Animal Bite and Rabies Postexposure Prophylaxis Reporting—United States, 2013

Vora, Neil M.; Clippard, Jessie; Stobierski, Mary Grace; Signs, Kimberly; Blanton, Jesse D.

doi:10.1097/phh.0000000000000125

Cited by 7 publications

(6 citation statements)

References 9 publications

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“… 4 These species, when healthy and provoked into biting, represent some of the lowest risk exposures evaluated in this model (of the scenarios strictly below the risk threshold, more than half were exposures to dogs or cats). PEP is not reportable in all states 38 and is not considered nationally notifiable to CDC. 39 This means there are no data to understand the distribution of PEP administration by species of biting animal.…”

Section: Discussionmentioning

confidence: 99%

Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US

et al. 2023

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ImportanceIn the US, rabies postexposure prophylaxis (PEP) is often administered without a comprehensive and regionally appropriate rabies risk assessment. For low-risk exposures, this can result in patients incurring out-of-pocket expenses or experiencing adverse effects of PEP unnecessarily.ObjectiveTo use a model to estimate (1) the probability that an animal would test positive for rabies virus (RABV) given that a person was exposed, and (2) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP, and to propose a risk threshold for recommending PEP according to model estimates and a survey.Design, Setting, and ParticipantsIn this decision analytical modeling study, positivity rates were calculated using more than 900 000 animal samples tested for RABV between 2011 and 2020. Other parameters were estimated from a subset of the surveillance data and the literature. Probabilities were estimated using Bayes’ rule. A survey was administered among a convenience sample of state public health officials in all US states (excluding Hawaii) plus Washington, DC and Puerto Rico to determine a risk threshold for PEP recommendation. Respondents were asked whether they would recommend PEP given 24 standardized exposure scenarios while accounting for local rabies epidemiology.Main Outcomes and MeasuresA quantitative and regionally appropriate approach for helping health care practitioners and public health professionals determine whether to recommend and/or administer rabies PEP.ResultsA total of 1728 unique observations were obtained from the model for the probability that an animal would test positive for RABV given that a person was exposed, and 41 472 for ) the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP. The median probability that an animal would test positive for RABV given that a person was exposed ranged from 3 × 10−7 to 0.97, while the probability that a person would die from rabies given that they were exposed to a suspect rabid animal and did not receive PEP ranged from 1 × 10−10 to 0.55. Fifty public health officials out of a target sample size of 102 responded to the survey. Using logistic regression, a risk threshold was estimated for PEP recommendation of 0.0004; PEP may not be recommended for exposures with probabilities below this threshold.Conclusions and RelevanceIn this modeling study of rabies in the US, the risk of death|exposure was quantified and a risk threshold was estimated. These results could be used to inform the decision-making process as to the appropriateness of recommending rabies PEP.

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Section: Discussionmentioning

confidence: 99%

Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US

et al. 2023

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“…An estimated 36,000 courses of rabies PEP are administered each year in the US 6 . The cost of rabies PEP varies greatly in the US and around the world, with the majority of the cost coming from RIG 7 . RIG is produced from the serum of RABV-immunized human donors (hRIG) or from hyper-immunized horses (eRIG).…”

Section: Introductionmentioning

confidence: 99%

A cocktail of human monoclonal antibodies broadly neutralizes North American rabies virus variants as a promising candidate for rabies post-exposure prophylaxis

Ejemel

Smith

Greenberg

et al. 2022

Sci Rep

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Human rabies remains a globally significant public health problem. Replacement of polyclonal anti-rabies immunoglobulin (RIG), a passive component of rabies post-exposure prophylaxis (PEP), with a monoclonal antibody (MAb), would eliminate the cost and availability constraints associated with RIG. Our team has developed and licensed a human monoclonal antibody RAB1 (Rabishield©), as the replacement for RIG where canine rabies is enzootic. However, for the highly diverse rabies viruses of North America, a cocktail containing two or more MAbs targeting different antigenic sites of the rabies glycoprotein should be included to ensure neutralization of all variants of the virus. In this study, two MAb cocktails, R172 (RAB1-RAB2) and R173 (RAB1-CR57), were identified and evaluated against a broad range of rabies variants from North America. R173 was found to be the most potent cocktail, as it neutralized all the tested North American RABV isolates and demonstrated broad coverage of isolates from both terrestrial and bat species. R173 could be a promising candidate as an alternative or replacement for RIG PEP in North America.

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“…Rabies postexposure prophylaxis (PEP) after suspicious exposures is known to be a critical intervention to prevent human rabies, a neglected tropical disease that would lead to approximately 3 million deaths without PEP each year [1]; globally, the World Health Organization (WHO) estimates that 29 million doses of PEP are given annually [2]. Cross-sectional analyses have identified sub-optimal adherence to the Advisory Committee on Immunization Practices (ACIP) recommendations to prevent human rabies, the official United States (U.S.) recommendations that include PEP guidance [3][4][5]. Public health surveillance about PEP including the number of people who receive PEP eachyear, whether PEP vaccination schedules were completed, and the types of exposure that prompted PEP, could identify inadequate practices that are known to occur in the U.S.; prompt outreach and education could be tailored to address frequently identified issues and ensure adherence to ACIP recommendations.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012–2018

et al. 2021

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Background An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies. Methodology/Principle findings To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate. We used national-level and state specific data from the Healthcare Cost & Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012–2017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012–2017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP. Conclusions Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.

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Animal Bite and Rabies Postexposure Prophylaxis Reporting—United States, 2013

Cited by 7 publications

References 9 publications

Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US

Risk of Rabies and Implications for Postexposure Prophylaxis Administration in the US

A cocktail of human monoclonal antibodies broadly neutralizes North American rabies virus variants as a promising candidate for rabies post-exposure prophylaxis

Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012–2018

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