Rabies Suspected Animal Contact Cases in a City with Animal Husbandry and the Appropriateness of Prophylactic Procedures
Seda Dagar1, Sibel Sahin2, Deniz Oray3, Arif Akkaya4, Ahmet Kama1, Gulsah Ucan1
1Department of Emergency, Kars State Hospital, Kars, Turkey
2Department of Emergency, Artvin State Hospital, Artvin, Turkey
3Department of Emergency Medicine, Izmir University Faculty of Medicine, Izmir, Turkey
4Department of Emergency Medicine, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
Keywords: Post-exposure prophylaxis; rabies; World Health Organization contact category
Abstract
Objectives
This study aims to evaluate the features of rabies suspected animal contact cases in the emergency department and the appropriateness of administering post-exposure prophylaxis procedures according to World Health Organization (WHO) instructions.
Methods
Rabies suspected animal contact cases that applied to the emergency department between August 2012 and December 2013 were included in the study. Patients’ data were obtained retrospectively from patient files, records of hospital automation system, and the “Rabies Suspected Animal Contact Cases Examination Form”. The post-exposure prophylaxis recommended by the WHO were compared to the prophylactic applications administered by the emergency department.
Results
A total of 515 cases were included in the study. According to WHO classification, cases involving category 3 injuries (n=378, 73.4%) were more common than the others (p>0.0001). Compared to post-exposure prophylaxis recommendations by the WHO, 44.7% of all cases (n=230) were administered inappropriate prophylaxis. Thirty-seven percent of cases received less rabies Ig than recommended, despite category 3 contact. Six percent of cases with category 2 contact were given unnecessary rabies Ig and all cases with category 1 contact (1.5% of all cases) were given unnecessary rabies vaccine.
Conclusions
We observed that in 44.7% of cases, post-exposure prophylaxis was applied inappropriately according to WHO instructions. Not only were there unnecessary vaccine and Ig applications, there were also missing prophylaxis procedures. Updating the current “Rabies Prevention and Control Directive” plus educating and controlling healthcare personnel on a regular schedule may help prevent inadequacies in prophylactic application.