CDC veterinarian (left) works with CDC Quarantine Station staff to inspect dogs for signs of illness upon arrival in the United States. Photo courtesy Sarah Meehan, CDC Does your clinic routinely ask about your patients’ travel history and review their vaccination records? The Centers for Disease Control and Prevention (CDC) enforces dog importation regulations with the aim of preventing the reestablishment of the canine rabies virus variant, or dog rabies, in the United States. In 2020, during the COVID pandemic, CDC documented increasing attempts to import dogs inadequately vaccinated against rabies compared to 2018 and 2019. Young puppies intended for sale or rescue often arrive in the United States with falsified rabies vaccination certificates, proclaiming the puppies to be much older than they actually are. These puppies are too young to be adequately vaccinated against rabies. In-demand designer dog breeds, especially French bulldogs, are frequently imported before being adequately immunized against rabies because six- to eight-week-old puppies can be sold for as much as $5,000 to $15,000 each in the U.S. market.1 CDC veterinarians at ports of entry identify discrepancies between the rabies vaccination certificate and the true age of the dog by oral examination of deciduous and permanent tooth eruption patterns. Permanent teeth begin to erupt around four months of age, which is the minimum age requirement for dogs to be considered adequately immunized against rabies. Rabies, one of the world’s deadliest diseases, is nearly 100 percent fatal in people and animals once symptoms appear. Dog rabies accounts for 99 percent of human deaths caused by rabies globally.2 After a decades-long elimination campaign, the United States was declared free of dog rabies in 2007;3 however, dog rabies is still enzootic in more than 100 countries around the world, and the risk of importing the variant back into the United States is ever-present. When dogs arrive CDC requires dogs arriving from countries at high risk for dog rabies and dogs that have been in a high-risk country within the past six months to have a CDC Dog Import Permit, a valid rabies vaccination certificate, and a rabies titer from an approved lab prior to arriving in the United States. The rabies vaccine must be administered by a licensed veterinarian on or after the dog is 12 weeks old. CDC regulations prohibit the importation of unvaccinated dogs and dogs younger than six months that have been in a high-risk country for dog rabies in the previous six months.4 The importation of dogs inadequately vaccinated against rabies poses a significant public health risk. Since 2015, four rabid dogs have been imported into the United States. In 2019, 26 dogs were imported from Egypt with rabies vaccination certificates and rabies serologic titers purportedly indicating previous vaccination. When one of the dogs from the shipment developed rabies symptoms and died three weeks after arrival, CDC confirmed the dog was infected with a variant of dog rabies present in Egypt. Rabies serologic titers were performed again on the remaining 25 dogs in the shipment as part of the investigation, and investigators determined the majority (18) had no serologic evidence of prior immunization against rabies.5 CDC is aware of a dog in Pennsylvania that tested positive for rabies on June 16, 2021. The dog was among a group of 33 dogs and one cat imported into the U.S. from Azerbaijan by an international animal rescue group on June 10. The investigation is still ongoing, but each importation of a rabid dog risks the lives of the people and animals exposed to the dog, poses the threat of reestablishing dog rabies in our domestic pet and wildlife populations, and can cost up to half a million dollars per importation to contain.5 How does this impact your practice? Although many clients are unaware their dogs were imported from overseas, adding a few routine questions to your patient exams can go a long way toward preventing the reestablishment of dog rabies in America. Veterinary professionals can help by: Asking where clients obtained their dogs: ° Did they buy the dog online? ° Did they visit the breeder to see where the dog was born and raised? ° Did they visit the shelter or rescue organization in-person? Inquiring about the international travel history of their patients: ° Ask to see all medical records and documentation that accompanied the dog if purchased online or from a breeder or rescue organization. ° Make note of any documents not in English or containing addresses in foreign countries. Reporting any sick dog with a history of international travel in the previous six months to your state veterinarian. Reporting vaccination records that do not match the age and appearance of the dog to your state veterinarian. ° Consider revaccinating dogs with discrepant medical records, as the dog may not be adequately protected against diseases such as parvovirus, distemper, and rabies. Being familiar with your state laws, which may require dogs to be vaccinated against