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

Abstract

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.

A statewide, cross‐sectional evaluation of the knowledge and level of concern of rabies among South Carolina residents

“…Although animal cases have declined in the United States overall, animal rabies cases have steadily increased in SC since 2011 (Rupprecht et al, 2013 ; SC DHEC, 2020 ): including a 48% increase between 2018 and 2019 alone (Ma et al, 2021 ). Evidence suggests rabies is a potentially reemerging, and often neglected, public health concern nationally and education is crucial to avoid fatalities (Kunkel et al, 2022 ; Pieracci et al, 2019 ; Whitehouse et al, 2021 ). Unlike other states, rabies management programs in SC do not include treatment for wildlife, such as using oral vaccination in baits (Davis et al, 2019 ; Ma et al, 2021 ).…”

Defining County-Level Terrestrial Rabies Freedom Using the US National Rabies Surveillance System: Surveillance Data Analysis

“…Human rabies deaths in the United States are rare, and rabies pre-exposure prophylaxis and postexposure prophylaxis (PEP) are effective when administered according to the Advisory Committee on Immunization Practices guidance [ 6 , 8 , 9 ]. Annually, an estimated 55,000 to 60,000 people in the United States receive rabies PEP for suspected rabies exposures at an estimated cost of >US $150 million [ 6 , 10 ]. The distribution of reservoir hosts in a given US county (ie, local administrative unit) can inform rabies risk assessment algorithms to determine if rabies PEP is required following a human exposure, based on the epizootiology of the area where the exposure occurred [ 11 ].…”