8.6.21 – Human Exposure to Oral Rabies Vaccine (Raboral V-RG)

Background:  The Anne Arundel County Department of Health and Wildlife Services of the U.S. Department of Agriculture will be distributing approximately 84,540  baits containing a live raccoon oral rabies vaccine (Raboral V-RG) throughout Anne Arundel County from August 26 to the end of September, weather permitting.  As in previous campaigns, two types of bait will be distributed by ground teams and helicopter.   In the Fishmeal polymer bait (FP), the liquid vaccine is contained in a plastic sachet embedded in a small brown brick, which is a solid matrix, made with fishmeal held together by a synthetic polymer binder and is rectangular in shape.  The second type of bait, called coated sachet (CS), looks like a light brown condiment packet, and is coated with a waxy fishmeal attractant.  Both bait forms contain identical liquid rabies vaccine inside the sachet.  The animal must bite into the sachet to be vaccinated.

Human Health Information:  The following information is provided in case you see patients concerned about this issue.  The oral rabies vaccine is genetically engineered in which the rabies glycoprotein has been inserted into live vaccinia virus (Copenhagen strain).  The vaccine cannot cause rabies, but a reaction to the vaccinia vector virus is possible.  Millions of doses of Raboral V-RG have been used in Europe, Canada and the U.S. with only two reported human vaccinia infections associated with direct contact with the vaccine.

  • A pregnant 28-year-old female with epidermolytic hyperkeratosis was bitten while removing a bait from her dog’s mouth. The plastic sachet containing the vaccine had been ruptured, thereby exposing the woman to the vaccine.  She developed a vaccinia infection consisting of vesicular lesions and adenopathy but recovered fully and later delivered a healthy baby.
  • A 35-year-old female on immunosuppressive medications for inflammatory bowel disease had contact with the vaccine after removing a bait from her dog’s mouth.  She held the bait in her hand and the vaccine leaked out on her hand and wrist where abrasions were present.  On day 4 post-exposure, red papules developed on her right hand.  PCR testing was positive for the presence of Orthopoxvirus   Subsequently she was treated with Vaccinia Immune Globulin and an investigational antiviral agent, ST-246.  The patient recovered without any sequelae.

Based on the rarity of human infections due to Raboral V-RG, this recombinant vaccine is felt to represent a low risk.  Immunocompromised individuals, children, pregnant women, as well as persons with a history of atopic dermatitis or other active exfoliative skin conditions are felt to be more susceptible to adverse events from contact with the vaccine.  Contact with bait with an intact plastic sachet poses no human health concern.  If a person eats the bait material or is exposed while removing bait from the mouth of a pet and the vaccine sachet is intact, it is not anticipated that any serious health condition will occur.

Please notify the Department of Health about all patients who have had contact with the oral rabies vaccine or bait or in whom you suspect a reaction to the vaccine. Call 410-222-1423 during business hours or 443-481-3140 after hours.

General information about the campaign is available on the Department’s website, www.aahealth.org/orv.

For medical information, call 410-222-7254, or call 443-481-3140 after business hours. Medical consultants are available to discuss medical aspects of exposure to the vaccine and/or bait.