BACKGROUND: In 2010, the Advisory Committee on Immunization Practices updated rabies post exposure prophylaxis (PEP) recommendations, reducing them from a five vaccine series to four. In 2016, the National Association of State Public Health Veterinarians updated quarantine guidelines for animals potentially exposed to rabies, no longer classifying animals receiving a late rabies vaccine booster the same as those never vaccinated. As rabies remains endemic throughout the US and the District of Columbia (DC), we surveyed medical professionals in DC to identify knowledge gaps in implementing the new guidelines.
METHODS: A 15-question survey was developed to assess rabies knowledge in human and veterinary medical providers. All licensed Doctors of Medicine (MD), Doctors of Osteopathic Medicine (DO), and Doctors of Veterinary Medicine (DVM), licensed in DC (n = 11,442) were contacted via email to complete an online survey (SurveyMonkey). Data collection occurred from December 2, 2016 to January 3, 2017. Analyses were performed using SAS 9.4.
RESULTS: Approximately 10% (n = 1,213) of DC licensed medical professionals completed the survey; 82.1% practiced clinically on a weekly basis. Among licensed physicians (n = 1077), 37.4% were aware of the four vaccine PEP series, 79.2% knew to administer human rabies immunoglobulin and vaccine as soon as possible after exposure (day 0), and 46.9% identified the correct anatomic site for PEP administration. Among licensed veterinarians (n = 136), 71.3% identified proper quarantine protocols when a vaccinated domestic animal bites a human and 19.8% when an unvaccinated domestic animal is exposed to high risk wildlife. Among all respondents, 73.2% recommended PEP when a bat was found in the room with a sleeping child and 85.6% knew a person with previous vaccination should receive PEP when exposed. While > 75% recognized bats and raccoons as vectors, 4% incorrectly identified pigeons. Unusual aggression was identified as a clinical sign in animals by 96.2% of respondents; however, approximately 13% incorrectly selected alopecia or hypothermia. Although 98.7% recognized that transmission occurs to a human via animal bites, only 49.5% recognized a scratch from a feral cat as a risk.
CONCLUSIONS: The survey identified major rabies knowledge gaps in both the human and veterinary medical communities, including the current PEP recommendations. These findings indicate health professionals need education on rabies epidemiology, risk factors, and common vectors, and will help direct Department of Health educational outreach to better prepare our medical community to monitor and control this persistent public health threat.