The total report rate was 6.2 reports per 100,000 baits distributed, with 4.4 reports per 100,000 AdRG1.3 baits distributed and 7.1 reports per 100,000 V-RG baits distributed (Table 2).
The other two incidents occurred with V-RG in women who had autoimmune conditions and were on immunosuppressive medications.
Two other adverse events were reported for V-RG baits in which the dogs regurgitated the baits.
Multistate surveillance of contacts with V-RG baits during 2001--2009 revealed 6.9 V-RG baits found per 100,000 V-RG baits distributed for the study period, compared with 14.7 V-RG baits found per 100,000 V-RG baits distributed in Ohio in 2012.
Because the risk for infection arises from exposure to vaccine virus rather than from contact with an intact bait, the higher proportion of human contacts that resulted in potential vaccine exposure with AdRG1.3 baits compared with V-RG baits deserves further evaluation.
An oral rabies vaccine consisting of a recombinant vaccinia vector (V-RG) has been used in the United States for over 20 years; during this time only two cases of human vaccinia infection from human contact with vaccine in the baits have been reported.
In 2012, a total 272,034 AdRG1.3 and 504,887 V-RG baits were distributed in Ohio.
On day 1 after her exposure to the V-RG vaccine, her physician obtained a baseline serum specimen for analysis of rabies virus neutralizing antibody (by direct virus neutralization) and orthopoxirus (vaccinia) immunoglobulin IgG and immunoglobulin IgM antibodies (by enzyme-linked immunosorbent assay).
Second, she had fresh abrasions and prolonged contact with V-RG vaccine (approximately 30 minutes) before washing her hands.
Since 1990, approximately 100 million doses of Raboral V-RG animal vaccine have been distributed in the United States by depositing baits by airplane or by hand in areas with dense populations of target wildlife species (e.g., raccoons in the eastern United States).
The ORV packets containing the V-RG vaccine are durable and typically do not leak unless punctured.
Persons with a history of atopic dermatitis or other active exfoliative skin conditions and those with immune deficiencies or immunosuppressive conditions are at greater risk for adverse outcomes (e.g., eczema vaccinatum and progressive vaccinia) after infections with nonhighly attenuated variants of vaccinia virus (6), including Raboral V-RG (7).