Large-scale human exposures to rabid or presumed rabid animals in the United States: 22 cases (1990–1996)

Lisa D. Rotz From the Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (Rotz, Rupprecht, Childs), and the Epidemic Intelligence Service Branch, Epidemiology Program Office (Rotz), Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333; and the Center for Molecular Medicine and Infectious Diseases, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061-0342 (Hensley).

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Jennifer A. Hensley From the Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (Rotz, Rupprecht, Childs), and the Epidemic Intelligence Service Branch, Epidemiology Program Office (Rotz), Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333; and the Center for Molecular Medicine and Infectious Diseases, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061-0342 (Hensley).

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Charles E. Rupprecht From the Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (Rotz, Rupprecht, Childs), and the Epidemic Intelligence Service Branch, Epidemiology Program Office (Rotz), Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333; and the Center for Molecular Medicine and Infectious Diseases, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061-0342 (Hensley).

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James E. Childs From the Viral and Rickettsial Zoonoses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (Rotz, Rupprecht, Childs), and the Epidemic Intelligence Service Branch, Epidemiology Program Office (Rotz), Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333; and the Center for Molecular Medicine and Infectious Diseases, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Tech and University of Maryland, Blacksburg, VA 24061-0342 (Hensley).

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Objective

To identify common elements of large-scale human exposures to rabid or presumed rabid animals in the United States from 1990 to 1996.

Design

Retrospective study.

Procedure

Health departments in 50 states and the District of Columbia were contacted regarding episodes of large-scale human exposures to rabid animals occurring between 1990 and 1996. A large-scale exposure was defined as administration of postexposure prophylaxis (PEP) to 25 or more people after an exposure to a rabid or presumed rabid animal or littermates. Incident-specific information was obtained through questionnaires sent to states reporting episodes. Data are reported as medians.

Results

Fifteen of 51 (29.4%) health departments reported 22 episodes; 72.7% involved companion animals or livestock. Twenty-six animals were involved in these 22 episodes, including 10 (38.5%) dogs, 4 (15.4%) livestock, 4 (15.4%) raccoons, 3 (11.5%) cats, 3 (11.5%) bats, and 2 (7.7%) ferrets. Schools (36.4%) and public places (22.7%) were the most common settings for exposures. Reportedly, 1,908 people received PEP. The cost for 10 episodes was $61,547/episode (range, $14,199 to $1,500,000). An episode-specific written algorithm for recommending PEP had been developed for use in only 4 (18.2%) episodes.

Clinical Implications

Large-scale exposures most commonly involved a single companion animal. Exposures attributable to improper handling of wildlife and unrestricted access of animals in schools and public areas can be potentially remedied by targeted education. Use of an episode-specific algorithm to determine need for PEP may also reduce the number of unnecessary treatments. (J Am Vet Med Assoc 1998;212:1198–1200)

Objective

To identify common elements of large-scale human exposures to rabid or presumed rabid animals in the United States from 1990 to 1996.

Design

Retrospective study.

Procedure

Health departments in 50 states and the District of Columbia were contacted regarding episodes of large-scale human exposures to rabid animals occurring between 1990 and 1996. A large-scale exposure was defined as administration of postexposure prophylaxis (PEP) to 25 or more people after an exposure to a rabid or presumed rabid animal or littermates. Incident-specific information was obtained through questionnaires sent to states reporting episodes. Data are reported as medians.

Results

Fifteen of 51 (29.4%) health departments reported 22 episodes; 72.7% involved companion animals or livestock. Twenty-six animals were involved in these 22 episodes, including 10 (38.5%) dogs, 4 (15.4%) livestock, 4 (15.4%) raccoons, 3 (11.5%) cats, 3 (11.5%) bats, and 2 (7.7%) ferrets. Schools (36.4%) and public places (22.7%) were the most common settings for exposures. Reportedly, 1,908 people received PEP. The cost for 10 episodes was $61,547/episode (range, $14,199 to $1,500,000). An episode-specific written algorithm for recommending PEP had been developed for use in only 4 (18.2%) episodes.

Clinical Implications

Large-scale exposures most commonly involved a single companion animal. Exposures attributable to improper handling of wildlife and unrestricted access of animals in schools and public areas can be potentially remedied by targeted education. Use of an episode-specific algorithm to determine need for PEP may also reduce the number of unnecessary treatments. (J Am Vet Med Assoc 1998;212:1198–1200)

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