Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA

Steinberg, Hannah D.; Bemis, Kelley; Frias, Mabel; Christiansen, Demian

doi:10.3201/eid2610.200232

Cited by 3 publications

(7 citation statements)

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“…1 US Department of Health and Human Services/Centers for Disease Control and Prevention rabies, 1,401 (5.8%) of which were confirmed positive. CDC estimates that 60,000 persons each year receive rabies PEP following animal exposures (3), approximately two-thirds of these may be attributed to bats, depending on the local rabies epidemiology (4).…”

mentioning

confidence: 99%

Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures — United States, August 2021

Kunkel¹,

Minhaj²,

Whitehill³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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mentioning

confidence: 99%

Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures — United States, August 2021

Kunkel¹,

Minhaj²,

Whitehill³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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“…Additionally, PEP recommendations could be improved if clinicians used health department rabies consultation services more frequently. In 2020, Steinberg et al 15…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, PEP recommendations could be improved if clinicians used health department rabies consultation services more frequently. In 2020, Steinberg et al found patients in Cook County, Illinois who received PEP were 87% less likely to have received inappropriate treatment if their health care practitioner consulted a health department (adjusted odds ratio, 0.13; 95% CI, 0.08-0.22). They also found differences in inappropriate PEP administration by animal species, which could be due to Advisory Committee on Immunization Practices guidelines being more complicated for domestic vs wild animals …”

Section: Discussionmentioning

confidence: 99%

“…In addition, most public health jurisdictions have their own guidelines for rabies risk assessments and testing suspect rabid animals, which typically consist of a static flowchart posted on the agency website . Both retrospective and prospective studies in the US have found that guidelines for when to administer PEP are often not followed . Common reasons for inappropriate PEP administration include (1) the animal tested negative for RABV, (2) the patient had no known animal contact, and (3) the bite was low risk for rabies .…”

Section: Introductionmentioning

confidence: 99%

“…8 , 9 , 10 , 11 , 12 Both retrospective and prospective studies in the US have found that guidelines for when to administer PEP are often not followed. 13 , 14 , 15 Common reasons for inappropriate PEP administration include (1) the animal tested negative for RABV, 15 (2) the patient had no known animal contact, 15 and (3) the bite was low risk for rabies. 15 In this study, we focus on issues related to the third reason.…”

Section: Introductionmentioning

confidence: 99%

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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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A Sufficiency of Caution

Brown

DeMaria

2023

Clinical Infectious Diseases

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Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA

Cited by 3 publications

References 3 publications

Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures — United States, August 2021

Notes from the Field: Three Human Rabies Deaths Attributed to Bat Exposures — United States, August 2021

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

A Sufficiency of Caution

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