[Federal Register Volume 88, Number 18 (Friday, January 27, 2023)]
[Notices]
[Pages 5348-5357]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-01688]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Notice of Extension of Temporary Suspension of Dogs Entering the 
United States From Countries With a High Risk of Rabies

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: The Centers for Disease Control and Prevention (CDC), within 
the Department of Health and Human Services (HHS), announces an 
extension of the current temporary suspension of the importation into 
the United States of dogs from high-risk rabies-enzootic countries 
(high-risk countries). This suspension includes dogs that have been in 
any high-risk countries during the previous six months.

DATES: The extension of the temporary suspension of the importation of 
dogs into the United States from high-risk countries will be 
implemented on February 1, 2023, when the current suspension expires, 
and will remain in effect through July 31, 2023.

FOR FURTHER INFORMATION CONTACT: Ashley C. Altenburger, J.D., Division 
of Global Migration and Quarantine, Centers for Disease Control and 
Prevention, 1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329. 
Telephone: 1-800-232-4636. For information regarding CDC regulations 
for the importation of dogs: Dr. Emily Pieracci, D.V.M., Division of 
Global Migration and Quarantine, Centers for Disease Control and 
Prevention, 1600 Clifton Road NE, MS H16-4, Atlanta, GA 30329. 
Telephone: 1-800-232-4636.

SUPPLEMENTARY INFORMATION: CDC is extending, but not modifying, the 
terms of the current temporary suspension. A suspension remains 
necessary to protect the public's health against the reintroduction of 
the dog-maintained rabies virus variant (DMRVV) into the United States. 
There is a continued threat posed by unvaccinated or inadequately 
vaccinated dogs from high-risk countries due to various factors. These 
include insufficient veterinary controls in high-risk countries to 
prevent the export of inadequately vaccinated dogs, and veterinary 
supply chain and workforce capacity shortages that have persisted since 
the global COVID-19 pandemic. These factors result in challenges to 
efforts to ensure dogs imported into the United States do not pose a 
public health threat. CDC

[[Page 5349]]

anticipates that these factors are likely to continue through July 31, 
2023.

I. Background and Authority

    Rabies, one of the deadliest zoonotic diseases, accounts for an 
estimated 59,000 human deaths globally each year.\1\ This equates to 
one human death every nine minutes.\2\ DMRVV is responsible for 98 
percent of these deaths.\2\ The rabies virus can infect any mammal, and 
once clinical signs appear, the disease is almost always fatal.\3\ In 
September 2007, at the Inaugural World Rabies Day Symposium, CDC 
declared the United States to be free of DMRVV.\4\ However, DMRVV is 
still a serious public health threat in the more than 100 countries 
where it remains enzootic. Preventing the entry of animals infected 
with DMRVV into the United States is a public health priority.
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    \1\ World Health Organization (2018). WHO Expert Consultation on 
Rabies (WHO Technical Report Series 1012). Retrieved from https://www.who.int/publications/i/item/WHO-TRS-1012.
    \2\ Id.
    \3\ Fooks, A.R., Banyard, A.C., Horton, D.L., Johnson, N., 
McElhinney, L.M., and Jackson, A.C. (2014) Current status of rabies 
and prospects for elimination. Lancet, 384(9951), 1389-1399. doi: 
10.1016/S0140-6736(13)62707-5.
    \4\ Velasco-Villa, A., Mauldin, M., Shi, M., Escobar, L., 
Gallardo-Romero, N., Damon, I., Emerson, G. (2017) The history of 
rabies in the Western Hemisphere. Antiviral Res, 146, 221-232. 
doi:10.1016/j.antiviral.2017.03.013.
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    Under section 361 of the Public Health Service Act (PHS Act) (42 
U.S.C. 264), the Secretary of Health and Human Services may make and 
enforce such regulations as in the Secretary's judgment are necessary 
to prevent the introduction, transmission, or spread of communicable 
diseases from foreign countries into the United States and from one 
state or possession into any other state or possession.\5\ Such 
regulations may provide for inspection, fumigation, disinfection, 
sanitation, pest extermination, destruction of animals or articles 
found to be sources of dangerous infection to human beings, and other 
measures. Under section 362 of the PHS Act (42 U.S.C. 265), the 
Secretary, and by delegation the Director of CDC (CDC Director),\6\ may 
prohibit entries and imports from foreign countries into the United 
States ``in whole or in part'' if there is a serious risk of 
introducing communicable disease and when required in the interest of 
public health.
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    \5\ Although the statute assigns authority to the Surgeon 
General, all statutory powers and functions of the Surgeon General 
were transferred to the Secretary of HHS in 1966, 31 FR 8855, 80 
Stat. 1610 (June 25, 1966), see also Public Law 96-88, 509(b), 
October 17, 1979, 93 Stat. 695 (codified at 20 U.S.C. 3508(b)). The 
Secretary has retained these authorities despite the reestablishment 
of the Office of the Surgeon General in 1987.
    \6\ See 42 CFR 71.51(e), 71.63.
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    Under 42 CFR 71.51, all dogs admitted into the United States must 
be accompanied by a valid rabies vaccination certificate,\7\ unless the 
dogs' owners or importers submit satisfactory evidence that dogs under 
six months of age have not been in a high-risk country or dogs older 
than six months have not been in a high-risk country for the six months 
before arrival.\8\ CDC maintains a publicly available list of high-risk 
countries \9\ and provides guidance for dog entry requirements based on 
the dog's country of origin.
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    \7\ Centers for Disease Control and Prevention (2022). What is a 
valid rabies vaccination certificate? Retrieved from https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/vaccine-certificate.html.
    \8\ Centers for Disease Control and Prevention (2019). Guidance 
Regarding Agency Interpretation of ``Rabies-Free'' as It Relates to 
the Importation of Dogs Into the United States. Federal Register, 
Vol. 84,724-730. Retrieved from https://www.federalregister.gov/documents/2019/01/31/2019-00506/guidance-regarding-agency-interpretation-of-rabies-free-as-it-relates-to-the-importation-of-dogs.
    \9\ Centers for Disease Control and Prevention (2022). What is a 
valid rabies vaccination certificate? Retrieved from https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/rabies-vaccine.html.
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    CDC subject matter experts review publicly available data and 
conduct an annual assessment to determine which countries have high 
risk of DMRVV.\10\ This assessment considers the following factors: 
presence or prevalence of domestically acquired cases of DMRVV in 
humans and animals; efforts towards control of DMRVV in dogs (such as 
dog vaccination coverage, dog population management, and existence and 
enforcement of legal codes to limit rabies transmission in dogs); and 
the quality of rabies surveillance systems, rate of testing, and 
laboratory capacity. If data are not available, the most conservative 
determination is applied, and the country is not considered to have a 
robust rabies control program. If a country has provided additional 
substantial data to support a DMRVV-free or low-risk status, CDC can 
review that information and re-assess the country's status.
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    \10\ Henry RE, Blanton JD, Angelo KM, Pieracci EG, Stauffer K, 
Jentes ES, Allen J, Glynn M, Brown CM, Friedman CR, Wallace R. A 
country classification system to inform rabies prevention guidelines 
and regulations. J Travel Med. 2022 Jul 14;29(4):taac046. doi: 
10.1093/jtm/taac046. PMID: 35348741.
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    Under 42 CFR 71.51(e), dogs may be subject to ``additional 
requirements as may be deemed necessary'' or ``to exclusion if coming 
from areas which the [CDC] Director has determined to have high rates 
of rabies.'' Based on the previously described criteria, CDC determined 
that high-risk countries constitute areas that have high rates of 
DMRVV, and dogs imported from these countries are thus subject to 
additional requirements and/or exclusion.\11\
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    \11\ Henry RE, Blanton JD, Angelo KM, Pieracci EG, Stauffer K, 
Jentes ES, Allen J, Glynn M, Brown CM, Friedman CR, Wallace R. A 
country classification system to inform rabies prevention guidelines 
and regulations. J Travel Med. 2022 Jul 14;29(4):taac046. doi: 
10.1093/jtm/taac046. PMID: 35348741.
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    Under 42 CFR 71.63, CDC may also temporarily suspend the entry of 
animals, articles, or things from designated foreign countries and 
places into the United States when it determines there exists in a 
foreign country a communicable disease that threatens the public health 
of the United States and the entry of imports from that country 
increases the risk that the communicable disease may be introduced. 
When such a suspension is issued, CDC designates the period of time or 
conditions under which imports into the United States are suspended. 
CDC likewise determined that DMRVV exists in countries designated as 
high-risk countries and that, if reintroduced into the United States, 
DMRVV would threaten the public health of the United States.
    Based on these legal authorities and determinations, on June 16, 
2021,\12\ CDC announced a temporary suspension of the importation of 
dogs from high-risk countries into the United States (86 FR 32041) (the 
temporary suspension). The temporary suspension went into effect on 
July 14, 2021. CDC issued the temporary suspension to protect the 
public health against the reintroduction of DMRVV into the United 
States at a time when resources were being diverted to the agency-wide 
response to the global COVID-19 pandemic.
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    \12\ Temporary Suspension of Dogs Entering the United States 
from High-Risk Rabies Countries. Federal Register, 86 FR 32041, June 
16, 2021.
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    At the time the temporary suspension was issued, CDC noted an 
increase in importers circumventing dog import regulations. Despite a 
decrease in international travel volumes due to the global COVID-19 
pandemic, there was a 52 percent increase in dogs ineligible for entry 
in 2020 as compared to 2018 and 2019. Additionally, four rabid dogs 
were imported into the United States between 2015 and 2021.
    The limited availability of public health resources due to the 
unprecedented global response to the COVID-19 pandemic resulted in 
reduced capacity at the Federal, state, and local levels to address the 
increased risk of the reintroduction of DMRVV. For these reasons, CDC 
implemented a temporary suspension prohibiting the

