[Federal Register Volume 88, Number 130 (Monday, July 10, 2023)]
[Notices]
[Pages 43570-43581]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-14342]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


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: In order to protect the United States against the potential 
reintroduction of the dog-maintained rabies virus variant (DMRVV) into 
the United States, 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 countries at high-risk 
for enzootic rabies (DMRVV high-risk countries). This suspension 
includes dogs that have been in any DMRVV 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 DMRVV high-risk countries will be 
implemented on August 1, 2023, when the current suspension expires, and 
will remain in effect through July 31, 2024.

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 of the importation into the 
United States of dogs from countries at high-risk for enzootic rabies 
(DMRVV high-risk countries), including dogs that have been in any DMRVV 
high-risk countries during the previous six months. 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 dogs from DMRVV 
high-risk countries which are unvaccinated or inadequately vaccinated 
against rabies. This continued threat is due to various factors, 
including: a high volume of dogs being imported into the United States 
contemporaneous with insufficient veterinary controls in DMRVV high-
risk countries to prevent the export of inadequately vaccinated dogs, 
inadequate global veterinary supply chains for vaccines and related 
materials, and persistent workforce capacity shortages, particularly in 
DMRVV high-risk countries that export dogs to the United States. CDC 
anticipates that these factors are likely to continue over the course 
of the next 12 months. Considering these factors, CDC has determined 
that it is necessary to extend the temporary suspension through July 
31, 2024, to ensure dogs imported into the United States do not pose a 
public health threat of reintroducing DMRVV into the United States.\1\
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    \1\ In consideration of both the anticipated needs for global 
rabies vaccine campaigns to return to pre-pandemic levels and to 
avoid disruption to importers' and the travel industry's operations, 
CDC has determined that a one-year extension of the temporary 
suspension is required to protect the public's health and is 
therefore in the public's interest. In the absence of a further 
extension of the temporary suspension or the adoption of an 
alternate framework to mitigate the importation of dogs infected 
with rabies, dog importation requirements would return to procedures 
that proved inadequate to prevent the import of rabid dogs into the 
United States.

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[[Page 43571]]

    Additionally, CDC is publishing a proposed rule as a companion 
document, published elsewhere in this issue of the Federal Register, 
that outlines 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. If adopted, this proposed rule would mitigate the need for 
further extensions of the temporary suspension.

I. Background and Authority

    Rabies is one of the deadliest zoonotic diseases and accounts for 
an estimated 59,000 human deaths globally each year.\2\ This equates to 
one human death every nine minutes.\3\ DMRVV is responsible for 98 
percent of these deaths.\4\ The rabies virus can infect any mammal and, 
once clinical signs appear, the disease is almost always fatal.\5\ In 
September 2007, at the Inaugural World Rabies Day Symposium, CDC 
declared the United States to be free of DMRVV.\6\ 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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    \2\ 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.
    \3\ Id.
    \4\ Hampson K, Coudeville L, Lembo T, et al.; Global Alliance 
for Rabies Control Partners for Rabies Prevention. Estimating the 
global burden of endemic canine rabies. PLoS Negl Trop Dis 
2015;9:e0003709. https://doi.org/10.1371/journal.pntd.0003709.
    \5\ 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.
    \6\ 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.\7\ 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),\8\ 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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    \7\ 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.
    \8\ 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,\9\ unless the 
dogs' owners or importers submit satisfactory evidence that dogs under 
six months of age have not been in a DMRVV high-risk country or dogs 
older than six months have not been in a DMRVV high-risk country during 
the six months prior to arrival.\10\ CDC maintains a publicly available 
list of DMRVV high-risk countries \11\ and provides guidance for dog 
entry requirements based on the dog's country of origin.
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    \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/vaccine-certificate.html.
    \10\ 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.
    \11\ 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.\12\ 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 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 DMRVV 
low-risk status, CDC can review that information and reassess the 
country's status.
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    \12\ 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 ``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 DMRVV 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.\13\
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    \13\ Id.
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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 
DMRVV high-risk countries and that, if reintroduced into the United 
States, DMRVV would threaten the public health of the United States.
    Pursuant to these legal authorities and determinations made 
thereunder, on June 16, 2021, CDC announced a temporary suspension of 
the importation of dogs from DMRVV high-risk countries into the United 
States to protect the public health against the reintroduction of DMRVV 
into the United States (the temporary suspension).\14\ The temporary 
suspension went into effect on July 14, 2021.
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    \14\ 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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    CDC found that the temporary suspension prohibiting the importation 
of dogs from DMRVV high-risk countries for rabies was especially 
necessary due to the diversion of public health resources to respond to 
the COVID-19 pandemic. The limited

[[Page 43572]]

