Transcript Rabies enquiries in Cheshire & Merseyside

Rabies enquiries
in
Cheshire & Merseyside
Dr Alex Stewart CCDC
Dr 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):
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enquiries rabies
enquiries rabies exposure
enquiries bites
case rabies
case diagnosis rabies
• Discussion with Colindale
• Web review of traveller information
HPZone
March 2010-Feb 2011
9 cases for prophylaxis
March 2011-Dec 2011
14 cases
• 46 enquiries
• 5 pre-exposure
• 27 enquiries post-exposure prophylaxis
– 23 provided prophylaxis
– 4 not bitten in at risk area
PEP by month
PEP by animal
u/k = referred
PEP by country
u/k = referred
2 cases pre-exposure prophylaxis
1 unvaccinated works in UK quarantine facility
PEP
• 7 given human rabies Ig (HRIG)
• 4 not known if Ig given
• remainder not given:
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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
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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
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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