[[Page 5350]]

importation of dogs from high-risk countries for rabies in July 2021. 
In addition, CDC implemented a CDC Dog Import Permit 13 
[(OMB Control Number 0920-0134 Foreign Quarantine Regulations (exp. 12/
31/2022), or as revised] during the temporary suspension to verify the 
documentation of imported dogs before they are flown to the United 
States.
    On June 10, 2022, CDC modified and extended the temporary 
suspension through January 31, 2023.\14\ Per the Federal Register 
notice announcing the extension and modification of the temporary 
suspension, all categories of importers are currently eligible to 
import dogs from high-risk countries. Commercially imported dogs are 
required to enter the United States at a port of entry with a live 
animal care facility \15\ with a Facilities Information and Resource 
Management System (FIRMS) code issued by U.S. Customs and Border 
Protection (CBP). CDC also expanded the list of the approved ports of 
entry to include 18 airports \16\ with a CDC quarantine station for 
importers with a valid U.S.-issued rabies vaccination certificate or a 
CDC Dog Import Permit.
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    \14\ 87 FR 33158 (June 1, 2022).
    \15\ https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/approved-care-facilities.html.
    \16\ The 18 approved ports of entry are: Anchorage (ANC), 
Atlanta (ATL), Boston (BOS), Chicago (ORD), Dallas (DFW), Detroit 
(DTW), Honolulu (HNL), Houston (IAH), Los Angeles (LAX), Miami 
(MIA), Minneapolis (MSP), New York (JFK), Newark (EWR), Philadelphia 
(PHL), San Francisco (SFO), San Juan (SJU), Seattle (SEA), and 
Washington DC (IAD).
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    Prior to modifying and extending the temporary suspension on June 
10, 2022, CDC also evaluated the latest scientific information on 
rabies serologic titer test results. Based on this evaluation, CDC 
reduced the waiting period requirement, which is the number of days 
between when a dog's sample is taken for a serologic titer test and 
when the dog can be imported into the United States, from 90 days to 45 
days.
    Lastly, the June 10, 2022, extension and modification of the 
temporary suspension allowed importers whose dogs are at least six 
months old, have a microchip, and have a valid U.S.-issued rabies 
vaccination certificate to enter the United States without a CDC Dog 
Import Permit at one of the 18 airports with a CDC quarantine station 
provided the dog appears healthy upon arrival. CDC made this change 
because of the reliability of the United States' rabies vaccine supply 
and to ease the burden on these importers.
    At this time, CDC is extending the temporary suspension through 
July 31, 2023, because of the continued risk for the reintroduction of 
DMRVV into the United States. This extension is based on the disruption 
of rabies vaccination campaigns globally that occurred due to the 
COVID-19 pandemic. Since CDC anticipates the timeline needed for global 
vaccination campaigns to recover will extend through July 31, 2023, the 
risk of a rabid dog being imported into the United States is increased 
during that time. Additionally, constraints on the global veterinary 
workforce capacity and veterinary supply chain shortages that were 
exacerbated by the COVID-19 pandemic have led to delayed or disrupted 
care for dogs, which increases the likelihood dogs imported into the 
United States may pose a public health threat.17 18 19 20 
Federal, state and local public health partners continue to respond to 
the global COVID-19 pandemic, which remains a Public Health Emergency 
of International Concern according to the World Health Organization 
(WHO) \21\ and a U.S. public health emergency per the HHS 
declaration.\22\ An imported rabid dog would potentially divert limited 
public health resources away from other critical ongoing public health 
responses.
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    \17\ https://www.theatlantic.com/health/archive/2022/07/not-enough-veterinarians-animals/661497/ 661497/.
    \18\ https://www.agcanada.com/2021/07/is-the-veterinarian-
shortage-real-or-
regional#:~:text=A%20perceived%20global%20shortage%20of%20veterinaria
ns%20is%20creating,for%20the%20quality%20of%20care%20they%20can%20off
er.
    \19\ https://www.thebusinessresearchcompany.com/report/
companion-animal-veterinary-vaccines-global-market-report.
    \20\ https://7news.com.au/lifestyle/pets/aussie-dog-owners-warned-of-national-vaccine-shortage-as-deadly-bacterial-disease-spreads-c-8568550.
    \21\ https://www.who.int/europe/news/item/19-10-2022-statement-on-the-thirteenth-meeting-of-the-international-health-regulations-
(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-
19)-pandemic.
    \22\ https://aspr.hhs.gov/legal/PHE/Pages/covid19-13Oct2022.aspx.
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    CDC will regularly review the terms of this notice to ensure that 
the terms remain necessary and that importers are not overly burdened 
while the public health of the United States remains protected from the 
reintroduction of DMRVV. In conducting this review, CDC will consider 
high-risk countries' rabies control programs, the latest scientific 
data, and international recommendations for rabies control. 
Additionally, CDC previously announced that it is developing a proposed 
rule that will outline requirements regarding an importation system to 
reduce fraud and improve the U.S. government's ability to verify U.S. 
entry requirements and mitigate the introduction of dogs infected with 
rabies and other communicable diseases of public health concern.\23\ 
Development of this proposed rule is ongoing.
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    \23\ See https://www.reginfo.gov/public/do/eAgendaViewRule?pubId=202204&RIN=0920-AA82.
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II. Public Health Rationale

A. Dog Importation Into the United States

    The United States was declared DMRVV-free in 2007. Importing dogs 
from high-risk countries involves a significant public health risk. The 
importation of just one dog infected with DMRVV risks re-introduction 
of the virus into the United States, resulting in a potential public 
health risk with consequent monetary cost and potential loss of human 
and animal life.24 25 26 DMRVV has been highly successful at 
adapting to new host species, particularly wildlife.\27\ One DMRVV-
infected dog could result in transmission to humans, domestic pets, or 
wildlife. In 2019, the importation of a single dog with rabies cost 
more than $400,000 for the public health investigations and rabies 
post-exposure prophylaxis (PEP) of exposed persons.28 29 To 
mitigate the risk of importing dogs with DMRVV, CDC requires compliance 
with its public health entry requirements.
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    \24\ World Bank (2012). People, Pathogens and Our Planet: The 
Economics of One Health. Retrieved from https://openknowledge.worldbank.org/handle/10986/11892.
    \25\ Raybern, C., Zaldivar, A., Tubach, S., Ahmed, F., Moore, 
S., Kintner, C., Garrison, I. (2020) Rabies in a dog imported from 
Egypt-Kansas, 2019. Morbidity and Mortality Weekly Report, 69(38), 
1374-1377. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6938a5-H.pdf.
    \26\ Jeon, S., Cleaton, J., Meltzer, M., Kahn, E., Pieracci, E., 
Blanton, J., Wallace, R. (2019). Determining the post-elimination 
level of vaccination needed to prevent re-establishment of dog 
rabies. PLoS Neglected Tropical Diseases, 13(12). https://doi.org/10.1371/journal.pntd.0007869.
    \27\ Velasco-Villa, A., Mauldin, M., Shi, M., Escobar, L., 
Gallardo-Romero, N., Damon, I., Emerson, G. (2017). The history of 
rabies in the Western Hemisphere. Antiviral Research, 146, 221-
232.doi:10.1016/j.antiviral.2017.03.013.
    \28\ Raybern, C., Zaldivar, A., Tubach, S., Ahmed, F., Moore, 
S., Kintner, C., Garrison, I. (2020) Rabies in a dog imported from 
Egypt-Kansas, 2019. Morbidity and Mortality Weekly Report, 69(38), 
1374-1377. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6938a5-H.pdf.
    \29\ Centers for Disease Control and Prevention (2022). Rabies 
Postexposure Prophylaxis. Retrieved from https://www.cdc.gov/rabies/medical_care/index.html.
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    Although the U.S. Government does not track the total number of 
dogs imported each year, it is estimated that approximately 1 million 
dogs are imported into the United States annually, of which 100,000 
dogs are