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. Despite a decrease in international travel 
volumes due to the global COVID-19 pandemic, CDC noted an increase in 
importers circumventing dog import regulations--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. For these reasons, CDC implemented the 
temporary suspension in July 2021. In addition, CDC implemented a CDC 
Dog Import Permit \15\ during the temporary suspension to verify the 
documentation of imported dogs before they are flown to the United 
States.
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    \15\ Approved under OMB Control Number 0920-1383 Importation 
Regulations (42 CFR 71 Subpart F) (exp. 1/31/2026, or as revised).
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    Since the temporary suspension first went into effect in July 2021, 
CDC has modified the terms of the suspension to allow for more dog 
imports as the public health situation has gradually improved and as 
more public health resources have become available globally. On June 1, 
2022, CDC announced a modified and extended temporary suspension, 
effective June 10, 2022 through January 31, 2023.\16\ The extension and 
modification of the temporary suspension permitted all categories of 
importers to import dogs from DMRVV high-risk countries, while 
requiring commercially imported dogs to enter the United States at a 
port of entry with a CDC-approved animal care facility with a 
Facilities Information and Resource Management System (FIRMS) code 
issued by U.S. Customs and Border Protection (CBP).\17\ CDC also 
expanded the list of the approved ports of entry to include 18 airports 
\18\ with a CDC quarantine station for importers with a valid U.S.-
issued rabies vaccination certificate or a CDC Dog Import Permit. On 
January 27, 2023, CDC announced an extension of the temporary 
suspension through July 31, 2023, without modifications.\19\ The 
extension took effect February 1, 2023, and continues to allow dogs 
from DMRVV high-risk countries to enter the United States under one of 
the options outlined in the June 10, 2022, extension.
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    \16\ Id.
    \17\ Centers for Disease Control and Prevention (2023). CDC 
Approved Animal Care Facilities. Retrieved from https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/approved-care-facilities.html.
    \18\ 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).
    \19\ 88 FR 5348 (Jan. 27, 2023).
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    At this time, CDC is extending the temporary suspension through 
July 31, 2024, because of the continued risk for the reintroduction of 
DMRVV into the United States. This extension is based on the increasing 
number of dogs being purchased internationally,20 21 22 23 
often from DMRVV high-risk countries, and imported into the United 
States and other rabies-free countries. This increase in international 
purchases of dogs is occurring contemporaneous with a high volume of 
dogs being imported into the United States and continued disruptions to 
rabies vaccination campaigns globally as a lingering effect of the 
diversion of public health resources during the COVID-19 pandemic. The 
rate of rabies in imported dogs is higher than the rate of domestically 
acquired rabies in dogs. Disruptions to rabies vaccination campaigns 
globally further elevate that risk, and CDC anticipates it will take at 
least two years, and possibly longer, for global vaccination campaigns 
to recover to pre-pandemic levels. This timeframe is based on modeling 
data which suggest that when rabies vaccination coverage is disrupted 
in rabies-free countries and cases begin occurring, countries can 
prevent reestablishment of the disease in as little as 2 years if 38-
56% of the dog population is vaccinated annually.\24\ Additionally, 
constraints on the global veterinary workforce capacity and global 
veterinary supply chain shortages have led to delayed or disrupted care 
for dogs, which also increases the likelihood dogs imported into the 
United States may pose a public health 
risk.25 26 27 28 29 30
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    \20\ 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.
    \21\ Wynne E. Dog lovers find prices rise steeply amid COVID-
fueled demand. Australian Broadcasting Corporation News. 20 May 
2021.
    \22\ Morgan L, Protopopova A, Birkler RID, Itin-Shwatz B, Sutton 
G, Gamliel A, et al. Human-dog relationships during the COVID-19 
pandemic: booming dog adoption during social isolation. Humanities 
and Social Science Communications. 2021; 7(150): 1-11.
    \23\ British Broadcasting Corporation. Illegal puppy trade 
warning as sales boom during the COVID pandemic. 18 NOV 2020. 
British Broadcasting Corporation News.
    \24\ 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.
    \25\ Zhang S. The great veterinary shortage. The Atlantic. July 
6, 2022. https://www.theatlantic.com/health/archive/2022/07/not-enough-veterinarians-animals/661497/.
    \26\ Martin D. Is the veterinarian shortage real or regional? 
AGCanada.com July 16, 2021. https://www.agcanada.com/2021/07/is-the-veterinarian-shortage-real-or-regional.
    \27\ The Business Research Company. Companion animal veterinary 
vaccines global market report 2023 (. . .). https://www.thebusinessresearchcompany.com/report/companion-animal-veterinary-vaccines-global-market-report.
    \28\ Lewin R. Aussie dog owners warned of national vaccine 
shortage as deadly bacterial disease spreads. 7 News.com.au. October 
17, 2022. https://7news.com.au/lifestyle/pets/aussie-dog-owners-warned-of-national-vaccine-shortage-as-deadly-bacterial-disease-spreads-c-8568550.
    \29\ Mathew R. Vaccine Shortage, Excess Workload of Vets Hamper 
Anti-rabies Vaccination Programme. Manorama. September 24, 2022. 
https://www.onmanorama.com/news/kerala/2022/09/24/kerala-anti-rabbies-vaccination-programme.html.
    \30\ Rabies is Likely to Spread in Sri Lanka in 2023 due to 
Vaccine Shortages. Business Standard. January 4, 2023. https://www.business-standard.com/article/international/rabies-is-likely-to-spread-in-sri-lanka-in-2023-due-to-vaccine-shortages-123010400640_1.html.
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    CDC will continue to review and reassess its list of DMRVV high-
risk countries annually and as additional substantial data become 
available.\31\ Such reviews are consistent with CDC practices. In 
conducting this review, CDC will consider DMRVV high-risk countries' 
rabies control programs, the latest scientific data, and international 
recommendations for rabies control. For example, in January 2023, CDC 
reviewed the list of DMRVV high-risk rabies countries and determined 
that Brunei and Bhutan had documented sufficient levels of canine 
rabies surveillance, canine vaccination, and laboratory testing over a 
multi-year timespan and demonstrated success in controlling DMRVV 
within their respective countries; as a result of this review Brunei 
and Bhutan were removed from the CDC list of DMRVV high-risk countries.
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    \31\ The web page that describes how CDC conducts the annual 
assessment of individual countries' rabies status worldwide is 
available at https://www.cdc.gov/rabies/resources/countries-risk.html.
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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 countries at high-risk for rabies 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; such a public 
health threat could result in loss of human and animal life and