rabies with a USDA-licensed rabies vaccine not available in foreign countries. - Be prepared to explain to clients why revaccination is required. In addition to rabies, imported dogs can also transmit other diseases of concern to people and animals, such as brucellosis, canine influenza, leptospirosis, leishmaniasis, and internal and external parasites. The crate bedding, dishes, and toys accompanying imported dogs can serve as fomites for foreign animal diseases, such as foot-and-mouth disease and African swine fever. Encourage clients to bathe their new pet within two days of arrival and purchase new crate bedding, dishes, and toys. Tell clients to contact the USDA Veterinary Services representative in their region for guidance on how to safely dispose of potentially contaminated items. Keep clients informed Veterinary professionals can help educate clients about the potential health risks of importing dogs from overseas and provide guidance for safer adoption and purchase practices for clients looking to adopt or purchase a new pet. To prevent the importation and spread of diseases from imported dogs, veterinary professionals can recommend: Adopting or purchasing pets from reputable locally based shelters and breeders. Visiting the animal before adoption or purchase. - Many shelters and rescue groups will evaluate each pet to ensure it will be the right fit for a family. A veterinary examination for new pets within 10 days of purchase or adoption. Additionally, caution clients about online puppy scams from overseas suppliers.6-8 For more information on avoiding puppy scams, see: www.cdc.gov/importation/internet-scams.html and https://www.bbb.org/article/news-releases/23354-bbb-study-update-puppy-scams-rising-in-2020. Emily G. Pieracci, DVM, MPH, DACVPM, serves as the zoonoses team lead in CDC’s division of global migration and quarantine. She previously worked in the CDC’s poxvirus and rabies branch where she focused extensively on canine rabies elimination programs in African and Asian countries before joining the zoonoses team in 2019. Dr. Pieracci earned her DVM from Washington State University in 2009 and is a Diplomate of the American College of Veterinary Preventative Medicine. Pieracci practices at a small animal veterinary clinic in Atlanta on the weekends. In her free time, she enjoys yoga and hiking with her dog. Cara E. Williams, DVM, is a veterinary medical officer on the zoonoses team in CDC’s division of global migration and quarantine. She earned a DVM and a certificate in global health in 2013 from the University of Wisconsin, Madison. Dr. Williams practiced livestock, exotic, and companion animal medicine on farms and in veterinary clinics for four years prior to joining the United States federal government in 2017 as a supervisory public health veterinarian for the USDA Food Safety and Inspection Service in the greater New York City metropolitan area of New Jersey. She joined CDC in July 2020, regulating the importation of dogs and cats that pose a public health risk. In her free time, Williams enjoys traveling internationally and hiking with her dogs and spouse. References Houle MK. Perspective from the Field: Illegal Puppy Imports Uncovered at JFK Airport [Internet]. Centers for Disease Control and Prevention; 2019 May 15 [cited 2021 Apr 21]. Available from: https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/operation-dog-catcher.html Hampson K, Coudeville L, Lembo T, Sambo M, Kieffer A, Attlan M, et al. Estimating the Global Burden of Endemic Canine Rabies. PLoS Neglected Tropical Diseases [Internet]. 2015 Apr 16; 9(4):e0003709. Available from: https://doi.org/10.1371/journal.pntd.0003709 CDC Newsroom. Press Release: US Declared Canine-Rabies Free [Internet]. 2007 Sep 7 [cited 2021 Apr 21]. Available from: https://www.cdc.gov/media/pressrel/2007/r070907.htm Centers for Disease Control and Prevention. What is a Valid Rabies Vaccination Certificate? [Internet]. [updated 2020 May 27; cited 2021 Apr 21]. Available from: https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/vaccine-certificate.html Raybern C, Zaldivar A, Tubach S, Ahmed FS, Moore S, Kintner C, et al. Rabies in a Dog Imported from Egypt — Kansas, 2019. MMWR Morb Mortal Wkly Rep [Internet]. 2020 Sep [cited 2021 Apr 21]; 69(38):1374–1377. Available from: http://dx.doi.org/10.15585/mmwr.mm6938a5 Centers for Disease Control and Prevention. Internet Adoption Scams Involving Imported Pets [Internet]. [updated 2016 Sep 1; cited 2021 Apr 21]. Available from: https://www.cdc.gov/importation/internet-scams.html Better Business Bureau. Online Puppy Scams Rising Sharply in 2020, BBB Warns [Internet]. Better Business Bureau; 2020 Dec 2 [cited 2021 Apr 28]. Available from: https://www.bbb.org/article/news-releases/23354-bbb-study-update-puppy-scams-rising-in-2020 CBC News. Puppy Scams Cost Canadians Thousands. Here’s How to Avoid Being Ripped Off [Internet]. CBC/Radio-Canada; 2021 Mar 23 [cited 2021 Apr 28]. Available from: https://www.cbc.ca/news/canada/calgary/puppy-scams-day-national-calgary-bbb-1.5960486