[[Page 5351]]

from high-risk countries.\30\ This estimate was based on information 
provided by airlines, CBP staff, and a study conducted at a U.S.-Mexico 
land border crossing.\31\
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    \30\ Centers for Disease Control and Prevention (2019). Guidance 
Regarding Agency Interpretation of ``Rabies-Free'' as It Relates to 
the Importation of Dogs Into the United States. Federal Register, 
Vol. 84, 724-730. Retrieved from https://www.federalregister.gov/documents/2019/01/31/2019-00506/guidance-regarding-agency-interpretation-of-rabies-free-as-it-relates-to-the-importation-of-dogs.
    \31\ McQuiston, J.H., Wilson, T., Harris, S., Bacon, R.M., 
Shapiro, S., Trevino, J., Marano, N. (2008.) Importation of dogs 
into the United States: risks from rabies and other zoonotic 
diseases. Zoonoses Public Health, 55(8-10), 421-6. doi:10.1111/
j.1863-2378.2008.01117.
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    CBP does record, by country, the number of dogs imported with 
formal entry under Harmonized Tariff Schedule (HTS) code 0106199120 and 
HTS description: Other live animals, other, dogs. The total number of 
dogs imported into the United States from all countries under this HTS 
category varied from 25,232 in 2018 to 58,540 in 2020. The number of 
dogs from high-risk countries under this HTS category averaged 16,390 
per year and varied from 9,966 to 24,031 over this three-year period. 
The number of dogs reported under this HTS category does not include 
dogs imported as checked baggage, hand-carried in airplane cabins, or 
crossing at land borders without formal entry. Thus, the number 
underestimates the true number of dogs imported into the United States.
    Since 2015, there have been four known rabid dogs imported into the 
United States. All four dogs were imported by rescue organizations for 
the purposes of adoption. These four cases, discussed below, highlight 
the immense public health resources required to investigate, respond 
to, and mitigate the public health threat posed by the importation of a 
rabid dog.
    In 2015, a rabid dog was part of a group of eight dogs and 27 cats 
imported from Egypt by a rescue group. The dog had an unhealed leg 
fracture and began showing signs of rabies four days after arrival. 
Following the rabies diagnosis, the rescue workers in Egypt admitted 
that the dog's rabies vaccination certificate had been intentionally 
falsified to evade CDC entry requirements.\32\ Eighteen people were 
recommended to receive rabies PEP, seven dogs underwent a six-month 
quarantine, and eight additional dogs housed in the same home as the 
rabid dog had to receive rabies booster vaccinations and undergo a 45-
day monitoring period.
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    \32\ Sinclair J., Wallace, R., Gruszynski K., Bibbs Freeman, M., 
Campbell, C., Semple, S., Murphy, J. (2015). Rabies in a dog 
imported from Egypt with a falsified rabies vaccination 
certificate--Virginia. Morbidity and Mortality Weekly Report, 64, 
1359-62. doi:10.15585/mmwr.mm6449a2.
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    In 2017, a ``flight parent'' (a person typically solicited through 
social media, often not affiliated with the rescue organization, and 
usually compensated with an airline ticket) imported four dogs on 
behalf of a rescue organization. One of the dogs appeared agitated at 
the airport and bit the flight parent prior to the flight. A U.S. 
veterinarian examined the dog one day after its arrival and then 
euthanized and tested the dog for rabies. A post-mortem rabies test 
showed that the dog was positive for the virus. Public health officials 
recommended that at least four people receive rabies PEP, and the 
remaining three dogs underwent quarantine periods ranging from 30 days 
to six months. An investigation revealed the possibility of falsified 
rabies vaccination documentation presented on entry to the United 
States.\33\
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    \33\ Hercules, Y., Bryant, N., Wallace, R., Nelson, R., Palumbo, 
G., Williams, J., Brown, C. (2018). Rabies in a dog imported from 
Egypt--Connecticut, 2017. Morbidity and Mortality Weekly Report 67, 
1388-91. doi:10.15585/mmwr.mm6750a3.
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    In 2019, a rescue group imported 26 dogs, all of which had rabies 
vaccination certificates and serologic documentation, indicating the 
development of rabies antibodies (in response to immunization), based 
on results from an Egyptian Government-affiliated rabies laboratory. 
However, one dog developed signs of rabies three weeks after arrival 
and had to be euthanized. The dog tested positive for rabies. Forty-
four people received PEP, and the 25 dogs imported on the same flight 
underwent re-vaccination and quarantines of four to six months. An 
additional 12 dogs had contact with the rabid dog and had to be re-
vaccinated and undergo quarantine periods ranging from 45 days to six 
months based on their previous vaccination status.\34\
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    \34\ Raybern, C., Zaldivar, A., Tubach, S., Ahmed, F., Moore, 
S., Kintner, C., Garrison, I. (2020) Rabies in a dog imported from 
Egypt-Kansas, 2019. Morbidity and Mortality Weekly Report, 69(38), 
1374-1377. Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6938a5-H.pdf.
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    On June 10, 2021, shortly before CDC published the temporary 
suspension, 33 dogs were imported into the United States from 
Azerbaijan by a rescue organization. All dogs had rabies vaccination 
certificates that appeared valid upon arrival in the United States. One 
dog developed signs of rabies three days after arrival and was 
euthanized. CDC confirmed the dog was infected with a variant of DMRVV 
known to circulate in the Caucus Mountain region of Azerbaijan. The 
remaining rescue animals exposed to the rabid dog during travel were 
dispersed across nine states, leading to what is believed to be the 
largest, multi-state, imported rabid dog investigation in U.S. 
history.\35\
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    \35\ Whitehill F, Bonaparte S, Hartloge C, et al. Rabies in a 
Dog Imported from Azerbaijan-Pennsylvania, 2021. MMWR Morb Mortal 
Wkly Rep 2022; 71: 686-689.
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    Eighteen people received PEP to prevent rabies as a result of 
exposure to this one rabid dog. Post-vaccination serologic monitoring 
of the remaining dogs and the public health investigation revealed that 
improper vaccination practices by the veterinarian in Azerbaijan likely 
contributed to the inadequate vaccination response documented in 48 
percent of the imported animals, including the rabid dog.\36\ The 33 
exposed animals were placed in quarantine periods ranging from 45 days 
to six months based on individual serologic titer test results and 
local jurisdictional requirements.\37\
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    \36\ Centers for Disease Control and Prevention (2021). CDC 
responds to a case of rabies in an imported dog. Retrieved from 
https://www.cdc.gov/worldrabiesday/disease-detectives/rabies-imported-dog.html.
    \37\ Whitehill F, Bonaparte S, Hartloge C, et al. Rabies in a 
Dog Imported from Azerbaijan-Pennsylvania, 2021. MMWR Morb Mortal 
Wkly Rep 2022; 71: 686-689.
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    CDC estimates that costs for public health investigations and 
subsequent cost of care for people exposed to rabid dogs range from 
$220,897 to $521,828 per importation event, as summarized in an 
economic analysis found on CDC's website.38 39 40 This cost 
estimate does not account for the worst-case outcomes, which include: 
(1) transmission of rabies to a person who dies from the disease; and 
(2) ongoing transmission to other domestic animals and wildlife species 
in the United States. A previous campaign to eliminate domestic dog-
coyote rabies virus variant jointly with gray fox (Texas fox) rabies 
virus variant in Texas over the period from 1995 through 2003 cost $34 
million,41 42 or $48 million in

[[Page 5352]]