[[Page 43573]]

consequential economic impact.32 33 34 Of additional concern 
is the fact that DMRVV has been highly successful at adapting to new 
host species, particularly wildlife. One imported DMRVV-infected dog 
could result in a new variant with potential to become established 
within new host species in the United States.\35\
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    \32\ World Bank (2012). People, Pathogens and Our Planet: The 
Economics of One Health. Retrieved from https://openknowledge.worldbank.org/handle/10986/11892.
    \33\ 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.
    \34\ 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.
    \35\ 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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    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 from DMRVV high-risk countries.\36\ This estimate was based on 
information provided by airlines, CBP staff, and a study conducted at a 
U.S.-Mexico land border crossing.\37\ Combined import data from CDC, 
CBP, and the U.S. Department of Agriculture (USDA) suggest that 
adoptions, rescues, purchases, and international movement of dogs from 
overseas have remained high since 2018.38 39 40 Demand for 
puppies and dogs imported for rescue, adoption, or resale has remained 
high since 2021.41 42 43 44 In light of the higher rate of 
rabies among imported dogs compared to dogs in the United States, the 
continued high volume of importations of dogs to the United States, and 
the contemporaneous insufficient veterinary controls, inadequate 
veterinary supply chains, and persistent workforce capacity shortages 
in DMRVV high-risk countries, the risk of rabies importation into the 
United States and re-introduction of DMRVV remains heightened.
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    \36\ 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.
    \37\ 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.
    \38\ Better Business Bureau. Online puppy scams rising sharply 
in 2020, BBB warns. 2020 December 2. Available from: https://www.bbb.org/article/news-releases/23354-bbb-studyupdate-puppy-scams-rising-in-2020.
    \39\ Centers for Disease Control and Prevention. Internal dog 
import data. August 2021-May 2023.
    \40\ U.S. Customs and Border Protection. Live animal imports FY 
2022 report to congress. Nov 4, 2022.
    \41\ 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.
    \42\ Wynne E. Dog lovers find prices rise steeply amid COVID-
fueled demand. Australian Broadcasting Corporation News. 20 May 
2021.
    \43\ Morgan L, Protopopova A, Birkler RID, Itin-Shwatz B, Sutton 
G, Gamliel A, et al. Human-dog relationships during the COVID-19 
pandemic: booming dog adoption during social isolation. Humanities 
and Social Science Communications. 2021; 7(150): 1-11.
    \44\ British Broadcasting Corporation. Illegal puppy trade 
warning as sales boom during the COVID pandemic. 18 NOV 2020. 
British Broadcasting Corporation News.
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    The rate of rabies is 14 times higher in imported dogs when 
compared to the rate of rabies acquired domestically by dogs in the 
United States.45 46 47 48 49 50 51 52 During 2015-2021 there 
were approximately 700,000 dogs imported from DMRVV high-risk countries 
of which four were found to have rabies upon entry into the United 
States--an annual incidence rate of 5.7 per 1 million dogs imported. In 
comparison, there were an estimated cumulative 616 million dogs in the 
United States during that same time period,\53\ of which approximately 
240 were found infected with an endemic wildlife variant of rabies 
during the same time--an annual incidence rate of 0.4 per 1 million.
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    \45\ Centers for Disease Control and Prevention. Guidance 
regarding agency interpretation of ``rabies-free'' as it relates to 
the importation of dogs into the United States. Federal Register 
Notice; 84 FR 724: 724-30. January 31, 2019. Available at: http://www.federalregister.gov/documents/2019/01/31/2019-00506/guidance-regarding-agency-interpretation-of-rabies-free-as-it-relates-to-the-importation-of-dogs.
    \46\ Ma X, Bonaparte S, Toro M, Orciari L, Gigante C, et al. 
Rabies surveillance in the United States during 2020. Journal of the 
American Veterinary Medical Association. 2022; 260 (10).
    \47\ Birhane M, Cleaton J, Monroe BP, Wadhwa A, et al. Rabies 
surveillance in the United States during 2015. Journal of the 
American Veterinary Medical Association. 2017; 250 (10).
    \48\ Ma X, Monroe BP, Cleaton J, Orciari L, Yager P, et al. 
Rabies surveillance in the United States during 2016. Journal of the 
American Veterinary Medical Association. 2018; 252 (8).
    \49\ Ma X, Monroe BP, Cleaton J, Orciari L, Yu L, et al. Rabies 
surveillance in the United States during 2017. Journal of the 
American Veterinary Medical Association. 2018; 253 (12).
    \50\ Ma X, Monroe BP, Wallace R, Orciari L, Gigante C, et al. 
Rabies surveillance in the United States during 2019. Journal of the 
American Veterinary Medical Association. 2021; 258 (11).
    \51\ Ma X, Bonaparte S, Corbett P, Orciari L, Gigante C, et al. 
Rabies surveillance in the United States during 2021. Journal of the 
American Veterinary Medical Association. 2023. DOI: https://doi.org/10.2460/javma.23.02.0081.
    \52\ Ma X, Monroe BP, Cleaton J, Orciari L, Gigante C, et al. 
Public veterinary medicine: Public health: Rabies surveillance in 
the United States during 2018. Journal of the American Veterinary 
Medical Association. 2020; 256 (2).
    \53\ American Veterinary Medical Association. U.S. pet 
statistics. Available at: ebusiness.avma.org/files/ProductDownloads/eco-pet-demographic-report-22-low-res.pdf.
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    All four rabid dogs imported into the United States during the 
2015-2021 period 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.\54\ Eighteen people were 
recommended to receive rabies post-exposure prophylaxis (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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    \54\ 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

