE MEDICINE TECHNICIANS.
(4) SPECIAL OPERATIONS PERSONNEL.
(5) PERSONNEL ASSIGNED TO AREAS WITH ENDEMIC RABIES WHO WILL NOT BE ABLE TO RECEIVE POST-EXPOSURE RABIES TREATMENT WITHIN A FEW DAYS OF AN INJURY CAUSED BY A HIGH-RISK ANIMAL.
B.  RABIES RISK MITIGATION.  REFS (A) AND (B) PROHIBIT MARINES AND SAILORS FROM ADOPTING AS PETS OR MASCOTS, CARING FOR, OR FEEDING ANY TYPE OF DOMESTIC OR WILD ANIMAL WHILE DEPLOYED TO THE CENTCOM AOR.  THE SAME PROHIBITION SHOULD APPLY IN FORCE HEALTH PROTECTION ORDERS CONCERNING OTHER DEPLOYMENT AREAS. REF (D) DIRECTS COMMANDERS TO EDUCATE PERSONNEL ON THE RISKS AND CONSEQUENCES OF ANIMAL BITES, APPROPRIATE MEASURES TO PREVENT BITES FROM STRAY OR WILD ANIMALS, AND GENERAL MEASURES TO OBTAIN EVALUATION AND TREATMENT UPON POSSIBLE EXPOSURE IN GARRISON AND WHILE DEPLOYED.  REF (E) PROVIDES POLICY TO HUMANELY AND SAFELY REMOVE ANIMALS FROM MILITARY BASES AND CAMPS IN THE GARRISON AND DEPLOYED SETTING TO MINIMIZE RABIES EXPOSURE RISK.
C.  POST-EXPOSURE EVALUATION AND TREATMENT.  PER REF (F), ANY INJURY CAUSED BY AN ANIMAL SUCH AS BITES AND SCRATCHES AS WELL AS ANY ANIMAL LICKING AN INDIVIDUALS MUCUS MEMBRANES OR OPEN SKIN WOUND REQUIRES URGENT MEDICAL EVALUATION TO ASSESS RABIES RISK AND PROVIDE TIMELY TREATMENT, IF REQUIRED.  BATS FOUND IN SLEEPING QUARTERS ARE CONSIDERED A RABIES RISK THAT REQUIRES EVALUATION EVEN WHEN THERE IS NO KNOWN BAT BITE (BECAUSE OF THE PAINLESS BITES THAT MAY HAVE BEEN INFLICTED).  BECAUSE LONG DELAYS AFTER EXPOSURE CAN OCCUR BEFORE RABIES SYMPTOMS DEVELOP, PREVIOUSLY UNREPORTED/UNDOCUMENTED INJURIES AS WELL AS INCOMPLETELY TREATED CASES MUST BE EVALUATED BY MEDICAL PERSONNEL FOR POSSIBLE TREATMENT.
5.  PERSONNEL NO LONGER ELIGIBLE FOR MILITARY MEDICAL CARE OR WHO ARE NOT NEAR A MILITARY TREATMENT FACILITY WHO NEED TO BE EVALUATED FOR A PREVIOUSLY UNREPORTED/UNDOCUMENTED/INCOMPLETELY TREATED EXPOSURE, SHOULD CALL THE ARMY WOUNDED SOLDIER AND FAMILY HOTLINE AT (800) 984-8523 TO COORDINATE THEIR EVALUATION AND CARE.  ALL SERVICES ARE USING THE CENTRAL ARMY HOTLINE FOR RABIES EXPOSURE EVALUATION WHEN LOCAL MEDICAL ASSETS ARE NOT AVAILABLE.
6. THIS MARADMIN IS EFFECTIVE IMMEDIATELY UPON RELEASE AND APPLIES TO THE MARINE CORPS TOTAL FORCE.
7. RELEASE AUTHORIZED BY RDML M. H. ANDERSON,DIRECTOR,HEALTH SERVICES, HEADQUARTERS UNITED STATES MARINE CORPS.//