Rabies Outbreak in an Urban, Unmanaged Cat Colony — Maryland, August 2024

Identification of Rabid Cat

On August 13, 2024, the Maryland Department of Health (MDH) was notified by the Cecil County (Maryland) Health Department (CCHD) that an aggressive feral cat from an unmanaged urban cat colony was found outside a hotel in northeast Maryland. Clinical signs were first observed on August 8, when the cat became aggressive and bit or scratched two local residents. The cat was captured on August 8 or 9 by local animal control and euthanized; 2 days later, the brain tissue tested positive at the state public health lab for rabies. A kitten from the same colony, which displayed similar behaviors, had been most recently seen by hotel staff members on August 13, suggesting that other cats in the colony might have also been rabid during this period.

Response Activities

CCHD and MDH coordinated with Cecil County Animal Services, Cecil County Emergency Services, and CDC to identify persons potentially exposed to the rabid cat and provide PEP if indicated. Because cats and other domestic animals can shed rabies virus for up to 10 days before onset of clinical signs (2), the potentially infectious period was determined to be July 29–August 13. Investigators initiated trapping activities and identified three groups of potentially exposed persons within this time frame: 1) hotel guests and staff members, 2) persons experiencing homelessness near the hotel, and 3) community members living near the hotel. This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.^§

Hotel Guests. To facilitate outreach to potentially exposed hotel guests, reservation records for hotel stays that occurred during the cats’ infectious period were reviewed, and the name and contact information for the reservation holder were collected. Investigators collaborated with the rabies points of contact for health departments in U.S. states and Canada for out-of-town hotel guests who might have been exposed. Contacted U.S. states were asked to estimate the human resource investment associated with the response.

Hotel guests who were Maryland residents were contacted via telephone or certified letter by their local health department to determine their rabies exposure risk. Maryland investigators asked a series of questions to ascertain 1) whether exposure had occurred and 2) whether PEP was indicated, including identifying any interaction with the rabid cat; exposure to the animal through bites, scratches, or other interactions; and history of previous rabies vaccination. An email was sent to out-of-state rabies points of contact at the state health department to apprise them of the rabies risk and request that they conduct rabies exposure risk assessments for their residents who had stayed at the hotel. CDC contacted Canadian public health officials to inform them of potential exposures among Canadian residents who had stayed at the hotel.

Local Residents. A reverse 911^¶ message was sent to all Cecil County mobile telephone subscribers to aid in identification of potentially exposed persons who lived in the local area but who had not stayed at the hotel. The message included a description of the situation and advised recipients to contact CCHD immediately if they, or anyone they knew, might have been exposed to cats or kittens from the colony or if they were aware of another animal that might have been exposed.

Persons Experiencing Homelessness and Walk-In Health Centers. According to hotel staff members and the CCHD special populations team, which provides community-based support to marginalized community members, at least three persons experiencing homelessness were determined to have been staying near the hotel during the cat’s infectious period. The CCHD special populations team worked to reach as many persons experiencing homelessness in the area as possible. The teams also notified nearby walk-in health centers and advised them to contact CCHD should any patients arrive with complaints of a recent animal bite or scratch. State partners were asked to provide estimates of the time needed to complete their outreach and investigations.

Identification of Exposed Persons

Review of hotel records identified 309 potentially exposed persons (hotel guests and staff members), including 107 (35%) Maryland residents from 10 local health jurisdictions and 202 (65%) persons from 27 U.S. states and Canada. MDH confirmed that 197 (63.8%) of these persons completed risk assessments. No additional exposures were identified among hotel guests. The two known persons with bite or scratch exposure received PEP** at a local emergency department on August 13.

CCHD received one phone call in response to the reverse 911 message; however, assessment revealed that no rabies exposure had occurred. Trusted community partners contacted two persons experiencing homelessness who were potentially exposed; one of these persons was determined to have been exposed on August 9 and received PEP on August 18. Thus, a total of three exposed persons were identified. None of the three persons have developed signs consistent with rabies to date. Among 29 jurisdictions involved, 17 (58.6%) provided personnel time estimates, totaling 450 hours.