[[Page 43574]]

falsified rabies vaccination documentation presented on entry to the 
United States.\55\
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    \55\ 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.
---------------------------------------------------------------------------

    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. As a 
result, forty-four people received rabies 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.\56\ The 
public health investigations and rabies PEP of exposed persons in this 
case cost more than $400,000 in state resources.57 58
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    \56\ 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.
    \57\ Id.
    \58\ Centers for Disease Control and Prevention (2022). Rabies 
Postexposure Prophylaxis. Retrieved from https://www.cdc.gov/rabies/medical_care/index.html.
---------------------------------------------------------------------------

    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 investigation of imported rabid dogs in U.S. 
history.\59\ 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.\60\ 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.\61\
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    \59\ 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.
    \60\ 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.
    \61\ 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.62 63 64 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. The U.S. National Rabies Control Program was 
started in 1944 and required decades of consistent dog vaccination and 
animal control programs to eliminate DMRVV from the United States. 
While the cost has never been published it is estimated to approach 1 
billion USD in direct rabies control costs.\65\
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    \62\ 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.
    \63\ 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.
    \64\ Centers for Disease Control and Prevention (2023). What is 
a Valid Rabies Vaccination Certificate? Retrieved from https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/vaccine-certificate.html.
    \65\ Based on assessments made by CDC Rabies Subject Matter 
Experts from annual operating costs to fund the U.S. national rabies 
control program including dog vaccination and post exposure 
prophylaxis costs.
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    Re-establishment of DMRVV in the United States would result in 
costly, years' long efforts to eliminate the virus again. The 
extraordinary cost of re-introduction of DMRVV is demonstrated by an 
instance of reintroduction that occurred in Texas, where DMRVV had been 
previously eliminated. The reintroduction lasted from 1995-2003 and 
resulted in several human deaths; the subsequent re-elimination of 
DMRVV cost $60 million (in 2022 USD) and required over 10 years of 
effort.66 67
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    \66\ 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.
    \67\ 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.
---------------------------------------------------------------------------

B. Insufficient Canine Vaccination Rates and Veterinary Controls in 
DMRVV 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.\68\ This number is less than one 
percent of dog importations. However, between January 2020 and July 
2021 (i.e., during the COVID-19 pandemic, prior to the temporary 
suspension taking effect), CDC documented more than 1000 instances of 
incomplete, inadequate, or fraudulent rabies vaccination certificates 
for dogs arriving from DMRVV high-risk countries.\69\ These cases 
resulted in dogs being denied entry into the United States and 
ultimately returned to their country of origin.
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    \68\ 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.
    \69\ 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.
---------------------------------------------------------------------------

    The significant increase in the number of dogs from DMRVV high-risk 
countries arriving with incomplete, inadequate, or fraudulent rabies 
vaccination certificates observed in 2020 and 2021 coincided with 
increased interest in purchasing dogs from the international rescues 
and breeders during the COVID-19 pandemic.70 71 72 One study 
noted a global increase in

[[Page 43575]]

