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BACKGROUND: Accurate and timely reporting of rabies test results and potential human exposures is necessary to guide case management and define rabies epidemiology. Accordingly, Nebraska Department of Health and Human Services (NDHHS) collaborated with Kansas State University Rabies Laboratory (KSU-RL) in 2011 to establish electronic laboratory reporting (ELR) of animal rabies test results to Nebraska’s Electronic Disease Surveillance System (NEDSS). To further improve Rabies Program management, additional enhancements were needed to capture and share exposure data for case follow-up.
METHODS: If potential human exposure is verified, NDHHS authorizes state-paid rabies testing through a contractual agreement with KSU-RL. Prior to 2013, authorized tests were requisitioned via phone calls to NDHHS from persons submitting specimens. Relevant exposure information was ascertained; however, no efficient processes existed to subsequently disseminate information to Nebraska local health departments (LHD) for case follow-up. Beginning in April 2013, all exposure-related data captured during test requisition were subsequently entered (manually) as case reports into NEDSS to provide immediate LHD notification. To further optimize efficiency, a secure, Internet-based requisition system for test authorization was deployed in October 2014 for reporting of potentially exposed persons and to allow electronic capture of robust exposure-related data for subsequent automated messaging to NEDSS via electronic Public Health Case Reporting (PHCR).
RESULTS: From July 1, 2013–June 30, 2014, KSU-RL provided 1,016 automated ELR rabies test reports to NDHHS NEDSS (643 bats, 153 cats, 107 dogs, 45 cattle, 21 raccoons, 8 skunks, and 39 other species); 15 (1.5%) were positive (5 skunks, 4 bats, 4 cattle, and 2 cats). Among these, 444 (43.7%) were state-paid tests associated with 606 potentially exposed persons; 432 (97.3%), 7 (1.6%), and 5 (1.1%) were negative, unsuitable, and positive, respectively. Post-exposure prophylaxis (PEP) was administered to 19 and avoided in 587 persons. To further enhance information flow, NDHHS also successfully established automated, electronic exposure information capture with PHCR data importing into NEDSS.
CONCLUSIONS: NDHHS has established comprehensive Rabies Program case management processes based on automated capture and exchange of both test results and associated human exposure information. Readily accessible data are now available to document and justify both economic and health benefits of state-funded rabies testing. Given substantial costs associated with PEP, medical cost savings can now be easily calculated when PEP avoidance is indicated and documented. The value of rabies ELR and automated capture of exposure data for case management in Nebraska can serve as a national model.