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 1

Rabies in Maryland  Reportable 1  300-500 animals confirmed rabid annually 2  Rabies postexposure prophylaxis (PEP) - Four-dose vaccine series and rabies immunoglobulin (RIG) 3 -Two-dose vaccine series only if previously immunized 3 Photo from CDC Rabies webpage.  Regulated by Code of Maryland Regulations (COMAR) 1 2

Create database of rabies PEP reporting forms What are the trends in rabies PEP Analyze data reporting in MD? Develop recommendations to improve PEP reporting 3

Methods  179 forms from 2013-2018  5 counties  10% random sample  Input forms electronically 4

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Results 8

 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%) 9 Photos from CDC Rabies webpages.

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

* 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. 11

Cats & Dogs Bats Anatomical Site of Exposure Arm/hand Unknown 12

Cats & Dogs Bats Types of Exposure Photo from Needpix.com. Single bite “Bat in room” 13

Cats & Dogs Bats  Multiple circumstances listed  “Other” Circumstances of Exposure 14

• 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. 15

Create distinct response Separate quarantine and choices for wild animal testing sections exposures, especially bats Next Steps Specify PEP completion Transform to online and deviations reporting forms 16

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. References 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 17

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 18

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