internet searches on Google regarding dog adoption during the 
pandemic.\73\ Since 2021, the demand for puppies and rescue dogs has 
remained high. The trend in purchasing and rescuing dogs from abroad 
has been noted in many countries, including the United 
States.74 75 76 77 Internationally, there has been 
significant growth within the companion animal breeding industry with 
increasing international trade.\78\ Multiple international and U.S. 
investigations have identified importations of puppies that were too 
young to meet rabies vaccination requirements.79 80 81 82 
There is growing evidence that criminal networks are becoming involved 
in the lucrative dog trade, and illegal puppy trade was reported to 
have increased during the pandemic.83 84 85
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    \70\ 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.
    \71\ Wynne E. Dog lovers find prices rise steeply amid COVID-
fueled demand. Australian Broadcasting Corporation News. 20 May 
2021.
    \72\ Morgan L, Protopopova A, Birkler RID, Itin-Shwatz B, Sutton 
G, Gamliel A, et al. Human-dog relationships during the COVID-19 
pandemic: booming dog adoption during social isolation. Humanities 
and Social Science Communications. 2021; 7(150): 1-11.
    \73\ Id.
    \74\ 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.
    \75\ Wynne E. Dog lovers find prices rise steeply amid COVID-
fueled demand. Australian Broadcasting Corporation News. 20 May 
2021.
    \76\ Morgan L, Protopopova A, Birkler RID, Itin-Shwatz B, Sutton 
G, Gamliel A, et al. Human-dog relationships during the COVID-19 
pandemic: booming dog adoption during social isolation. Humanities 
and Social Science Communications. 2021; 7(150): 1-11.
    \77\ Velez M. I adopted my dog Cannoli from overseas. It's 
easier than you think. 9/20/2020. Available at: https://www.thedailybeast.com/i-adopted-my-dog-cannoli-from-overseas-its-easier-than-you-think.
    \78\ Maher J, Wyatt T. European illegal puppy trade and 
organized crime. Trends in Organized Crime. 2021; 24(4) 506-525.
    \79\ 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.
    \80\ Zucca P, Rossman MC, Osorio JE, Karem K, De Benedictis P, 
Haifsl J, et al. The `bio-crime model' of cross-border cooperation 
among veterinary public health, justice, law enforcements, and 
customs to tackle the illegal animal trade/bio-terrorism and to 
prevent the spread of zoonotic diseases among human population. 
Frontiers in Veterinary Science. 2020; 7: 1-13.
    \81\ Cocchi M, Danesi P, DeZan G, Leati M, Gagliazzo L, et al. A 
three-year biocrime sanitary surveillance on illegally imported 
companion animals. Pathogens. 2021; 10(80):1-12.
    \82\ Houle MK. Perspective from the field: Illegal puppy imports 
uncovered at JFK airport. 2017. Available at: www.cdc.gov/ncezid/dgmq/feature-stories/operation-dog-catcher.html.
    \83\ Maher J, Wyatt T. Rural-urban dynamics in the UK illegal 
puppy trade: trafficking and trade in man's best friend. 
International Journal of Rural Law and Policy. 2019; 9 (2): 1-20.
    \84\ Zucca P, Rossman MC, Osorio JE, Karem K, De Benedictis P, 
Haifsl J, et al. The `bio-crime model' of cross-border cooperation 
among veterinary public health, justice, law enforcements, and 
customs to tackle the illegal animal trade/bio-terrorism and to 
prevent the spread of zoonotic diseases among human population. 
Frontiers in Veterinary Science. 2020; 7: 1-13.
    \85\ British Broadcasting Corporation. Illegal puppy trade 
warning as sales boom during the COVID pandemic. 18 NOV 2020. 
British Broadcasting Corporation News.
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    Additionally, reports of international movement of animals with 
missing microchips, no proof of rabies vaccination, or underage dogs 
with fraudulent vaccination records have been documented in the United 
States and abroad.86 87 The increases in international dog 
movement and fraudulent or questionable paperwork have raised concerns 
among state and local animal and health departments, breeders and dog 
organizations, and veterinary associations. A rabies serological 
(antibody) titer is an estimation of an immune response against rabies 
virus (either through exposure or vaccination). While there is no 
``protective'' titer against rabies virus, survival against rabies 
virus infection is often more likely to occur the higher the animal's 
titer at the time of infection.\88\ The World Organisation for Animal 
Health considers a level of 0.5 IU/mL a ``passing'' antibody titer 
level.
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    \86\ 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.
    \87\ Zucca P, Rossman MC, Osorio JE, Karem K, De Benedictis P, 
Haifsl J, et al. The `bio-crime model' of cross-border cooperation 
among veterinary public health, justice, law enforcements, and 
customs to tackle the illegal animal trade/bio-terrorism and to 
prevent the spread of zoonotic diseases among human population. 
Frontiers in Veterinary Science. 2020; 7: 1-13.
    \88\ CDC. Rabies Serology. Available at: www.cdc.gov/rabies/specific_groups/hcp/serology.html#What%20Does%20A%20Rabies%20Virus%20Titer%20Mean?
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    A 2015 study found that 53% of imported rescue dogs arriving in 
Norway with rabies vaccinations administered at least 21 days before 
arrival had titers less than 0.5 IU/mL.\89\ Nineteen percent of dogs in 
the study had titers less than 0.1 IU/mL, ``raising concerns as to 
whether they had been vaccinated against rabies at all.'' \90\ Two 
rabid dog importation events in the United States were also extensively 
evaluated, including serological evaluation of all dogs that were 
transported together. In these two events, one in 2019 and one in 2021, 
44% (25 of 57) of dogs failed to mount an anamnestic response to 
booster vaccination; an indication that they were unvaccinated or 
inappropriately vaccinated prior to arrival in the US.91 92
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    \89\ Klevar S, Hogasen HR, Davidson RK, Hammes IS, Treiberg 
Berndtsson L, LundA. Cross-border transport of rescue dogs may 
spread rabies in Europe. The Veterinary Record. 2015; 176 (26): 672.
    \90\ Id.
    \91\ 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.
    \92\ 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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    During the COVID-19 pandemic, canine rabies vaccination campaigns 
were suspended in many DMRVV high-risk countries, which resulted in an 
increase in canine and human rabies cases.93 94 The pause in 
canine vaccination campaigns and the delay in re-establishing pre-COVID 
rabies vaccination rates in dogs in many DMRVV high-risk countries, 
combined with insufficient veterinary controls to prevent or eliminate 
DMRVV within a country,\95\ as well as prevent the exportation of 
inadequately vaccinated dogs with fraudulent paperwork, presents an 
ongoing and significant public health risk.
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    \93\ 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.
    \94\ 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.
    \95\ WHO Expert Consultation on Rabies, third report. Geneva: 
World Health Organization; 2018 (WHO Technical Report Series, No. 
1012). License: CC BY-NC-SA 3.0 IGO.
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    A survey of global, regional, national, and local partners from the 
network of the United Against Rabies Forum \96\ and rabies 
practitioners found that the global COVID-19 pandemic impacted rabies 
control efforts in many DMRVV 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 COVID-19 activities. Among respondents who 
reported diversion of rabies control funds to COVID-19 responses, they 
reported that animal rabies vaccines and dog vaccination campaigns were 
often the first rabies control activities to be cut.\97\
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    \96\ 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.
    \97\ 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.