2020 U.S. dollars. Re-establishment of DMRVV into the United States 
could result in costly efforts over several years to eliminate the 
virus again.
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    \38\ Raybern, C., Zaldivar, A., Tubach, S., Ahmed, F., Moore, 
S., Kintner, C., Garrison, I. (2020) Rabies in a dog imported from 
Egypt-Kansas, 2019. MMWR Morb Mort Wkly Rep, 69(38), 1374-1377. 
Retrieved from https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6938a5-H.pdf.
    \39\ Centers for Disease Control and Prevention (2019). Guidance 
Regarding Agency Interpretation of ``Rabies-Free'' as It Relates to 
the Importation of Dogs Into the United States. Federal Register, 
Vol. 84, 724-730. Retrieved from https://www.federalregister.gov/documents/2019/01/31/2019-00506/guidance-regarding-agency-interpretation-of-rabies-free-as-it-relates-to-the-importation-of-dogs.
    \40\ https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/vaccine-certificate.html.
    \41\ Thomas, S., Wilson, P., Moore, G., Oertli, E., Hicks, B., 
Rohde, R., Johnston, D. (2005). Evaluation of oral rabies 
vaccination programs for control of rabies epizootics in coyotes and 
gray foxes: 1995-2003. Journal of the American Veterinary Medicine 
Association, 227(5), 785-92. doi: 10.2460/javma.2005.227.785.
    \42\ Sterner, R., Meltzer, M., Shwiff, S., Slate, D. (2009). 
Tactics and Economics of Wildlife Oral Rabies Vaccination, Canada 
and the United States. Emerging Infectious Diseases, 15(8), 1176-
1184. doi: 10.3201/eid1508.081061.
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B. Ongoing COVID-19 Response Activities

    Since January 2020, public health resources globally have been 
dedicated to responding to the COVID-19 pandemic, which remains a 
public health emergency as declared by the HHS Secretary and a Public 
Health Emergency of International Concern as declared by WHO. This 
context caused a lapse in canine rabies vaccination efforts in high-
risk countries.43 44 In the United States, the public health 
response to combatting the emergence of SARS-CoV-2 variants has 
required sustained Federal, state, and local public health resources.
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    \43\ Kunkel, A., Jeon, S., Joseph, H., Dilius, P., Crowdis, K., 
Meltzer, M., Wallace, R. (2021). The urgency of resuming disrupted 
dog rabies vaccination campaigns: a modeling and cost-effectiveness 
analysis. Scientific Reports, 11, 12476. doi:10.1038/s41598-021-
92067-5.
    \44\ Raynor, B., D[iacute]az, E., Shinnick, J., Zegarra, E., 
Monroy, Y., Mena. C., . . . Castillo-Neyra, R.(2021). The impact of 
the COVID-19 pandemic on rabies reemergence in Latin America: The 
case of Arequipa, Peru. PLoS Neglected Tropical Diseases, 15(5), 
e0009414. doi:10.1371/journal.pntd.0009414.
---------------------------------------------------------------------------

    The importation of a rabid dog on June 10, 2021, diverted public 
health resources from CDC, the U.S. Department of Agriculture (USDA), 
and nine states away from critical COVID-19 response activities. Any 
increase in the number of dogs with inadequate or falsified rabies 
vaccination certificates arriving in the United States increases the 
likelihood of a DMRVV-importation event and threatens the diversion of 
critical public health resources.\45\
---------------------------------------------------------------------------

    \45\ Pieracci, E., Williams, C., Wallace, R., Kalapura, C., 
Brown, C. U.S. dog importations during the COVID-19 pandemic: Do we 
have an erupting problem? PLoS ONE, 16(9), e0254287. doi: 10.1371/
journal.pone.0254287.
---------------------------------------------------------------------------

C. Insufficient Canine Vaccination Rates and Veterinary Controls in 
High-Risk Countries To Prevent the Export of Inadequately Vaccinated 
Dogs

    Historically, approximately 60 to 70 percent of CDC's dog entry 
denials (or about 200 cases annually) have been based on fraudulent, 
incomplete, or inaccurate paperwork.\46\ This number is less than one 
percent of dog importations. However, between January and December 2020 
(i.e., during the global COVID-19 pandemic), CDC documented more than 
450 instances of incomplete, inadequate, or fraudulent rabies 
vaccination certificates for dogs arriving from high-risk countries. 
This number increased for the first six months of 2021, during which 
time CDC documented more than 560 instances of incomplete, inadequate, 
or fraudulent rabies vaccination certificates for dogs arriving from 
high-risk countries.\47\ These cases resulted in dogs being denied 
entry into the United States and ultimately returned to their country 
of origin.
---------------------------------------------------------------------------

    \46\ Centers for Disease Control and Prevention (2021). 
Quarantine Activity Reporting System (version 4.9.8.8.2.2A). Dog 
Importation data, 2010-2019. Accessed 1 October 2022.
    \47\ Pieracci, E., Williams, C., Wallace, R., Kalapura, C., 
Brown, C. U.S. dog importations during the COVID-19 pandemic: Do we 
have an erupting problem? PLoS ONE, 16(9), e0254287. doi: 10.1371/
journal.pone.0254287.
---------------------------------------------------------------------------

    During the global COVID-19 pandemic, canine rabies vaccination 
campaigns were suspended in many high-risk countries, which resulted in 
an increase in canine and human rabies cases.48 49 The pause 
in canine vaccination campaigns and the delay in re-establishing pre-
COVID rabies vaccination rates in dogs in many high-risk countries, 
combined with insufficient veterinary controls in place to prevent the 
exportation of inadequately vaccinated dogs with fraudulent rabies 
vaccination certificates, presents a significant public health risk.
---------------------------------------------------------------------------

    \48\ Kunkel, A., Jeon, S., Joseph, H., Dilius, P., Crowdis, K., 
Meltzer, M., Wallace, R. (2021). The urgency of resuming disrupted 
dog rabies vaccination campaigns: a modeling and cost-effectiveness 
analysis. Scientific Reports, 11, 12476. doi:10.1038/s41598-021-
92067-5.
    \49\ Raynor, B., D[iacute]az, E., Shinnick, J., Zegarra, E., 
Monroy, Y., Mena. C., . . . Castillo-Neyra, R.(2021). The impact of 
the COVID-19 pandemic on rabies reemergence in Latin America: The 
case of Arequipa, Peru. PLoS Neglected Tropical Diseases, 15(5), 
e0009414. doi:10.1371/journal.pntd.0009414.
---------------------------------------------------------------------------

    A survey of global, regional, national, and local rabies working 
partners from the network of the United Against Rabies Forum \50\ and 
rabies practitioners found that the global COVID-19 pandemic impacted 
rabies control efforts in many high-risk countries during 2020. The 
study authors reported that dog vaccinations were administered as 
planned in just four percent of the countries for which data were 
available. Around half of respondents reported that funds for rabies 
control were diverted to global COVID-19 activities. However, even in 
countries where funds were not diverted, it was reported that funding 
for rabies control was insufficient and unpredictable even before the 
global COVID-19 pandemic. Among respondents who reported diversion of 
rabies control funds to global COVID-19 responses, they reported that 
animal rabies vaccines and dog vaccination campaigns were often the 
first rabies control activities to be cut.\51\
---------------------------------------------------------------------------

    \50\ A forum supported by the Food and Agriculture Organization 
of the United Nations, the World Organisation for Animal Health, and 
the World Health Organization (the Tripartite), which takes a multi-
sectoral, One Health approach bringing together governments, vaccine 
producers, researchers, non-governmental organizations and 
development partners to end human deaths from dog-mediated rabies.
    \51\ Nadal D, Abela-Ridder B, Beeching S, Cleaveland S, Cronin 
K, Steenson R and Hampson K (2022). The Impact of the First Year of 
the COVID-19 Pandemic on Canine Rabies Control Efforts: A Mixed-
Methods Study of Observations About the Present and Lessons for the 
Future. Front Trop Dis 3:866811.doi: 10.3389/fitd.2022.866811.
---------------------------------------------------------------------------

