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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

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Rabies enquiries in Cheshire & Merseyside

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  1. Rabies enquiries in Cheshire & Merseyside Dr Alex Stewart CCDC Dr Katie Whiteway F2

  2. 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

  3. ?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

  4. 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 • 4not bitten in at risk area

  5. PEP by month

  6. PEP by animal u/k = referred

  7. PEP by country u/k = referred 2 cases pre-exposure prophylaxis 1 unvaccinated works in UK quarantine facility

  8. 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)

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

  10. Main websites • NHS Choices • National Travel Health Network and Centre (NaTHNaC) • Well Travelled Clinic (Liverpool School of Tropical Medicine)

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

  12. 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

  13. 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

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