Top 5 Takeaways

  1. Elimination of Dog-maintained Rabies Virus Variant (DMRVV) in the US: The US eliminated DMRVV in 2007. However, between 2015-2019, three rabid dogs were imported from Egypt, where DMRVV is endemic, highlighting the risks of reintroduction.
  2. Development of a Risk Mitigation Strategy: CDC developed a comprehensive risk mitigation strategy allowing the importation of 296 dogs from Egypt from May 2019 to December 2020, significantly reducing the risk of rabid dog importations.
  3. Importance of Serologic Testing: A key component of the risk mitigation strategy was serologic testing for rabies antibody titers, ensuring dogs imported from Egypt posed no public health risk in the US.
  4. Impact on Public Health Policy: The strategy has shown to be effective in ensuring the safety of dog imports, offering a model for future policy decisions on dog importations to prevent rabies reintroduction.
  5. Prevention of Rabies Transmission: No rabies cases were reported among the 296 dogs imported under the new guidelines, demonstrating the effectiveness of CDC’s risk mitigation measures in protecting public health.

Original Article Author and Citation

Corresponding Author

Michelle Latzer,, 404-498-3062.

Suggested Citation

Latzer M, Pieracci EG, Altenburger A, Stauffer KE, Brown CM. Review of CDC’s Suspension of and Advance Written Approval Process for Dogs Entering the United States from Egypt — May 2019–December 2020. MMWR Morb Mortal Wkly Rep 2022;71:1081–1084. DOI:


This MMWR article reports on the CDC’s successful development and implementation of a risk mitigation strategy to permit the importation of dogs from Egypt, significantly reducing the public health risks associated with rabies. After the importation of three rabid dogs from Egypt, the CDC suspended dog imports from Egypt and introduced a comprehensive strategy involving serologic testing, conditional import permits, and mandatory revaccination, which allowed for the safe importation of 296 dogs.


CDC collected data through applications uploaded to the CDC’s Quarantine Activity Reporting System (QARS) and analyzed deidentified data. The risk mitigation strategy required serologic testing for rabies antibody titer, revaccination with a U.S. Department of Agriculture-licensed rabies vaccine, and compliance with the National Association of State Public Health Veterinarians Rabies Compendium recommendations.


The risk mitigation strategy was developed in consultation with a diverse group of subject matter experts. It highlighted the challenges of controlling canine rabies in countries where DMRVV is endemic and demonstrated the effectiveness of CDC’s strategy in preventing the introduction of rabies through dog imports.


CDC’s risk mitigation strategy for the importation of dogs from Egypt has proven to be a public health success, preventing the reintroduction of DMRVV into the United States and serving as a model for future policy decisions regarding the importation of dogs from rabies-endemic countries.

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