Community Survey after Rabies Outbreaks, Flagstaff, Arizona

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Community Survey after Rabies Outbreaks, Flagstaff, Arizona

Abstract and Introduction


Flagstaff, Arizona, USA, experienced notable outbreaks of rabies caused by a bat rabies virus variant in carnivore species in 2001, 2004, 2005, 2008, and 2009. The most recent epizootic involved transmission among skunk and fox populations and human exposures. Multiple, wide-ranging control efforts and health communications outreach were instituted in 2009, including a household survey given to community members. Although the Flagstaff community is knowledgeable about rabies and the ongoing outbreaks in general, gaps in knowledge about routes of exposure and potential hosts remain. Future educational efforts should include messages on the dangers of animal translocation and a focus on veterinarians and physicians as valuable sources for outreach. These results will be useful to communities experiencing rabies outbreaks as well as those at current risk.


More than 90% of rabies cases in the United States are in wild animals. Most reported cases of rabies occur among carnivores, including raccoons, skunks, and foxes, in addition to many bat species. Despite the elimination of canine rabies virus variants in the United States, domestic animals, including cats and dogs, are infected each year from exposures to rabid wildlife. In addition, ≈2–4 human rabies cases are reported each year in the United States, and exposure to rabid animals or animals suspected of being rabid is common, with ≈35,000–38,000 persons receiving rabies postexposure prophylaxis (PEP) each year. One of the primary methods for rabies prevention and control is practical and accurate public health information. Recognition of the signs and severity of rabies, exposure routes, behavioral and environmental risk factors, and appropriate domestic animal welfare are critical messages for disease prevention and require appropriate public education for persons of all ages.

Rabies virus is generally transmitted among members of the same species, and specific rabies virus variants are associated geographically with independent reservoir species. Spillover of rabies virus variants from 1 species to another occurs, but sustained transmission of such variants in nonreservoir species is rare. The area around Flagstaff, Arizona (Coconino County), USA, was free of sustained rabies virus transmission until 2001, when a spillover of a bat rabies virus variant was followed by a suspected host shift, with increased transmission in striped skunk (Mephitis mephitis) populations. Control measures were launched to halt rabies spread in skunks and limit the potential for human exposures. These efforts appeared to control rabies spread in skunk populations until 2004, when 5 striped skunks and 1 gray fox (Urocyon cinereorgenteus) were diagnosed as rabid, and rabies was confirmed in an additional striped skunk, a gray fox, and a feral cat (Felis catus) in 2005. Rabies was quiescent after this resurgence in 2004/2005 until fall 2008 when the disease was confirmed in several gray foxes and striped skunks. The establishment of rabies in fox populations was troubling because the extensive home range of foxes threatened its containment in the Flagstaff area. Given the size of this epizootic, the potential for spread to other areas, and several notable human exposures, a large, interagency effort was launched to control the resurgence of rabies in Flagstaff.

In October 2009, a survey was distributed to Flagstaff households in an area where rabid animals had been captured in 2008 and 2009. This area also had a history of rabies epizootics since 2001. Attitudes and practices regarding management of exposure to domestic and wild animals are essential to define in areas where persons and their pets may have an increased chance of coming into contact with a rabid animal. An assessment of community knowledge of rabies and interactions with animal reservoirs can help target educational messages during seasonal disease peaks or at the beginning of an epizootic. We present an update on the most recent outbreak and the results of a community survey in Flagstaff.

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