    Additionally, there are global veterinary workforce capacity and 
veterinary supply chain shortages, exacerbated by the COVID-19 
pandemic, that have led to delayed or disrupted care for dogs (and 
other pets) globally. The lack of veterinarians, veterinary 
technicians, and other animal care staff who are available to provide 
care for dogs prior to travel, combined with a lack of veterinary 
supplies such as drugs and vaccines, increase the likelihood dogs 
imported into the United States may pose a public health 
threat.52 53 54 55
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    \52\ https://www.theatlantic.com/health/archive/2022/07/not-enough-veterinarians-animals/661497/ 661497/.
    \53\ https://www.agcanada.com/2021/07/is-the-veterinarian-
shortage-real-or-
regional#:~:text=A%20perceived%20global%20shortage%20of%20veterinaria
ns%20is%20creating,for%20the%20quality%20of%20care%20they%20can%20off
er.
    \54\ https://www.thebusinessresearchcompany. com/report/
companion-animal-veterinary-vaccines-global-market-report.
    \55\ https://7news.com.au/lifestyle/pets/aussie-dog-owners-warned-of-national-vaccine-shortage-as-deadly-bacterial-disease-spreads-c-8568550.
---------------------------------------------------------------------------

D. Potentially Unsafe Conditions for Dogs Arriving From High-Risk 
Countries Without Appropriate Rabies Vaccination Certificates

    Prior to the implementation of the suspension, dogs arriving from 
high-risk countries without appropriate rabies vaccination certificates 
were denied entry and returned to the country of origin on the next 
available flight.\56\ Airlines were required to house dogs awaiting 
return to their country of origin

[[Page 5353]]

at a facility that meets the USDA's Animal Welfare Act standards, 
preferably a live animal care facility with an active custodial bond 
and a FIRMS code issued by CBP. If a live animal care facility with a 
CBP-issued FIRMS code was not available, the airline was required, at a 
minimum, to provide accommodation meeting the USDA's Animal Welfare Act 
standards.\57\
---------------------------------------------------------------------------

    \56\ Centers for Disease Control and Prevention (2019). Guidance 
Regarding Agency Interpretation of ``Rabies-Free'' as It Relates to 
the Importation of Dogs Into the United States. Federal Register, 
Vol. 84 724-730. Retrieved from https://www.federalregister.gov/documents/2019/01/31/2019-00506/guidance-regarding-agency-interpretation-of-rabies-free-as-it-relates-to-the-importation-of-dogs.
    \57\ U.S. Department of Agriculture (2020). Animal Welfare 
Regulations; Part 3, Subpart A: Transportation Standards. Sections 
3.14-3.20. Retrieved from https://www.aphis.usda.gov/animal_welfare/downloads/AC_BlueBook_AWA_508_comp_version.pdf.
---------------------------------------------------------------------------

    Some airlines housed dogs in cargo warehouses that created an 
unsafe environment for dogs due to the prolonged periods of time 
between flights, inadequate cooling and heating, poor cleaning and 
sanitization of crates, and inability to physically separate the 
animals from areas of the warehouse where other equipment, machinery, 
and goods are used and stored. Cargo warehouse staff who are not 
trained to house, clean, and care for live animals with appropriate 
personal protective equipment were at risk of bites, scratches, and 
exposures to potentially infectious bodily fluids from dogs left in 
cargo warehouses.
    During 2020, due to the global COVID-19 pandemic, there were fewer 
international flights worldwide,58 59 resulting in delayed 
returns for dogs denied entry. While international flights in 2022 
increased compared to 2020-2021, the number of flights remained 
somewhat below pre-pandemic levels with uncertainty regarding how 
quickly international passenger traffic will fully recover to pre-
pandemic levels.\60\ In August 2020, a dog denied entry based on 
falsified rabies vaccination certificates later died while in the 
custody of an airline at Chicago O'Hare International Airport. Despite 
CDC's request to find appropriate housing at a local kennel or 
veterinary clinic, the airline left the dog, along with 17 other dogs, 
in a cargo warehouse without food and water for more than 48 hours.\61\
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    \58\ Josephs, L. (2020). American Airlines cutting international 
summer schedule by 60% as coronavirus drives down demand. CNBC. 
Retrieved from https://www.cnbc.com/2020/04/02/coronavirus-update-american-airlines-cuts-summer-international-flights-by-60percent-as-demand-suffers.html.
    \59\ American Airlines (2020). American Airlines announces 
additional schedule changes in response to customer demand related 
to COVID-19. American Airlines Newsroom. Retrieved from https://news.aa.com/news/news-details/2020/American-Airlines-Announces-Additional-Schedule-Changes-in-Response-to-Customer-Demand-Related-to-COVID-19-031420-OPS-DIS-03/default.aspx.
    \60\ International Civil Aviation Organization (2022). Effects 
of novel coronavirus (COVID-19) on civil aviation: economic impact 
analysis. Retrieved from https://www.icao.int/sustainability/Documents/Covid-19/ICAO_coronavirus_Econ_Impact.pdf.
    \61\ CBS Broadcasting (2020). Dog dies at O'Hare Airport 
warehouse, 17 others saved after being left without food or water 
for 3 days. CBS Chicago. Retrieved from https://www.cbsnews.com/chicago/news/dog-dies-at-ohare-airport-warehouse-17-others-saved-after-being-left-without-food-or-water-for-3-days.
---------------------------------------------------------------------------

    While costs associated with housing, caring for, and returning dogs 
are the responsibility of the importer (or airline if the importer 
abandons the dog), some importers and airlines are reluctant to pay 
these costs, requiring the U.S. Government to find appropriate interim 
housing facilities and veterinary care. The cost for housing, care, and 
returning improperly vaccinated dogs ranges between $1,000 and $4,000 
per dog, depending on the location and time required until the next 
available return flight. Because there is no reimbursement system in 
place, and seeking reimbursement is administratively challenging, the 
U.S. Government is left to bear these costs when airlines and importers 
do not. From May through December 2020, CDC spent more than 3,000 
personnel-hours at an estimated cost of $270,000 to respond to the 
attempted importation of unvaccinated or inadequately vaccinated dogs 
from high-risk countries. The time spent represented a substantial 
increase from previous years due to (1) the increase in dogs with 
inadequate documentation; and (2) the additional time spent identifying 
interim accommodations for the dogs because of the reduced outbound 
international flight schedules due to the pandemic.
    During 2020, CDC observed a 52 percent increase (from an average of 
300 to 450) in the number of dogs ineligible for entry compared to 2018 
and 2019.\62\ The trend continued in the first half of 2021 when there 
was a 24 percent increase (from 450 to 560) in the number of dogs 
ineligible for entry compared to the whole of 2020.\63\ From January 1, 
2021, to July 13, 2021, prior to CDC's suspension taking effect, there 
were 16 sick dogs and 18 dead dogs reported to CDC upon arrival in the 
United States. From July 14, 2021, when the suspension was implemented, 
to September 30, 2022, CDC has denied entry to 145 dogs, and eight sick 
dogs and 26 deaths have been reported to CDC. This substantial decrease 
in the number of dogs denied entry since the implementation of the 
suspension and limited number of sick and dead dogs arriving in the 
United States has resulted in an estimated $55,000 to $190,000 in cost 
savings to importers and $3,400 to $170,000 in cost savings to Federal 
and state public health and animal health agencies when comparing the 
two periods.
---------------------------------------------------------------------------

    \62\ Pieracci, E., Williams, C., Wallace, R., Kalapura, C., 
Brown, C. U.S. dog importations during the COVID-19 pandemic: Do we 
have an erupting problem? PLoS ONE, 16(9), e0254287. doi: 10.1371/
journal.pone.0254287.
    \63\ Centers for Disease Control and Prevention. Quarantine 
Activity Reporting System (version 4.9.8.8.2.2A). Dog Importation 
data, January 1, 2021-July 14, 2021. Accessed: 04 January 2022.
---------------------------------------------------------------------------

    During the timeframe of the current suspension, the number of dogs 
denied entry and the number of sick and dead dogs has substantially 
decreased despite the increased communicable disease risk due to 
disruptions to vaccination programs in high-risk countries and 
veterinary supply chain and staffing shortages worldwide. This 
constitutes strong evidence that the suspension has been effective at 
preventing the importation of dogs that present a communicable disease 
risk that would otherwise require significant U.S. resources to 
address. There was an increasing number of dogs denied entry in 2020 
and 2021, prior to the suspension, and there were fewer international 
flights in 2020 and 2021 compared to 2022.\64\ If the increase in 
number of flights in 2022 corresponded with numbers of dogs denied 
entry per flight in 2021 and 2022, lifting the suspension at this time 
could result in a return to pre-suspension or greater numbers of dogs 
denied entry along with an associated large increase of sick, dead, or 
inadequately vaccinated dogs arriving in the United States that could 
quickly overwhelm already strained public health and veterinary 
healthcare systems.
---------------------------------------------------------------------------

    \64\ U.S. Bureau of Transportation Statistics. (2022) August 
2022 U.S. Airline Traffic Data. https://www.bts.gov/newsroom/august-2022-us-airline-traffic-data.
---------------------------------------------------------------------------

    Since there remains an elevated level of risk of a rabid dog being 
imported into the United States compared to before the global COVID-19 
pandemic and because responding to imports of potentially rabid dogs or 
dogs with other communicable illnesses of public health concern 
requires significant veterinary and public health resources, lifting 
the suspension would be unwarranted at this time.
    Instead, CDC is extending the temporary suspension for dogs 
arriving into the United States from high-risk countries. Given that 
the conditions for dog importations under the suspension have prevented 
the reintroduction of DMRVV into the United States and have decreased 
the number of issues with imported dogs (suspected fraudulent

[[Page 5354]]

documentation, dogs abandoned by importers, sick and dead dogs arriving 
in the United States) compared to the period prior to the suspension, 
maintaining the current requirements for dog importation should not 
result in an increased need for veterinary and public health resources 
to address dog importation issues.

