Free Indiana State Department of Health RABIES EXAMINATION - Indiana

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ISDH LAB USE ONLY

LAB NUMBER ID NUMBER DATE RECEIVED DATE REPORTED

RABIES EXAMINATION
State Form 37763 (R10/10-07)

SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.

This form must be filled out completely and accompany the specimen. Please fax this form to (317.927.7804) for priority samples. Animals that have potentially exposed a person or household pet to rabies will be given priority handling. Exposure is defined as any penetration of skin by the teeth of a potentially rabid animal or contamination of scratches, abrasions, open wounds, or mucous membranes with the saliva or potentially infectious material (such as brain tissue) of a potentially rabid animal.

Sender: Phone Number (

) ______-______________

Fax Number (

) ______-____________________

Facility Name___________________________________ Address_______________________________________ City _________________ State IN ZIP __________

Date of death of animal_______________________ Date Shipped ______________________________ Sender Occupation____________________________

County _________________

Address where animal originated_________________________________________ Identify breed, color marking___________________________________

Kind of animal______________________ Clinical information regarding the animal:

Was animal immunized? Yes No Do not know not applicable Was the animal known to have exhibited any signs and/or symptoms of illness? Yes No If YES, specify___________________________________________________________________________________________ Did the animal exhibit any of the following? paralysis convulsions aggressive unable to eat or drink excessive salivation

noticeable change in behavior Yes

other_________________________________________________________ No If YES, Name and Phone No. ________________( Human )______________ None

Was the animal treated by a veterinarian?

Exposure Information: The suspected animal exposed a: Name/Address/Phone Number

Animal, specify______________________

Date of Exposure

Type of Exposure
scratch handling scratch handling bite other bite other

Results Notification: ALL POSITIVE RESULTS WILL BE REPORTED BY TELEPHONE TO THE INDIVIDUAL WHOSE NAME IS LISTED BELOW AND TO THE LOCAL HEALTH DEPARTMENT. Please list the name of the individual who will be responsible for arranging treatment of this (these)
patient(s) if this should be necessary. You must include telephone numbers where this individual can be reached during working hours, after working hours, and on weekends. The State does not supply or administer the prophylaxis for rabies. By State Communicable Disease Reporting Rule, "Every case of a human bitten by a domestic or wild animal shall be reported promptly to the Local Health Officer having jurisdiction (410 IAC 1-2.1).

Name___________________________________________

Telephone (9 am to 4:30 pm) ( After 4:30 pm and weekends (

) ________________________ ) ________________________

ALL RESULTS WILL BE FAXED TO THE SENDER, IF A FAX NUMBER IS PROVIDED.

DO NOT WRITE BELOW THIS LINE - FOR LAB USE ONLY FLUORESCENT ANTIBODY TEST RESULTS _____Negative ______Positive ______Unsatisfactory _____Decomposed Time________ ( )__________________________________

RESULTS TELEPHONED: Date_______________ Copies to: Communicable Disease

Reported to: ___________________________________ Microbiologist: __________________________________

Local Health Department

SENDER NOTE: NOTIFY PATIENT OF RESULTS

INSTRUCTIONS FOR THE SUBMISSION OF ANIMAL HEADS AND BATS FOR RABIES TESTING

SPECIMEN
Since brain tissue is examined for the diagnosis of rabies, only the animal head will be accepted for diagnostic purposes. Animals should be euthanized in a manner that will not destroy the brain. The neck should be severed at the midpoint between the base of the skull and shoulders. For bats, the whole dead animal should be submitted. Brain material from animals with central nervous disease symptoms may be submitted by veterinarians or veterinary diagnostic laboratories as part of their diagnostic process without regard to bite or other exposure status. Only fresh, non-fixed tissue is acceptable. A negative finding for rabies can be made only if a complete cross section of the brain stem is examined. Examination may be made at the level of the pons, medulla, or midbrain. All rabies specimens must be properly packaged before delivery to the Indiana State Department of Health (ISDH) Laboratories.

COMPLETION OF FORM
Complete the sections labeled Sender, Clinical information regarding the animal, Exposure Information, and Results Notification on the front of the specimen submission form. For high priority specimens, please alert the lab by sending a fax copy of this form (317.927.7804) before sealing the form in a separate plastic zip-lock bag and enclosing it with the specimen. An incomplete form may result in the delay of conveying vital information to the person or persons exposed. Provide tracking numbers when available.

PACKAGING OF SPECIMENS
Place animal head specimens for rabies diagnosis in a leak proof container (e.g., double bag using heavy-duty plastic bags) and seal tightly. Place this container in an insulated shipping carton and enclose a sealed refrigerant pack to keep the specimen cold. DO NOT USE WET ICE. The use of sealed cold packs eliminates the problem of the refrigerant leaking from the shipping container. Specimens should be kept cold, but preferably not frozen. Freezing the head will delay testing, since it may take up to 24 hours to thaw; it also damages the tissue.

SHIPMENT OF SPECIMENS
Shipment via courier service is usually the most rapid method of delivery. The US Postal Service will not accept this type of specimen for mailing. At the time of this printing, United Parcel Service (UPS) will accept specimens for delivery to the ISDH Laboratories if properly packaged. Consult with your local UPS representative to obtain the most current shipping/packaging requirements for UPS. Use the following address for shipping specimens: Rabies Laboratory Indiana State Department of Health Laboratories 550 West 16th Street, Suite B Indianapolis, IN 46202 To contact the lab or to send a fax copy of the form to alert lab of high priority specimen: 317.921.5500 (8:15 -4:45 M-F, except holidays) 317.233.1325 (after hours ISDH duty officer) 317.927.7804 FAX

REPORTING OF RESULTS
Positive rabies test results will be reported immediately by telephone to both the local health department officials and to the individual identified for Results Notification. Negative test results will routinely be reported by fax if a fax number is provided.

MAMMALS IN THE ORDER RODENTIA
These mammals include squirrels, rats, mice, guinea pigs, hamsters, gerbils, beavers, moles, and voles. They are rarely rabid in the United States and should be submitted for rabies testing only under exceptional circumstances. Consult your local health department when rodents or lagomorphs (rabbits/hares) are involved.

CONTACTS FOR FURTHER INFORMATION
For questions concerning suspected rabies incidents involving possible human exposure, contact James Howell, DVM, ISDH Veterinary Epidemiologist, at 317.233.7272. For questions concerning suspected rabies incidents involving possible domestic animal exposure, contact Sandra Norman, DVM, Indiana Board of Animal Health, at 317.227.0323. For general laboratory questions, contact the ISDH Laboratories at 317.921.5500.