The current study indicated that snakebites are common injuries treated at NC EDs, with a strong seasonal and geographic component. Additional research is needed to further characterize the circumstances associated with snakebites for the development of preventive measures and public health education.

Summary Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.

Animal bite surveillance using both ICD-9-CM E-codes and chief complaint keyword searches may result in increased surveillance sensitivity. From January 1, 2008, through December 31, 2010, there were 26,353 NC DETECT ED visits made by North Carolina residents with a dog bite E-code (E906.0). A chief complaint keyword search similar to that used by Bregman and Slavinski was employed on a 10% random sample (n=2,636) of the dog bite E-coded visits. There were 1,833 (69.5%) sample visits that contained the word "dog" or a common misspelling (e.g., dob or bog) and the word "bite" or some derivation (e.g., bit or bitten) in the chief complaint field. The word "animal" or a recognized mammalian animal (e.g., cat) and the word "bite" or some derivation of the word were found in the chief complaint fields of 281 (10.7%) sample visits. However, 522 (19.8%) dog bite E-coded sample visits would not have been identified as animal bite-related ED visits using only this keyword search criteria. In 411 (78.7%) of those 522 visits, the chief complaint field contained a description of the injury or its sequelae (e.g., a facial laceration or abscess), rather than specifying a bite.Animal bite surveillance using ED visit data may vary by public health agency due to syndromic surveillance system capabilities, availability of ICD-9-CM codes, and the desired balance of surveillance sensitivity and specificity. However, ICD-9-CM final diagnosis codes and E-codes are considered part of a minimum dataset for syndromic surveillance systems using ED visit data.2 Therefore, we encourage agencies that collect this data element to consider using animal bite-related ICD-9-CM E-codes in addition to chief complaint keyword searches for identification of animal bite-related ED visits.

No abstract

No abstract