Rabies Postexposure Prophylaxis
abstract & commentary
Source: Moran GJ, et al. Appropriateness of rabies postexposure prophylaxis treatment for animal exposures. JAMA 2000;284:1001-1007.
In that there has been but a single confirmed rabies survivor in the United States in the last three decades, rabies may be acknowledged as a uniformly fatal disease. Thanks primarily to control of rabies in domestic animals, the number of annual cases has dropped from more than 100 at the beginning of the 20th century, to only 1-3 yearly.
Rabies among animals, however, especially raccoons, has increased almost 20% since 1996. No cases of human rabies have ever been documented subsequent to exposure to raccoon rabies. Appropriate administration of rabies prophylaxis treatment is important not only to prevent rabies, but also to avoid unnecessary administration to persons not at risk, since the process is not without discomfort, and is costly ($1500 for a treatment course alone, without physician or office/hospital fees). This trial is the first prospective one to assess appropriateness of rabies prophylaxis administration.
Of 2030 patients with rabies exposure, 6.7% received prophylaxis. Of 136 patients who received prophylaxis, 40% were considered inappropriate, most commonly due to the fact that the culprit animal was available for observation or testing, which could obviate intervention. Of 1894 persons not receiving prophylaxis, 6.3% were considered inappropriate, most commonly because the culprit animal was not available for observation.
Moran and colleagues conclude that enhanced adherence to appropriate use of rabies prophylaxis is needed, and may be advanced by provision of easy access to and availability of suggested locale-specific and circumstance-specific guidance, through health department assistance and guideline promulgation. (Dr. Kuritzky is Clinical Assistant Professor, University of Florida, Gainesville, Fla.)
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