Rabies Post-Exposure Prophylaxis Reporting Requirements by State, 2012

BACKGROUND:   As part of an effort to assess the feasibility of making rabies post-exposure prophylaxis (rPEP) a reportable condition in Michigan, we sought to review rPEP reporting requirements in other states.  In the event of a rabies biologics shortage, estimates of rPEP needs in each state would be critical to allocating existing biologics stocks to prevent rabies deaths.   The monitoring of rPEP administration could also aid public health in its efforts to assure the appropriate administration of these valuable biologics.

METHODS:   We conducted an informal survey by e-mail of state public health veterinarians.  For states for which no response was received, reportable disease lists and state disease reporting guidance documents available on the Web were used to gather data. 

RESULTS:   We received personal confirmation of rPEP reporting requirements for 43/53 states (81%).  Requirements were grouped into three categories: not reportable, explicitly reportable and implicitly reportable.  In 14 states (26%), rPEP was explicitly reportable (i.e., rPEP was listed as a reportable condition).  In 5 states (9%), rPEP was implicitly reportable.  In these states, while rPEP itself wasn’t directly a reportable condition, there was another means in place to monitor rPEP use such as requiring state authorization for product release from a pharmacy.  In the remaining 34 states (64%), rPEP was not reportable.

CONCLUSIONS:   Less than half of states (36%) monitored rPEP usage in some way.  Of these states, none reported having high reporting compliance.  Nationally, there is no means of obtaining a reliable estimate of rPEP usage.  Because of the great cost to the healthcare system due to inappropriate rPEP administration and periodic rPEP biologics shortages, an innovative solution to improving reporting is needed.