III. Conditions for Dog Importation Under the July 10, 2021, Temporary 
Suspension

    During the temporary suspension of dogs arriving from countries at 
high risk for dog rabies, eligible importers, including owners of 
service dogs, U.S. and foreign-government personnel, and persons 
permanently relocating to the United States, could apply to import 
their personally owned pet dogs. People were also permitted to import 
dogs for science, education, exhibition, or bona fide law enforcement 
purposes. To receive a CDC Dog Import Permit, eligible importers had to 
provide a rabies vaccination certificate prior to the dog arriving in 
the United States that met the criteria outlined below, as well as 
rabies serologic titers from a CDC-approved laboratory if the dog was 
vaccinated outside the United States. Dogs were also required to be at 
least six months of age and have a microchip implanted prior to arrival 
in the United States.
    For dogs arriving from high-risk countries, the rabies vaccination 
certificates had to include the following information to be considered 
complete and accurate:
     Name and address of owner;
     Breed, sex, date of birth (approximate age if date of 
birth unknown), color, markings, and other identifying information for 
the dog;
     Microchip number;
     Date of rabies vaccination and vaccine product 
information;
     Date the vaccination expires; and
     Name, license number, address, and signature of 
veterinarian who administered the vaccination.
    For a rabies vaccine to be effective, a dog must be at least 12 
weeks (84 days) of age at the time of administration. A dog's initial 
vaccine must also be administered at least four weeks (28 days) before 
arrival in the United States for the dog to be considered adequately 
vaccinated against rabies.

A. Extension of the Temporary Suspension Enacted June 10, 2022

    On June 10, 2022, CDC extended and modified the temporary 
suspension to allow a pathway for all importers to import dogs into the 
United States utilizing one of the three options listed in sections IV-
VII below. CDC is now extending the suspension through July 31, 2023. 
Although CDC is providing clarifying language to the entry requirements 
in section IV-VI below, it is not modifying the terms of the current 
suspension itself. CDC will be implementing the use of a standardized 
rabies vaccination form to reduce errors and omissions frequently 
documented on rabies vaccination certificates. This form will not 
require any new information to be submitted to CDC but will assist 
importers in ensuring the rabies vaccination form they submit includes 
all required information. This will help to reduce wait times for 
importers applying for CDC dog import permits.

IV. Conditions for Entry of U.S.-Vaccinated Dogs During the Extension

    Through this notice, CDC is continuing the current requirements for 
entry of U.S.-vaccinated dogs. Dogs returning to the United States from 
high-risk countries with a valid U.S.-issued rabies vaccination 
certificate will be allowed to enter the United States without a CDC 
Dog Import Permit, if the dog:
     Is six-months of age or older;
     Has an ISO-compatible microchip; \65\
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    \65\ ISO means international standards organization.
---------------------------------------------------------------------------

     Arrives at one of 18 CDC-approved ports of entry with CDC-
staffed quarantine stations; and
     Has a valid U.S. rabies vaccination certificate 
documenting that the dog was vaccinated against rabies by a U.S.-
licensed veterinarian in the United States on or after the date the dog 
was 12 weeks (84 days) of age and at least four weeks (28 days) before 
the date of arrival in the United States if it was the dog's first 
rabies vaccine. The rabies vaccination certificate must include:
    [cir] Name and address of owner;
    [cir] Breed, sex, date of birth (approximate age if date of birth 
unknown), color, markings, and other identifying information for the 
dog;
    [cir] Microchip number;
    [cir] Date of rabies vaccination and date next vaccine is due 
(i.e., date the vaccination expires);
    [cir] Vaccine manufacturer, product name, lot number and product 
expiration date; and
    [cir] Name, license number, address, and signature of veterinarian 
who administered the vaccination.
    U.S. veterinarians, at their option, may choose to include the 
above information on the CDC Rabies Vaccination and Microchip Record 
(OMB No. 0920-1383) for U.S.-vaccinated dogs prior to traveling outside 
the United States, but completion of the form is not required for a 
U.S.-vaccinated dog's re-entry into the United States if all other 
necessary information has been provided. The form is available for 
download online at: www.cdc.gov/dogpermit.
    U.S.-vaccinated dogs with expired U.S. rabies vaccination 
certificates must meet the requirements for foreign-vaccinated dogs 
after being revaccinated prior to U.S. entry.
    There is no limit on the number of U.S.-vaccinated dogs with valid 
U.S.-issued rabies vaccination certificates that an importer can 
import.
    These requirements are consistent with CDC's practices as of 
December 1, 2021, and are a continuation of the terms of the modified 
temporary suspension announced in the June 2022 Federal Register notice 
(87 FR 33158, June 1, 2022).

V. Conditions for Entry of Foreign-Vaccinated Dogs With a CDC Dog 
Import Permit During the Extension

    CDC is continuing to require foreign-vaccinated dogs to meet the 
terms of the modified temporary suspension published in the June 2022 
Federal Register notice (87 FR 33158, June 1, 2022). Importers of 
personal pet dogs may receive up to two CDC Dog Import Permits (i.e., 
permits for two dogs) during the suspension period. Commercial 
importers and personal pet owners who do not have serologic titer 
results for their dogs will also continue to have an alternate pathway 
for importation.
    All importers of personal pet dogs (defined for the purpose of this 
notice as owners or importers attempting to import fewer than three 
dogs total during the suspension and not intended for resale, rescue, 
or adoption) from high-risk countries are eligible to apply for a CDC 
Dog Import Permit. Commercial dog importers (defined for the purpose of 
this notice as importing three or more dogs during the suspension or 
those being imported for resale, rescue, or adoption) are not eligible 
to apply for a CDC Dog Import Permit and their dogs must meet the 
requirements for entry outlined in Section VI below.
    Foreign-vaccinated dogs arriving from high-risk countries with a 
valid CDC Dog Import Permit will be allowed to enter the United States 
if the dogs:
     Are six-months of age or older (photographs of the dog's 
teeth are required for age verification);
     Have an ISO-compatible microchip;

[[Page 5355]]

     Have a CDC Rabies Vaccination and Microchip Record 
([approved under OMB Control Number 0920-1383 Importation Regulations 
(42 CFR 71 Subpart F) (exp. 1/31/2026, or as revised)]) completed by 
the veterinarian who administered the rabies vaccine. The record must 
state that the vaccine was administered on or after the date the dog 
was 12 weeks (84 days) of age. The record must be in English;
     Have serologic evidence of rabies vaccination (titer) from 
an approved rabies serology laboratory \66\ (serologic titer results 
>=0.5 IU/mL are required) with the sample collected at least 45 days 
prior to entry and no greater than 365 days before entry; and
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    \66\ Centers for Disease Control and Prevention (2022). Approved 
Rabies Serology Laboratories for Testing Dogs. Retrieved from 
https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/approved-labs.html.
---------------------------------------------------------------------------