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[[Page 43576]]

    Additionally, global veterinary workforce capacity and global 
veterinary supply chain shortages that have led to delayed or disrupted 
care for dogs (and other pets) have been exacerbated by the COVID-19 
pandemic. 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. 98 99 100 101 Challenges 
with rabies vaccine administration, distribution, potency, quality, and 
storage in many countries also contributed to inadequate protection 
against rabies prior to the pandemic; these challenges continue as 
public health infrastructure recovers post-
pandemic.102 103 104 105 The extension of the temporary 
suspension is intended to provide time for CDC and its partners to 
build a robust dog importation system that better protects U.S. public 
health from these challenges.
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    \98\ Zhang S. The great veterinary shortage. The Atlantic. July 
6,2022. https://www.theatlantic.com/health/archive/2022/07/not-enough-veterinarians-animals/661497/.
    \99\ Martin D. Is the veterinarian shortage real or regional? 
AGCanada.com July 16, 2021. https://www.agcanada.com/2021/07/is-the-veterinarian-shortage-real-or-regional.
    \100\ The Business Research Company. Companion animal veterinary 
vaccines global market report 2023 (. . .). https://www.thebusinessresearchcompany.com/report/companion-animal-veterinary-vaccines-global-market-report.
    \101\ Lewin R. Aussie dog owners warned of national vaccine 
shortage as deadly bacterial disease spreads. 7 News.com.au. October 
17,2022. https://7news.com.au/lifestyle/pets/aussie-dog-owners-warned-of-national-vaccine-shortage-as-deadly-bacterial-disease-spreads-c-8568550.
    \102\ Hu RL, Fooks AR, Zhang SF, Liu Y, Zhang F. Inferior rabies 
vaccine quality and low immunization coverage in dogs in China. 
Epidemiol Infect. 2008; 136: 1556-63.
    \103\ Yale G, Sudarshan S, Taj S, Patchimuthu GI, Mangalanathan 
BV, et al. Investigation of protective level of rabies antibodies in 
vaccinated dogs in Chennai, India. VetRecord. 2021; 8: e8.
    \104\ 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.
    \105\ Rota Modari E, Alonso S, Mancin M, De Nardi M, Hudson-
Cooke S, Veggiato C, et al. Rabies vaccination: higher failure rates 
in imported dogs than those vaccinated in Italy. Zoonoses and Public 
Health 2022; 64 (2): 146-55.
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C. Potentially Unsafe Conditions for Dogs Arriving From DMRVV High-Risk 
Countries Without Appropriate Rabies Vaccination Certificates

    Prior to the implementation of the temporary suspension of the 
importation of dogs from countries at high-risk for rabies in July 
2021, dogs arriving from DMRVV high-risk countries without appropriate 
rabies vaccination certificates were denied entry to the United States 
and returned to the country of origin on the next available 
flight.\106\ Airlines were required to house dogs awaiting return to 
their country of origin at a facility meeting 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 to, at a minimum, provide accommodation meeting the USDA's 
Animal Welfare Act standards.\107\
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    \106\ 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.
    \107\ 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.
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    However, due to the prolonged periods of time between flights, some 
airlines housed dogs in cargo warehouses. These accommodations created 
an unsafe environment for dogs because of 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.
    Because of the COVID-19 pandemic, there were fewer international 
flights worldwide in 2020,108 109 resulting in delayed 
returns for dogs denied entry. 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.\110\
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    \108\ 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.
    \109\ 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.
    \110\ 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.
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    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 DMRVV 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 found to be ineligible for entry 
compared to 2018 and 2019.\111\ 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

[[Page 43577]]

compared to the whole of 2020.\112\ From January 1, 2021, to July 13, 
2021, prior to CDC's temporary 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 temporary suspension was initially 
implemented, to March 1, 2023, CDC has denied entry to 185 dogs, and 12 
sick dogs and 34 deaths have been reported to CDC. This substantial 
decrease in the number of dogs denied entry (average of 93 dogs/month 
pre-suspension compared to 8 dogs/month during the suspension) since 
the implementation of the temporary suspension and reduced number of 
sick and dead dogs (average of 3 sick dogs/month pre-suspension 
compared to 0.6 sick dogs/month during the suspension; 3 dead dogs/
month compared to 1.6 dead dogs/month during the suspension) arriving 
in the United States has resulted in an estimated $46,000 to $154,000 
in cost savings to importers and $2,400 to $120,000 in cost savings to 
Federal, state, and local public health and animal health agencies when 
comparing the two periods. The risk of dogs dying while being held in 
unsafe conditions continues however and, in the absence of a return to 
pre-pandemic global vaccination campaigns and public health resources, 
would likely be exacerbated if the temporary suspension were to be 
lifted at this time. For example, in March 2023, a dog arrived at a 
port of entry without a CDC-approved animal care facility and was 
housed by the airline in a cargo warehouse where it was later found 
dead.
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    \111\ 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.
    \112\ 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.
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    Since the temporary suspension initially took effect in mid-July 
2021, the number of dogs denied entry and the number of sick and dead 
dogs has decreased substantially despite the increased communicable 
disease risk due to pandemic-related disruptions to vaccination 
programs in DMRVV high-risk countries and veterinary supply chain and 
staffing shortages worldwide. These data constitute 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. Prior to the temporary 
suspension, an increasing number of dogs were denied entry into the 
United States in 2020 and 2021, and there were fewer international 
flights in 2020 and 2021 compared to 2022.\113\ If the increased number 
of international flights in 2023 corresponds with numbers of dogs 
denied entry per flight in 2020 and 2021, then lifting the temporary 
suspension at this time, absent other public health measures, could 
result in a number of dogs denied entry equal to or greater than pre-
suspension numbers. A concomitant increase in the number of sick, dead, 
or inadequately vaccinated dogs arriving in the United States could 
quickly overwhelm local public health and veterinary healthcare systems 
which do not have resources to provide long-term care or quarantine for 
imported dogs.
---------------------------------------------------------------------------

