Appropriateness of Rabies Postexposure Prophylaxis Treatment for Animal Exposures

Moran, Gregory J.; Talan, David A.; Mower, William R.; Newdow, Michael; Ong, Samuel; Nakase, Janet Y.; Pinner, Robert W.; Childs, James E.

doi:10.1001/jama.284.8.1001

Cited by 125 publications

(67 citation statements)

References 14 publications

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“…In rural Pennsylvania, cat encounters accounted for 44 % of human PEPs, more than any other species [26]. In urban emergency rooms, cats accounted for >15 % of patients receiving PEP [42]. The average rabid cat generates between 1 and 6 human PEPs [19,24].…”

Section: Discussionmentioning

confidence: 99%

Temporal dynamics of rabies in a wildlife host and the risk of cross-species transmission

et al. 2004

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An epidemiological model was developed for rabies, linking the risk of disease in a secondary species (cats) to the temporal dynamics of disease in a wildlife reservoir (raccoons). Data were obtained from cats, raccoons, and skunks tested for rabies in the northeastern United States during 1992-2000. An epizootic algorithm defined a time-series of successive intervals of epizootic and inter-epizootic raccoon rabies. The odds of diagnosing a rabid cat during the first epizootic of raccoon rabies was 12 times greater than for the period prior to epizootic emergence. After the first raccoon epizootic, the risk for cat rabies remained elevated at levels six- to seven-fold above baseline. Increased monthly counts of rabid raccoons and skunks and decreasing human population density increased the probability of cat rabies in most models. Forecasting of the public health and veterinary burden of rabies and assessing the economics of control programmes, requires linking outcomes to dynamic, but predictable, changes in the temporal evolution of rabies epizootics.

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Section: Discussionmentioning

confidence: 99%

Temporal dynamics of rabies in a wildlife host and the risk of cross-species transmission

et al. 2004

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“…et al suggest that the use of PEP was inappropriate in 40% of vaccinated patients. 17 In our study, PEP was given to a majority of patients with dog or cat exposures, and these animals accounted for 70% of all vaccinated cases. Since domestic animals can serve as a link for rabies virus between wildlife and humans, vaccination of dogs and cats continues to be an extremely effective public health measure in preventing rabies in humans.…”

Section: Discussionmentioning

confidence: 77%

Post-exposure rabies prophylaxis in humans exposed to animals in Lublin province (Eastern Poland) in 2012–2015 – A retrospective study

Krzowska-Firych

Tomasiewicz

Kozøowska

2017

Human Vaccines & Immunotherapeutics

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Rabies continues to be one of the most important viral diseases and remains a significant threat to public health across the globe. The post-exposure prophylaxis in humans can effectively prevent death after exposure to a potentially infected animal. In Poland, recommendations for rabies PEP followed the national guidelines which recommend that people should receive PEP when bitten by an animal suspected to be infected by rabies. PEP in humans includes cleansing and disinfecting the wound or point of contact, and administering anti-rabies immunization. Rabies vaccine should be given for contacts of category II and category III exposures. RIG should be given for category III contact. The vaccination schedule includes 5 doses given within a 30 day period (the Essen regimen).The aim. The aim of our study was to determine the frequency of post-exposure prophylaxis among patients exposed to animals and also to assess the animal species suspected as a source of rabies exposure.Methods. We have retrospectively analyzed medical records from the years 2012-2015 of all adult patients who were exposed to animals and consulted at the Dispensary of Rabies Prophylaxis in the Department of Infectious Diseases at the Medical University in Lublin, Poland. All consulted patients were asked to give an informed consent in case of decision to use collected data for future research work.Ethical approval was obtained from the Ethics Committee of the Medical University of Lublin, Poland, and all patients included in this study gave an informed consent during consultation after the exposure to animals.Results. During the studied 4-year period, 511 persons exposed to animals were consulted and prophylactic procedure consisting of active immunization were applied in 54.2% of the total consulted. Dogs and cats were the most common animal species suspected as the source of the rabies exposure. Anti-rabies prophylaxis was applied in 45.8% of all vaccinated patients exposed to dogs, and in 24.2% exposed to cats. All patients with bite wounds were consulted at the Department of Surgery and wound care followed surgical recommendations. In the study group, 45 patients had category III contact. There were 38 patients exposed to dogs, and 7 exposed to cats. There were no people exposed to wildlife in this group. All animals were available for veterinary observation. During and after exposure, none of the animals that serve as a potential source of infection presented with symptoms of rabies. The local epidemiological data indicated that during exposures of our patients, there were no confirmed cases of rabies among animals in Lublin province. Based on the data mentioned above, RIG was not applied.During the studied period in Lublin province, rabies was confirmed mainly in wildlife, and only in 2 dogs.Conclusions. In Lublin province, people are still at risk of exposure to rabid animals. The majority of our patients were vaccinated after domestic animals exposure, but rabies was confirmed mainly in wildlife, and since 2013, there were no ca...

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“…A review of the appropriateness of rabies PEP based on data from 11 university-affiliated emergency departments determined that rabies PEP was inappropriately administered to 40 percent of the patients who received PEP. 17 Likewise, a study conducted in Florida found that rabies PEP was unnecessarily given to almost one quarter of the 160 patients who received rabies PEP in 1997 and 1998. 18 Increased involvement of public health staff in the decision-making process through increased reporting of animal exposures and rabies PEP cases may reduce the number of people who receive rabies PEP needlessly and help assure that it is given when indicated.…”

Section: • Discussionmentioning

confidence: 99%

Completeness of Reporting of Rabies Postexposure Prophylaxis in King County, Washington

Thiede

Koepsell

et al. 2008

Journal of Public Health Management and Practice

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The completeness of rabies postexposure prophylaxis (PEP) reporting was evaluated in King County, Washington State. Information on rabies immune globulin prescriptions was obtained from hospital pharmacies associated with emergency departments in King County from 2003 to June 2006. Rabies immune globulin is given at the initiation of rabies PEP which is usually started at emergency departments. Because pharmacies are not regular sources of rabies PEP reporting, we compared pharmacy cases with cases reported via routine passive surveillance methods. A capture-recapture method was used to calculate the estimated number of unreported cases from all sources. Reporting completeness was calculated by dividing the number of cases reported via routine surveillance with the sum of reported and estimated unreported cases. Seventy-one unreported rabies PEP cases were identified by comparing previously reported cases with pharmacy cases. A total of 128 cases were estimated to have been missed by the surveillance system. Overall reporting completeness was 62 percent increasing to almost 80 percent in 2005 and 2006. Our findings illustrate the importance of evaluating surveillance systems and suggest that it may be useful to institute active rabies PEP surveillance with emergency departments in addition to continuing educating healthcare providers and facilities about reporting.

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Appropriateness of Rabies Postexposure Prophylaxis Treatment for Animal Exposures

Cited by 125 publications

References 14 publications

Temporal dynamics of rabies in a wildlife host and the risk of cross-species transmission

Temporal dynamics of rabies in a wildlife host and the risk of cross-species transmission

Post-exposure rabies prophylaxis in humans exposed to animals in Lublin province (Eastern Poland) in 2012–2015 – A retrospective study

Completeness of Reporting of Rabies Postexposure Prophylaxis in King County, Washington

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