     Arrive at one of the 18 CDC-approved ports of entry with 
CDC-staffed quarantine stations.
    In order to reduce the time to review applications and issue CDC 
Dog Import Permits, CDC is requiring that importers of foreign-
vaccinated dogs submit the rabies vaccination and microchip information 
via the form CDC Rabies Vaccination and Microchip Record (OMB No. 0920-
1383). As of October 31, 2022, almost half of CDC Dog Import Permit 
applicants submitted an incomplete application with information 
pertaining to the rabies vaccination certificate constituting the 
majority of the missing information. Requiring importers to submit the 
CDC Rabies Vaccination and Microchip Record form will help ensure they 
submit all required information and will reduce the burden on importers 
by reducing the time it takes for them to receive a permit. 
Additionally, CDC has included a description on the form to clarify for 
veterinarians the information to which they are attesting when they 
sign the form on behalf of an importer. The form is available for 
download online at: www.cdc.gov/dogpermit.
    To apply for a CDC Dog Import Permit, importers whose dogs meet the 
entry requirements listed above must submit the Application for Special 
Exemption for a Permitted Dog Import, [approved under OMB Control 
Number 0920-1383 Importation Regulations (42 CFR 71 Subpart F) (exp. 1/
31/2026), or as revised]. The permit application is available online at 
www.cdc.gov/dogpermit.
    The importer's application, with all supporting documentation, must 
be submitted at least 30 business days (i.e., excluding weekends and 
U.S. federal holidays) before the date on which the dog will enter the 
United States. Importers may submit an application electronically at 
www.cdc.gov/dogpermit. An application cannot be made at the port of 
entry upon the dogs' arrival in the United States; dogs that arrive 
without a CDC Dog Import Permit will be returned to their country of 
departure on the next available flight or quarantined at the importer's 
expense at a CDC-approved animal care facility (if one is available at 
the port of entry where the dog arrived) pending availability and 
payment of all associated examination, vaccination, and quarantine fees 
upfront (see Section VI).
    Within 10 days of arrival, foreign-vaccinated dogs with a CDC Dog 
Import Permit must receive a USDA-licensed rabies booster vaccination 
administered by a U.S. veterinarian.

VI. Conditions for Entry of Foreign-Vaccinated Dogs Without a CDC Dog 
Import Permit During the Extension

    CDC is continuing the requirements of the temporary suspension 
published in the June 2022 Federal Register notice (87 FR 33158, June 
1, 2022) that provide a pathway for commercial dog importers to import 
dogs. While importers of commercial shipments of dogs cannot apply for 
a CDC Dog Import Permit, a separate entry process, as outlined below, 
has been established. All commercial dog importers from high-risk 
countries may import dogs provided that the dogs, upon entering the 
United States, are examined, revaccinated, and have proof of an 
adequate titer from a CDC-approved laboratory upon arrival or are held 
in quarantine at a CDC-approved animal facility until they meet CDC 
entry requirements. Importers of personally owned pets may also choose 
to use this pathway in lieu of obtaining a CDC Dog Import Permit.
    Foreign-vaccinated dogs without a valid CDC Dog Import Permit must 
meet all other entry requirements (sections VI-VII) prior to arrival 
and must also meet the following requirements:
     Dogs must enter at a port of entry with a CDC-approved 
animal facility; \67\
---------------------------------------------------------------------------

    \67\ Centers for Disease Control and Prevention (2022). Bringing 
a dog into the United States. Retrieved from www.cdc.gov/dogtravel.
---------------------------------------------------------------------------

     Dogs must be six months of age or older at the time of 
entry;
     Dogs must have an ISO-compatible microchip; and
     Dogs must have a CDC Rabies Vaccination and Microchip 
Record [approved under OMB Control Number 0920-1383 Importation 
Regulations (42 CFR 71 Subpart F) (exp. 1/31/2026, or as revised)]) 
completed by the veterinarian who administered the rabies vaccine. The 
record must state that the vaccine was administered on or after the 
date the dog was 12 weeks (84 days) of age. The record must be in 
English;
     Importers must provide all required entry documents (CDC 
Rabies Vaccination and Microchip Record, serologic titer results if 
available, photos of dogs' teeth) to the CDC-approved animal care 
facility at least 10 days before the dogs' arrival;
     Importers must arrange for an examination date and time 
and reserve space with a CDC-approved animal facility;
     Importers must arrange for transportation by a CBP-bonded 
transporter (i.e., provided by the airline carrier or a CDC-approved 
animal facility) to a CDC-approved animal facility immediately upon the 
dogs' arrival to the United States; and
     Dogs must undergo veterinary examination and revaccination 
against rabies at a CDC-approved animal facility upon arrival at the 
importer's expense.
    In order to reduce the time for facility operators to review the 
documents required to request a reservation at a CDC-approved animal 
care facility, CDC is requiring that importers of foreign-vaccinated 
dogs submit the rabies vaccination and microchip information via the 
form CDC Rabies Vaccination and Microchip Record. Requiring importers 
to submit the CDC Rabies Vaccination and Microchip Record (OMB NO. 
0920-1383) form will help ensure they submit all required information 
and will reduce the burden on importers and the CDC-approved animal 
care facilities by reducing the time it takes for facility operators to 
review all required documents. Additionally, CDC has included a 
description on the form to clarify for veterinarians that to which they 
are attesting when they sign the form for an importer.
    Dogs must also be held at the CDC-approved animal facility until 
the following entry requirements are completed:
     Veterinary health examination by a USDA-accredited 
veterinarian for signs of illness, including zoonotic or foreign animal 
diseases. Suspected or confirmed zoonotic or foreign animal diseases 
must be reported to CDC, USDA, the state or territorial public health 
veterinarian, and the state or territorial veterinarian. The CDC-
approved animal care facility must not release the dog without the 
written approval of CDC;

[[Page 5356]]

     Vaccination against rabies with a USDA-licensed rabies 
vaccine and administered by a USDA-accredited veterinarian;
     Confirmation of microchip number;
     Confirmation of age through dental examination by a USDA-
accredited veterinarian; and
     Verification of adequate rabies titer from a CDC-approved 
laboratory.\68\ Serologic titer results of >=0.5IU/mL are required from 
a CDC-approved laboratory, with the sample collected at least 45 days 
prior to entry and no greater than 365 days before entry. Dogs that 
arrive without documentation of an adequate rabies titer from an 
approved laboratory must be housed at the CDC-approved animal facility 
for a 28-day quarantine at the expense of the importer following 
administration of the U.S. rabies vaccine in addition to meeting the 
criteria listed above. Dogs cannot be released from quarantine unless 
all requirements have been met.
---------------------------------------------------------------------------

    \68\ Approved laboratories can be found at: www.cdc.gov/importation/bringing-an-animal-into-the-united-states/approved-labs.html.
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    Importers are responsible for all fees associated with the 
importation of dogs into the United States, including transportation, 
examination, vaccination, and quarantine fees.
    Foreign-vaccinated dogs arriving without a CDC Dog Import Permit 
must enter the United States through a CDC-approved port of entry with 
a CDC-approved animal care facility. As of December 2022, these 
facilities are located at: Atlanta Hartsfield-Jackson International 
Airport, John F. Kennedy International Airport (New York), Los Angeles 
International Airport, Miami International Airport, and Washington 
Dulles International Airport (outside Washington, DC). Importers are 
responsible for reserving examination times and space at the CDC-
approved animal care facility prior to arrival in the United States. 
Dogs that arrive at unapproved ports of entry or without reservations 
at a CDC-approved animal care facility will be denied entry and 
returned to the country of departure.

VII. Continued Conditions for All Dogs From High-Risk Countries During 
the Extension

    Consistent with the terms of the original temporary suspension 
published in the June 2021 Federal Register notice (86 FR 32041, June 
16, 2021), all dogs arriving from high-risk countries must be 
microchipped prior to arrival in the United States. The microchip can 
be administered in any country and does not need to be a U.S.-issued 
microchip. The microchip number must be listed on the rabies 
vaccination certificate. The microchip must be ISO-compatible.
    Any dog from a high-risk country will be excluded from entering the 
United States and returned to its country of departure on the next 
available flight, regardless of carrier or route, if the dog arrives 
under any of the following circumstances:
     A dog arrives in the United States and does not meet the 
minimum pre-arrival requirements (i.e., age greater than six months, 
microchip, and either valid U.S.-issued rabies vaccination certificate 
or complete and accurate CDC Rabies Vaccination and Microchip Record);
     A dog presented does not match the description of the 
animal listed on the permit (if required), U.S. rabies vaccination 
certificate, or CDC Rabies Vaccination and Microchip Record;
     A dog arrives at an unapproved port of entry;
     A dog arrives at an airport with a CDC-approved animal 
care facility without a reservation and no space at the facility is 
available; or
     Importer refuses transportation to, or receipt of or 
payment for services at, a CDC-approved animal care facility (if 
required). CDC may consider the dog abandoned and transfer custody of 
the dog to the airline carrier for final disposition.
    The importer shall be financially responsible for all housing, 
care, and return costs. If an importer abandons a dog while it is at a 
CDC-approved animal care facility, the carrier shall become responsible 
for all costs associated with the care, housing, and return of the dog 
to the country of departure. In keeping with current practice, 
importers should continue to check with Federal, state, and local 
government officials regarding additional requirements of the final 
destination prior to entry or re-entry into the United States.

