rabies enquiries in cheshire & merseyside dr alex stewart ccdc dr katie whiteway f2
TRANSCRIPT
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 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)
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