Rabies enquiries in cheshire merseyside
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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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Rabies enquiries in cheshire merseyside

Rabies enquiries in Cheshire & Merseyside

Dr Alex Stewart CCDC

Dr Katie Whiteway F2


Current hpa rabies guidance

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

?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

    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


    Pep by month

    PEP by month


    Pep by animal

    PEP by animal

    u/k = referred


    Pep by country

    PEP by country

    u/k = referred

    2 cases pre-exposure prophylaxis

    1 unvaccinated works in UK quarantine facility


    Rabies enquiries in cheshire merseyside

    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)


    Colindale

    Colindale

    National Ig issuing centre:

    “Number of calls has remained static this year”


    Main websites

    Main websites

    • NHS Choices

    • National Travel Health Network and Centre (NaTHNaC)

    • Well Travelled Clinic (Liverpool School of Tropical Medicine)


    Advice slightly differs

    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

    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

    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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