Prompt treatment is critical after rabies exposure
People wait an average of 10 days before seeking medical advice after being exposed to potentially rabid animals overseas, and people in the United Kingdom wait an average of 3 days to seek treatment following a bat encounter, according to findings from two studies presented at European Congress of Clinical Microbiology and Infectious Diseases.
Although symptoms typically take 2 to 3 months to appear after exposure, they can also appear as soon as 1 week if the bite is severe, or they may take up to several years. Once clinical symptoms of rabies appear, the virus is almost always fatal, making prompt treatment critical.
"Preventive treatments are 100% effective if given promptly after exposure,” Kevin Brown, MD, head of Rabies and Immunoglobulin Service for Public Health England, said in a news release. "That's why seeking prompt care is so important, even if the wound or incident seems very trivial. If you are bitten, scratched, or licked by an animal you must wash the wound or site of exposure with plenty of soap and water and seek medical advice without delay. Travelers should not delay waiting for treatment until they return to the U.K.”
Rabies post-exposure treatment over 3 years in the U.K.
Brown and colleagues conducted a 3-year retrospective review of cases requiring rabies post-exposure treatment from one of the 10 Rabies and Immunoglobulin Service centers in Manchester, England, Between June 2015 and June 2018, they found 200 patients, aged 0 to 77 years, who received post-exposure treatment.
before exposure, and 78% of treatment was administered to travelers returning to the U.K. from 43 different countries. Moreover, 22% received treatment after a reported exposure to a bat in the U.K.
According to the poster, 48.4% of people who were exposed overseas waited until they returned to the U.K. to seek treatment.
“While the risk of catching rabies in the U.K. is extremely low, it is important that all potential bat bites are risk-assessed and treated as necessary,” Brown said. “Bat bites in the U.K. often do not leave a mark, and are felt rather than seen.”
Trends in rabies exposure, treatment needs
Brown and colleagues investigated the trends in rabies post-exposure treatment in England from 2001 to 2018 using data collected in a rabies database provided through the Rabies and Immunoglobulin Service for Public Health England.
They discovered the number of risk assessments performed for rabies post-exposure increased 7.5-fold from 2001 to 2018. Specifically, the assessment revealed an increase from 393 cases in 2001 to 2,949 in 2018. Brown and colleagues noted that while a majority of cases were the result of dog bites that occurred in South and South East Asia, approximately one in 10 were for bat bites that occurred in England.
Although more than 60% of people who sustained a bat bite sought treatment within 2 days of exposure, more than 30% of individuals who were exposed overseas and did not have previous rabies immunization waited until they returned to England to seek treatment.
“The findings highlight the importance of raising public awareness around the risks of rabies, both for travelers visiting rabies-infected countries and from bat exposures in the U.K.,” Brown said.
In 2018, the guidance on post-exposure treatment for rabies in the U.K. was updated, reducing the routine vaccine schedule from five doses to four. Brown and colleagues also assessed the impact of the updated guidelines that also included a calculated composite risk for rabies.
Brown and colleagues discovered a significant increase in the number of calls about possible rabies cases in the first 6 months after the new guidelines were introduced compared with the same time period in 2017. However, they also observed a decrease in vaccines and vials of immunoglobulin use.
“Those completing the risk assessment found the process easier to follow, and there was less risk of inappropriate treatment given,” Brown said. “The new guidance has led to a significant reduction in the costs of running the program, whilst still ensuring appropriate treatment for those at potential risk of rabies." – by Marley Ghizzone
Brown KE, Russell K. Abstract 1931. Presented at: ECCMID; April 13-16, 2019; Amsterdam.
Goodwin L, et al. Abstract 299. Presented at: ECCMID; April 13-16, 2019; Amsterdam.
Disclosures: The authors report no relevant financial disclosures.