    \113\ 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.
---------------------------------------------------------------------------

    Because there remains an elevated level of risk of a rabid dog 
being imported into the United States and 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 temporary suspension would be unwarranted at 
this time.
    Instead, CDC is extending the temporary suspension for dogs 
arriving into the United States from DMRVV high-risk countries. Given 
that temporary suspension has proven successful in preventing the 
reintroduction of DMRVV into the United States and has resulted in a 
decrease in the number of issues with imported dogs (i.e., suspected 
fraudulent documentation, dogs abandoned by importers, sick and dead 
dogs arriving in the United States) compared to the period prior to the 
temporary 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. As noted 
above, in a companion document published elsewhere in this Federal 
Register, CDC is proposing a rule revising entry requirements that 
outlines a framework and set of operations that would mitigate the need 
for further extensions of the temporary suspension, should these 
procedures be adopted.

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

    CDC is extending without modification the terms of the current 
temporary suspension, which was effective February 1, 2023. Dogs 
returning to the United States from DMRVV 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 International Standards Organization (ISO)-
compatible microchip;
     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 
\114\ 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.
---------------------------------------------------------------------------

    \114\ (OMB No. 0920-1383); 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 extended 
temporary suspension announced in the January 27, 2023 Federal Register 
notice.\115\
---------------------------------------------------------------------------

    \115\ 88 FR 5348 (Jan. 27, 2023), effective February 1, 2023.

---------------------------------------------------------------------------

[[Page 43578]]

IV. 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 temporary suspension published in the January 27, 2023 
Federal Register notice.\116\ Importers of personal pet dogs may 
receive up to two CDC Dog Import Permits (i.e., permits for two dogs) 
during the temporary suspension period.\117\ Commercial importers and 
personal pet owners who do not have serologic titer results or CDC Dog 
Import Permits for their dogs will also continue to have an alternate 
pathway for importation as outlined in Section V.
---------------------------------------------------------------------------

    \116\ Id.
    \117\ The two-permit limit is for the effective date of this 
notice from August 1, 2023-July 31,2024.
---------------------------------------------------------------------------

    All importers of personal pet dogs (defined for the purpose of this 
notice as owners or importers who are not importing for the purpose of 
resale, rescue, or adoption and who are attempting to import fewer than 
three dogs total between August 1, 2023-July 31, 2024) from DMRVV 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 alternate pathway 
requirements for entry outlined in Section V below.
    Foreign-vaccinated dogs arriving from DMRVV 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;
     Have a CDC Rabies Vaccination and Microchip Record \118\ 
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;
---------------------------------------------------------------------------

    \118\ Approved under OMB Control Number 0920-1383 Importation 
Regulations (42 CFR 71 subpart F) (exp. 1/31/2026, or as revised).
---------------------------------------------------------------------------

     Have serologic evidence of rabies vaccination (titer) from 
an approved rabies serology laboratory \119\ (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
---------------------------------------------------------------------------

    \119\ 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.
    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.\120\
---------------------------------------------------------------------------

    \120\ 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 if the dog meets the 
requirements outlined in Section V, the dog may be quarantined at the 
importer's expense at a CDC-approved animal care facility (if one is 
located at the port of entry where the dog arrived) pending 
availability and payment of all associated examination, revaccination, 
and quarantine fees upfront.
    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.

V. 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 January 27, 2023, Federal Register notice \121\ that 
provide an alternate pathway for importers of personally owned pets who 
do not have a CDC Dog Import Permit and 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 
DMRVV 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 care 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.
---------------------------------------------------------------------------

    \121\ 88 FR 5348 (Jan. 27, 2023), effective February 1, 2023.
---------------------------------------------------------------------------

    Foreign-vaccinated dogs without a valid CDC Dog Import Permit must 
meet all of the following requirements:
     Dogs must enter at a port of entry with a CDC-approved 
animal care facility; \122\
---------------------------------------------------------------------------

    \122\ 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 \123\ completed by the veterinarian who administered the rabies 
vaccine. The record must be complete and 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;
---------------------------------------------------------------------------

    \123\ Approved under OMB Control Number 0920-1383 Importation 
Regulations (42 CFR 71 Subpart F) (exp. 1/31/2026, or as revised).
---------------------------------------------------------------------------

     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 care facility;
     Importers must arrange for transportation by a CBP-bonded 
transporter (i.e., provided by the airline carrier or a CDC-approved 
animal care facility) to a CDC-approved animal care 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 care facility upon arrival at 
the importer's expense.
    Dogs must also be held at the CDC-approved animal care facility 
until the following entry requirements are completed:
     Veterinary health examination by a USDA-accredited 
veterinarian for signs of illness, including zoonotic or foreign

[[Page 43579]]

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 report all 
signs of illness or parasitism to CDC and may not release the dog 
without the written approval of CDC;
     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.\124\ 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 care 
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.
---------------------------------------------------------------------------

    \124\ Approved laboratories can be found at: www.cdc.gov/importation/bringing-an-animal-into-the-united-states/approved-labs.html.
---------------------------------------------------------------------------

    Importers are responsible for all fees associated with the 
importation of dogs into the United States, including transportation, 
examination, revaccination, 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 May 1, 2023, 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.

