Rabies and Postexposure Prophylaxis | CDC EID

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Volume 16, Number 3–March 2010
Dispatch
Terrestrial Rabies and Human Postexposure Prophylaxis, New York, USA
Millicent Eidson and Anissa K. Bingman
Author affiliations: University at Albany School of Public Health, Rensselaer, New York, USA (M. Eidson, A. Bingman); and New York State Department of Health, Albany, New York, USA (M. Eidson)

Suggested citation for this article

Abstract
During 1993–2002, cats accounted for 2.7% of rabid terrestrial animals in New York but for one third of human exposure incidents and treatments. Nonbite exposures and animals of undetermined rabies status accounted for 54% and 56%, respectively, of persons receiving rabies treatments.

Rabies has an almost 100% case-fatality rate and requires considerable resources for control (1). In the United States, canine rabies is controlled with vaccination and control of dogs (2). Infection occurs primarily from bite wounds. In US cases diagnosed before death, patients died 6–43 days after clinical onset (3). Although <10 human cases have been diagnosed annually since 1990 (2) in the United States, potential exposure incidents and rabies postexposure prophylaxis (PEP) of humans are not rare. PEP is the treatment regimen for 1 person, with 2–5 vaccine injections and immune globulin, depending on prior vaccination history. PEP is unnecessary if an animal is not rabid at exposure.

A rabies outbreak in raccoons in the mid-Atlantic states in 1977 (4) reached New York state, which has many areas with land types favored by raccoons (5,6), in 1990. In this study, we identified terrestrial rabies trends statewide in New York, with an aim toward prioritizing control. Previous analyses have focused on only part of the state (7) or on a shorter time period (8).

The Study
In New York, need for PEP is determined by outcome of 10-day confinement (of all domestic animals) or laboratory testing (all species). Healthcare providers report suspected rabies exposures to local health departments, which absorb authorized PEP costs beyond those borne by third-party payers and partial reimbursement by the New York State Department of Health (9).

We analyzed exposure data collected electronically during 1993–2002. Exposures to bats and humans, animals submitted only for surveillance, and data from New York City (not part of the reporting system) were excluded. Rabies was diagnosed by direct fluorescent antibody staining. We analyzed data with SAS version 9.2 (SAS Institute, Cary, NC, USA) using US census data for rates (www.factfinder.census.gov). Because of skewed distributions, we used Spearman rank correlation coefficients for measures of association.

The number of terrestrial animals submitted declined 56% from 10,552 in 1993 to 4,631 in 2002. The number and proportion of rabid animals, which decreased from 2,637 (25.0%) in 1993 to 608 (13.1%) in 2002, were strongly associated with the number of submitted animals (Spearman r = 0.99, p<0.0001).

For 70.4% of the 13,004 exposure incidents during 1993–2002, an animal was not submitted for testing (Table 1). These incidents accounted for 10,097 (55.6%) of the 18,154 persons receiving PEP. Untestable and positive animals accounted for 2.6% and 23.4% of PEP, respectively. For 3.6% of exposure incidents, PEP began before rabies was ruled out.

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Suggested Citation for this Article
Eidson M, Bingman AK. Terrestrial rabies and human postexposure prophylaxis, New York, USA. Emerg Infect Dis [serial on the Internet]. 2010 Mar [date cited]. http://www.cdc.gov/EID/content/16/3/527.htm

DOI: 10.3201/eid1603.090298