Rabies enquiries in

Cheshire & Merseyside

Dr Alex Stewart CCDCDr Katie Whiteway F2

Current HPA rabies guidance

• Vaccinate if exposure to terrestrial animal not in ‘no risk’ area OR from a bat in any area

• Ig recommended for unvaccinated + skin penetration

• Antibodies until vaccine response (1st 7 days)

• Ig not necessary if minor scratches or bites by an apparently health animal

?increase in C&M post-exposure calls

• HPZone search (March 2010-Dec2011): enquiries rabies enquiries rabies exposure enquiries bites case rabies case diagnosis rabies

• Discussion with Colindale• Web review of traveller information

HPZone

• 46 enquiries

• 5 pre-exposure • 27 enquiries post-exposure prophylaxis– 23 provided prophylaxis– 4 not bitten in at risk area

March 2010-Feb 20119 cases for prophylaxis

March 2011-Dec 201114 cases

PEP by month

PEP by animalu/k = referred

PEP by country

u/k = referred

2 cases pre-exposure prophylaxis1 unvaccinated works in UK quarantine facility

PEP

• 7 given human rabies Ig (HRIG) • 4 not known if Ig given • remainder not given:– 4 too minor an injury – 4 missed the 7-day window – 2 pre-exposure prophylaxis – 1 ‘as primates are low risk mode of transmission’,

(not normally considered in the HPA guidelines)

Colindale

National Ig issuing centre:“Number of calls has remained static this year”

Main websites• NHS Choices• National Travel Health Network

and Centre (NaTHNaC)• Well Travelled Clinic (Liverpool

School of Tropical Medicine)

Advice slightly differs

• Who should receive pre-exposure prophylaxis• Avoiding bites• What to do if bitten• Costs• Timing• Protection • Animal contact• Wound toilet

Other sources• Travel agents– Thomas Cook - basic advice (e.g. avoid cats)– EasyJet – nothing– Thompson => FCO

• FCO => GP– Turkey page – rabies not mentioned

• Guide books – Lonely Planet “if you will be travelling off the beaten track

you might want to consider an anti-rabies jab”

• BBC

Recommendations

• Continued good documentation on HPZone• Adherence to HPA guidance for enquiries• Monitor levels of enquiries• Ensure health professionals aware of the need

to educate the public on reducing the risk of rabies and seeking urgent help if any possible exposure occurs