The University’s College of Veterinary Medicine hosted a talk on rabies last night. Dr. Lloyd Novick of East Carolina University led the event, The Slippery Slope: Rabies Post-Exposure Prophylaxis.
Novick , chair for the department of public health at ECU Brody School of Medicine, discussed the human post-exposure prophylaxis to prevent rabies virus infection after potential exposure to the virus.
Post-Exposure Prophylaxis, or PEP, is the treatment administered to humans after encounters with potentially rabid animals.
This “slippery slope” to which Novick refers is the problem with usage and requests for PEP. More often than not, professionals do not recommend PEP. In part, this is due to cost; one case involving PEP can set a patient back $1000. Moreover, it is unnecessary in almost all cases.
In spite of expert advice, individuals still insist upon PEP even in the most unlikely cases of contraction. Novick has found individuals-particularly mothers of patients-will change their story to make for a more severe case after they are met with rejection.
“A classic example of this is that there are no bites or scratches documented, but the caller reports handling an animal that they are concerned about. It is not uncommon to hear that the caller initially indicates that they do not have any open lesions on their hands or arms, but when they learn that they do not require PEP, they often report that they do in fact have cuts, scrapes…”
This common request for the PEP has led to overusage , a growing problem in the public health sector.
Chelsea Stowe, a research associate at Brody’s Department of Public Health, discussed the topic at the event and in her paper, “An Examination of the Overuse of RPEP in the United States.”
Stowe cites there are 120,000 potential rabies exposures per year, while “potential rabies exposure” includes an individual’s encounter with a possibly rabid animal. Of these, there are roughly 40,000 people who receive rabies PEP per year.
However, only one to two human rabies cases actually occur per year. Stowe defines these as cases “in which the subject or subjects involved in the encounter exhibit clinical symptoms.”
“Administration of rabies PEP is secondary prevention-it stops a disease already present in the body,” Stowe said. “But PEP is costly.”
Because the problem has grown to be so costly, Stowe recommends through her research more risk assessments be done and more exact figures be formulated so the level of need may be better understood.
PEP isn’t useless, though. Novick reminds students it is a “virtually, universally fatal disease,” and there have only been three cases of survival without the vaccine.
Another problem with controlling rabies is animal control varies by state, as does health departments’ course of action for dealing with the disease.
Some common practices are for states to require local governments to obtain animals showing signs of rabies for euthanasia and testing, or that those potentially exposed to rabies be administered a booster vaccination, quarantined or observed.
The most common practice is for an animal to be obtained and observed over a 10-day confinement period, if domestic, before rabies diagnosis may be reached. Or, the animal may be euthanized and tested if wild, or in some cases, domestic.
Professor for the Department of Population Health and Pathobiology Jay Levine introduced the speakers. In discussion, he reminded audience members of the first case for rabies since a resurgence after the 1960s hit close to home.
“A foal was brought to the hospital at the CVM,” Levine said.
Cases remain rare. And while more consistent preventative work may be done on the parts of veterinarians, physicians, and public health employees, there are a few steps individuals may take to prevent the contraction of rabies.
“Wild animals, feral cats and strays should be avoided,” Novick said. “Particularly by children.”
Novick also suggests individuals be wary of any unusual animal behavior, such as fox sightings in the middle of the day.
