Evaluating Utility of Human Rabies Postexposure Prophylaxis - - PowerPoint PPT Presentation

Evaluating Utility of Human Rabies Postexposure Prophylaxis Reporting in Maryland

Erin Beasley, DVM MPH Candidate, Class of 2020

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Rabies in Maryland

 Reportable1  300-500 animals confirmed rabid annually2  Rabies postexposure prophylaxis (PEP)

• Four-dose vaccine series and rabies immunoglobulin (RIG)3
• Two-dose vaccine series only if previously immunized3

 Regulated by Code of Maryland Regulations (COMAR)1

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Photo from CDC Rabies webpage.

What are the trends in rabies PEP reporting in MD?

Create database of rabies PEP reporting forms Analyze data Develop recommendations to improve PEP reporting

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Methods

 179 forms from 2013-2018  5 counties  10% random sample  Input forms electronically

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Results

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Patients

 Average age: 36 years old  Mostly female (58.4%)  Majority white race (92.6%)

Animals

 Top 3 species reported:

• 1. 1. Cats (31.6%)
• 2. 2. Bats (31.1%)
• 3. 3. Dogs (22.3%)

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Photos from CDC Rabies webpages.

10 * n=177 forms due to 2 blank entries for species.

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* Of 52 total tested animals for rabies. One test result entry was blank for Baltimore County. Baltimore County: 14 entries, excluding the 1 blank entry. Calvert County: 4 entries. Frederick County: 24 entries. Queen Anne’s County: 8 entries. Washington County: 1 entry.

Anatomical Site of Exposure

Cats & Dogs Bats

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Arm/hand Unknown

Types of Exposure

Cats & Dogs Bats

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Single bite “Bat in room”

Photo from Needpix.com.

Circumstances

• f Exposure

Cats & Dogs

 Multiple circumstances listed

Bats

 “Other”

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• Baltimore County: 35 entries. Calvert County: 13 entries. Frederick County: 60 entries (excluding 1 blank response

for PEP duration). Queen Anne’s County: 18 entries. Washington County: 24 entries.

• Non-deviated PEP was considered for patients receiving four vaccination doses and HRIG with a 14-day duration or

receiving a booster series with a 3-day duration.

Next Steps

Create distinct response choices for wild animal exposures, especially bats Separate quarantine and testing sections Specify PEP completion and deviations Transform to online reporting forms

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References

1 Code of Maryland Regulations. Title 10: Maryland Department of Health. Subtitle 06: Diseases.

Chapter 02: Communicable Diseases – Rabies. (2019).

2 Maryland Department of Health (n.d.). Data and statistics: Rabies. Maryland Department of

Health: Center for Zoonotic and Vector-borne Diseases. https://phpa.health.maryland.gov/OIDEOR/CZVBD/Pages/rabies.aspx.

3 Rupprecht, C. C. (2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis

to prevent human rabies: Recommendations of the Advisory Committee on Immunization

• Practices. Morbidity and Mortality Weekly Report, 59(RR-2), 1-9.

Photos: CDC (2019). Rabies. Centers for Disease Control and Prevention. https://www.cdc.gov/rabies/transmission/body.html https://www.cdc.gov/rabies/exposure/animals/bats.html https://www.cdc.gov/rabies/exposure/animals/domestic.html https://www.cdc.gov/rabies/prevention/animals.html n.a. n.d. Dog Angry Dog Aggressive Free Photo. Needpix.com. https://www.needpix.com/photo/190738/dog-angry-dog-aggressive-snappy-biting-animal- cocker-spaniel

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Acknowledgments

 Dr. David Crum, State Public Health Veterinarian  Dr. Kim Mitchell, Chief of Rabies and Vector-Borne Diseases  Mary Armolt, Administrative Officer II  Center for Zoonotic and Vector-Borne Diseases at the Maryland Department of Health  Paulani Mui  Dr. Beth Resnick  PHASE Internship

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