VIII. Additional Determinations Relating to This Notice

    Pursuant to the terms of this notice, CDC is extending the 
temporary suspension for the importation of dogs from high-risk 
countries. This suspension includes dogs originating in DMRVV low-risk 
or DMRVV-free countries that have been in a high-risk country in the 
previous six months (not including animals transiting through high-risk 
countries).
    To enter the United States, dogs imported from a high-risk country 
must meet certain entry requirements as described in Sections IV 
through VII of this notice.

                          Table 1--Entry Conditions for Dogs Under Extended Suspension
----------------------------------------------------------------------------------------------------------------
                                         Dogs with valid  CDC
                                          Dog Import Permit       Dogs with valid  CDC     Dogs with valid  CDC
     Dogs with valid U.S. Rabies        (fewer than three dogs   Rabies Vaccination and   Rabies Vaccination and
    Vaccination certificate (RVC)        being  imported with       Microchip Record      Microchip Record with
                                                titer)               without titer                titer
----------------------------------------------------------------------------------------------------------------
At least six months of age...........  At least six months of   At least six months of   At least six months of
                                        age.                     age.                     age.
Microchip............................  Microchip..............  Microchip..............  Microchip.
Entry allowed at 18 ports of entry     Entry allowed at 18      Entry allowed at five    Entry allowed at five
 with CDC quarantine station.           ports of entry with      ports of entry with      ports of entry with
                                        CDC quarantine station   CDC-approved animal      CDC-approved animal
                                        with valid CDC Dog       care facility.           care facility.
                                        Import Permit issued
                                        prior to arrival.
Titer not needed.....................  Serologic titer (>=0.5   Not applicable*........  Serologic titer (>=0.5
                                        IU/mL) from a CDC-                                IU/mL) from a CDC-
                                        approved laboratory.                              approved laboratory.
                                       Titer drawn at least 45                           Titer drawn at least 45
                                        days before entry and                             days before entry and
                                        not more than 365 days                            not more than 365 days
                                        before entry.                                     before entry.
No quarantine........................  No quarantine..........  28-day quarantine at     No quarantine.
                                                                 CDC-approved animal
                                                                 care facility.

[[Page 5357]]

 
Veterinary exam, booster vaccination   Veterinary exam or       Veterinary examination,  Veterinary examination,
 or quarantine not required unless      quarantine not           booster vaccination,     booster vaccination,
 the animal appears ill upon arrival.   required with valid      and paperwork            and paperwork
                                        CDC Dog Import Permit    verification at CDC-     verification at CDC-
                                        unless the animal        approved animal care     approved animal care
                                        appears ill upon         facility required upon   facility required upon
                                        arrival.                 arrival.                 arrival.
                                       Booster vaccination is
                                        required within 10
                                        days of arrival by
                                        U.S. veterinarian.
----------------------------------------------------------------------------------------------------------------
* This is an alternate pathway for importation in the event documentation of an adequate titer is not available
  upon arrival.

    The suspension will continue to reduce the risk of importation of 
DMRVV, ensure public health safeguards are in place for the importation 
of dogs from high-risk countries, and preserve public health resources. 
The terms of the suspension allow for sufficient safeguards to mitigate 
the public health risk. The suspension will also allow CDC to continue 
to work with Federal, state, territorial and local partners, airlines, 
and other affected parties to consider options for a more streamlined 
and efficient dog importation process that will be safer for pets. Most 
importantly, it will ensure that U.S. public health remains protected.
    Therefore, pursuant to 42 CFR 71.51(e) and 42 CFR 71.63, CDC hereby 
excludes the entry and suspends (subject to the terms and conditions 
outlined in this notice) the importation of dogs from high-risk 
countries, including dogs from DMRVV low-risk and DMRVV-free countries 
if the dogs have been present in a high-risk country in the previous 
six months.
    Additionally, under 42 CFR 71.63, CDC continues to find that DMRVV 
exists in countries designated as high-risk countries and that, if 
reintroduced into the United States, DMRVV would threaten the public 
health of the United States. The continued entry of dogs from high-risk 
countries in the context of rabies vaccination campaign disruptions and 
veterinary supply and veterinary workforce shortages as a result of the 
global COVID-19 pandemic as well as the insufficient safeguards in 
place to prevent the exportation of inadequately vaccinated dogs from 
high-risk countries further increases the risk that DMRVV may be 
introduced, transmitted, or spread into the United States. CDC has 
coordinated in advance with other Federal agencies as necessary to 
implement and enforce this notice.
    CDC further clarifies through this notice that there is no agency 
policy of using the ``least restrictive means'' (as that concept is 
typically understood and applied in cases involving interests protected 
by the U.S. Constitution) in regard to animal importations under 42 CFR 
part 71. ``The Due Process Clause of the Fourteenth Amendment imposes 
procedural constraints on governmental decisions that deprive 
individuals of liberty or property interests.'' Nozzi v. Hous. Auth. of 
City of Los Angeles, 806 F.3d 1178, 1190 (9th Cir. 2015). However, 
``[d]ue process protections extend only to deprivations of protected 
interests.'' Shinault v. Hawks, 782 F.3d 1053, 1057 (9th Cir. 2015). 
Because individuals have no protected property or liberty interest in 
importing dogs into the United States, it is CDC's policy to not employ 
a constitutional analysis of ``least restrictive means'' in regard to 
animal imports under 42 CFR part 71. See Ganadera Ind. v. Block, 727 
F.2d 1156, 1160 (D.C. Cir. 1984) (``no constitutionally-protected right 
to import into the United States''); see also Arjay Assoc. v. Bush, 891 
F.2d. 894, 896 (Fed. Cir. 1989) (``It is beyond cavil that no one has a 
constitutional right to conduct foreign commerce in products excluded 
by Congress.'').
    Notwithstanding, to the extent that any court determines that an 
analysis of ``least restrictive means'' is necessary, CDC finds and 
asserts that the measures contained in this notice constitute the least 
restrictive means of protecting the public's health from the 
reintroduction of DMRVV. Although a complete ban on all dog imports 
would arguably provide a greater level of public health protection, it 
would deprive individuals of the many benefits arising from dog imports 
including the companionship offered by pet dogs. Similarly, removing 
all restrictions at this time (as has been explained in this notice) 
would endanger the public's health and risk the reintroduction of DMRVV 
based on, among other things, the lack of veterinary controls in 
foreign countries. Accordingly, in establishing the terms and 
conditions of this notice, CDC has carefully balanced the need to 
protect the public's health against the potential burden on importers 
and determined that the measures in this notice constitute the least 
restrictive means.
    This notice is not a legislative rule within the meaning of the 
Administrative Procedure Act (APA), but rather a notice of an exclusion 
and temporary suspension taken under the existing authority of 42 CFR 
71.51(e) and 42 CFR 71.63, which were previously promulgated with full 
notice and comment. If this notice qualifies as a legislative rule 
under the APA, notice and comment and a delay in effective date are not 
required because there is good cause to dispense with prior public 
notice and the opportunity to comment on this notice. Considering the 
insufficient safeguards in place to prevent the exportation of 
inadequately vaccinated dogs from high-risk countries, and the risk of 
reintroduction of DMRVV from dogs being imported from high-risk 
countries, it would be impractical and contrary to the public's health, 
and by extension the public's interest, to delay the issuance and 
effective date of this notice. Notwithstanding, CDC is publishing this 
notice in advance of its effective date, to allow potential dog 
importers and other interested parties sufficient time to adjust their 
practices in accordance with the terms of this temporary suspension.
    This temporary suspension will enter into effect on February 1, 
2023, and remain in effect through July 31, 2023, unless modified or 
rescinded by the CDC Director based on public health or other 
considerations.

    Dated: January 24, 2023.
Sherri Berger,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2023-01688 Filed 1-24-23; 4:15 pm]
BILLING CODE 4163-18-P