Rabies Post-Exposure Prophylaxis Use — Kansas, 2012

BACKGROUND:  Investigation of confirmed animal rabies cases and unsuitable rabies specimen submissions represents a significant burden for local health departments (LHD) in Kansas with an average of 100 investigations annually. Public health conducts exposure risk assessments for each human contact and provides recommendations for post-exposure prophylaxis (PEP). Previously, little information was available regarding PEP administration to persons potentially exposed to rabies. The implementation of a new electronic disease surveillance system (EpiTrax) during 2012 provided a method to capture information on PEP recommendations and use for each contact.

METHODS:  We evaluated all case reports involving animal rabies test positive and unsuitable specimens reported to Kansas Department of Health and Environment (KDHE) from January 1 – October 31, 2012 for animal species, number of human contacts, exposure type, number of contacts recommended PEP, and number of contacts that received PEP. Exposure type was classified as bite, non-bite (e.g. contamination of open wounds or mucous membranes with saliva), or no exposure.

RESULTS:  Specimens from 1,079 animals were submitted for rabies tests; 53 tested positive and 14 were unsuitable. Forty-five of 67 (67%) positive and unsuitable specimens were from wildlife, including 32 skunks, 9 bats, 3 raccoons, and 1 coyote. Twenty-two (33%) were domestic animals, including 9 cats, 6 horses, 5 cows, and 2 dogs. Five (11%) wildlife cases had at least one human contact identified. Six human contacts (range 0-2 per case) were identified for wildlife cases, all associated with skunks. Exposure type included 1 bite and 1 non-bite; 4 had no exposure. PEP was recommended by public health for two (33%) wildlife contacts; 4 (67%) received PEP. There were no wildlife contacts that refused PEP. Sixteen (73%) domestic animal cases had at least one human contact identified. Forty human contacts were identified for domestic animal cases (range 0-7 per case). Exposure type included 13 bites and 18 non-bites; 9 had no exposure. PEP was recommended by public health for 28 (70%) domestic animal contacts; 33 (83%) received PEP.  There were no domestic animal contacts that refused PEP.

CONCLUSIONS:  Domestic animals represent one-third of rabies cases in Kansas; however, they have more human contacts per case and are responsible for most PEP use. Exposure risk assessments conducted by public health officials reduced the number of contacts receiving PEP; however, contacts classified as having no exposure received PEP based on recommendations from their healthcare provider. Improved communication between public health officials and healthcare providers could reduce unnecessary PEP utilization.