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

    Consistent with the terms of the original temporary suspension 
published in the June 16, 2021, Federal Register notice,\125\ all dogs 
arriving from DMRVV 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 CDC Rabies Vaccination and Microchip 
Record or U.S.-issued rabies vaccination certificate. The microchip 
must be ISO-compatible.
---------------------------------------------------------------------------

    \125\ 86 FR 32041 (June 16, 2021), effective July 14, 2021.
---------------------------------------------------------------------------

    Any dog from a DMRVV high-risk country not otherwise meeting the 
requirements outlined in Sections III-V above 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.

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

                     Table 1--Entry Conditions for Dogs Under Extended Temporary Suspension
----------------------------------------------------------------------------------------------------------------
                                         Dogs with valid CDC
                                           Dog ImportPermit       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                              Titer drawn at least
                                        45 days before entry                              45 days before entry
                                        and not more than 365                             and not more than 365
                                        days before entry.                                days before entry.

[[Page 43580]]

 
No quarantine........................  No quarantine..........  28-day quarantine at     No quarantine.
                                                                 CDC-approved animal
                                                                 care facility.
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. Booster         arrival.                 arrival.
                                        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 temporary suspension will continue to reduce the risk of 
importation of DMRVV and ensure public health safeguards are in place 
for the importation of dogs from DMRVV high-risk countries. The terms 
of the temporary suspension allow for sufficient safeguards to mitigate 
the public health risk. The temporary suspension will also allow CDC to 
continue to work with Federal partners and the animal transportation 
industry to implement more streamlined processes for verification of 
vaccination records prior to travel. The proposed rule issued as a 
companion document published elsewhere in this Federal Register 
reflects these streamlined processes. CDC will also continue to 
identify additional animal care facilities for the safe housing of 
animals arriving at ports of entry. Most importantly, it will ensure 
that U.S. public health remains protected.
    Therefore, pursuant to 42 CFR 71.51and 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 DMRVV high-risk 
countries, including dogs from DMRVV low-risk and DMRVV-free countries 
if the dogs have been present in a DMRVV 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 DMRVV 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 DMRVV 
high-risk countries in the context of rabies vaccination campaign 
disruptions and veterinary supply and veterinary workforce shortages as 
a result of the COVID-19 pandemic, as well as the insufficient 
safeguards in place to prevent the exportation of inadequately 
vaccinated dogs from DMRVV 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 high volume of imported dogs 
contemporaneous with insufficient veterinary controls in DMRVV high-
risk countries to prevent the export of inadequately vaccinated dogs as 
well as inadequate veterinary supply chains and persistent workforce 
capacity shortages in DMRVV high-risk countries that export dogs to the 
United States. 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 
high volume of imported dogs contemporaneous with insufficient 
veterinary controls in DMRVV high-risk countries to prevent the export 
of inadequately vaccinated dogs, inadequate veterinary supply chains, 
and persistent workforce capacity shortages in DMRVV high-risk 
countries that export dogs to the United States, 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 assure potential dog importers and other 
interested parties that the terms of the temporary suspension have not 
changed, and therefore does not require

[[Page 43581]]

changes to their current operations and will remain in effect through 
July 31, 2024.
    CDC has further determined that good cause exists for a one-year 
extension of the temporary suspension through July 31, 2024, to address 
public health concerns regarding importation of dogs infected with 
rabies. Moreover, in parallel to this notice announcing the extension 
of the temporary suspension, CDC is proposing a rule revising entry 
requirements to address these concerns regarding importation of rabid 
dogs and fraudulent vaccination documentation. The proposed rule 
outlines a framework and set of operations that would mitigate the need 
for further extensions of the temporary suspension, should these 
procedures be adopted. In consideration of both the anticipated needs 
for global rabies vaccine campaigns to return to pre-pandemic levels 
and to avoid disruption to importers' and the travel industry's 
operations, CDC has determined that a one-year extension of the 
temporary suspension through July 31, 2024, is required to protect the 
public's health and is therefore in the public's interest. In the 
absence of further extension of the temporary suspension, dog 
importation requirements would return to procedures that proved 
inadequate to prevent the import of rabid dogs into the United States. 
A one-year extension provides time for CDC to continue to build a 
robust dog importation system while global rabies vaccination efforts 
continue to rebound. It will also avoid potential public confusion 
regarding changing dog importation requirements and better address the 
needs of importers, the animal care and transport industry, and Federal 
partners who have indicated they would need time to adequately prepare 
for any changes to their current operations. The proposed rule 
published in parallel with this extension provides an opportunity for 
public comment and input on any new procedures.
    This temporary suspension will enter into effect on August 1, 2023, 
and remain in effect through July 31, 2024, unless modified or 
rescinded by the CDC Director based on public health or other 
considerations.

Kathryn Wolff,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2023-14342 Filed 7-6-23; 4:15 pm]
BILLING CODE 4163-18-P