Louisa Castrodale1. 1. Alaska Section of Epidemiology, Anchorage, AK 99503, USA. louisa.castrodale@alaska.gov
Abstract
OBJECTIVE: The aim of this study was to summarize the Alaska experience in centralizing distribution of rabies postexposure prophylaxis (PEP). METHODS: Data were collected from standard treatment sheets used to track doses and notes related to the exposure investigations. RESULTS: From 2002 to 2007, the annual PEP usage rate was 2.2 per 100,000. Dogs were involved in 79% (68/86) of exposures. More than 50% (49/87) of people were exposed to a confirmed rabid animal; 31 (63%) of those people experienced nonbite exposures. Conversely, of the remaining 38 people exposed to an animal for which rabies status could not be confirmed, 35 (92%) sustained a bite or puncture. Direct and indirect costs averaged more than $3000 per person. CONCLUSIONS: The Alaska PEP usage rate was lower and the proportion of people exposed to confirmed rabid animals was higher when compared with other states. Alaska public health personnel invested significant time to ensure that PEP was only given when indicated. Without this gatekeeper approach, PEP would likely be administered at a much higher rate because medical facility staff lacks the time or ability to investigate animal exposures to rule out rabies. In Alaska, centralizing rabies PEP not only serves the patient's best interest, but it also makes efficient use of a potentially scarce product and supports rabies surveillance efforts by guaranteeing animals for testing. Such a program might not be feasible for a more populous state or jurisdiction, or areas with different rabies epizootiology; however, that may change if the supply of rabies biologics changes in the future.
OBJECTIVE: The aim of this study was to summarize the Alaska experience in centralizing distribution of rabies postexposure prophylaxis (PEP). METHODS: Data were collected from standard treatment sheets used to track doses and notes related to the exposure investigations. RESULTS: From 2002 to 2007, the annual PEP usage rate was 2.2 per 100,000. Dogs were involved in 79% (68/86) of exposures. More than 50% (49/87) of people were exposed to a confirmed rabid animal; 31 (63%) of those people experienced nonbite exposures. Conversely, of the remaining 38 people exposed to an animal for which rabies status could not be confirmed, 35 (92%) sustained a bite or puncture. Direct and indirect costs averaged more than $3000 per person. CONCLUSIONS: The Alaska PEP usage rate was lower and the proportion of people exposed to confirmed rabid animals was higher when compared with other states. Alaska public health personnel invested significant time to ensure that PEP was only given when indicated. Without this gatekeeper approach, PEP would likely be administered at a much higher rate because medical facility staff lacks the time or ability to investigate animal exposures to rule out rabies. In Alaska, centralizing rabies PEP not only serves the patient's best interest, but it also makes efficient use of a potentially scarce product and supports rabies surveillance efforts by guaranteeing animals for testing. Such a program might not be feasible for a more populous state or jurisdiction, or areas with different rabies epizootiology; however, that may change if the supply of rabies biologics changes in the future.
Authors: Stephanie A Shwiff; Ray T Sterner; Michele T Jay; Shefali Parikh; Amy Bellomy; Martin I Meltzer; Charles E Rupprecht; Dennis Slate Journal: J Wildl Dis Date: 2007-04 Impact factor: 1.535
Authors: Susan A O'Bell; Jennifer McQuiston; Linda J Bell; Sue C Ferguson; L A Williams Journal: Public Health Rep Date: 2006 Mar-Apr Impact factor: 2.792