In the Journals

HCW exposure to rabies required conservative approach for PEP

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October 30, 2014

Rabies poses a significant concern for health care workers who are treating patients with the infection, and a conservative approach including comprehensive risk screening, counseling and timely post-exposure prophylaxis is required, researchers recently reported.

“Transmission of rabies has been documented in cases of organ and/or tissue transplant,” researcher Virginia L. Kan, MD, of the infectious diseases section at the Veterans Affairs Medical Center in Washington, D.C., and colleagues wrote. “However, there has been no reported transmission to health care workers (HCWs) during their care of patients with rabies. Given the lack of human-to-human transmission of rabies from the literature, as well as our own experience, a conservative approach seems appropriate for determining which HCWs should receive [post-exposure prophylaxis] PEP after caring for a patient with rabies.”

When rabies was confirmed in a patient who had recently received a renal transplant, the investigators from the infection control, infectious diseases and occupational health departments at the Washington VA Center evaluated the risk for infection among HCWs. They identified HCWs with potential exposure, conducted a risk assessment and gave PEP when indicated.

They identified 222 HCWs who were potentially exposed to rabies after searching electronic medical records and conducting interviews. All underwent a risk assessment involving interviews with the HCWs as well as counseling. A senior infectious disease specialist and an occupational health physician discussed each high-risk exposure and the potential need for PEP.

Nine of the HCWs received PEP; eight were considered high-risk exposures, and one without high-risk sought PEP outside of the hospital. No HCW was bitten by the patient. Exposures included broken skin contact with the patient’s respiratory secretion or tears; handling soiled instruments; and mucosal splashes. PEP was well-tolerated among all the HCWs. There have been no secondary cases or PEP adverse effects more than 21 months after the patient presented.

“After confirmation of a sentinel case of acute rabies, a coordinated effort by staff from infection control, infectious diseases and occupational health resulted in a prompt risk assessment of all potentially exposed HCWs, including trainees rotating at our teaching hospital,” the researchers wrote. “Our relatively low rate of provision of PEP was likely due to HCWs’ use of standard precautions during patient care and to the extensive education and counseling regarding rabies transmission risk to HCWs.”

Disclosure: The researchers report no relevant financial disclosures.

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