Variation in Post Exposure Prophylaxis of Rabies in Patients Presenting with an Animal Exposure to the PennState Hershey Emergency Department

Open Access
Muller, Alison
Graduate Program:
Public Health Sciences
Master of Science
Document Type:
Master Thesis
Date of Defense:
July 07, 2016
Committee Members:
  • Vernon Michael Chinchilli, Thesis Advisor
  • Brian Jeremy Kipe, Committee Member
  • Kristen H Kjerulff, Committee Member
  • Rabies
  • emergency medicine
  • animal bite
  • rabies post exposure prophylaxis
  • Rabies Human Immunoglobulin
ABSTRACT Rabies infection is caused by the RNA virus, Lyssavirus Rhabdoviridae. Rabies leads among infectious diseases in mortality by victimizing an estimated 40,000 – 60,000 people globally every year. There is no standard protocol for patients presenting with an animal exposure and suspected rabies infection to the emergency department. Routine treatment for animal bites includes cleaning and irrigation of the wound, debriding the wound, imaging for residual matter, and suturing followed by a tetanus booster and antibiotics. Rabies PEP is administered on a case-by-case basis. The Penn State Hershey Medical Center Emergency Department currently issues rabies post exposure prophylaxis at a rate of eleven times that of the national average of actual cases of rabies per year. Few studies have been conducted regarding the variation among emergency medicine providers as compared to the Advisory Committee of Immunization Practices. This study aims to detect variation between providers and their adherence to Advisory Committee Immunization Practice guidelines in patients presenting to the Penn State Hershey Medical Center Emergency Department for a complaint of an animal exposure between January 1, 2011 and January 1, 2016. Participant charts were reviewed and data was abstracted according to four collection instruments specific to patient demographics, the involved animal, wound care, and rabies post exposure prophylaxis compliance. The data was analyzed (n = 400) as a binary outcome variable and the probability of a “yes” event (provider adherence to the ACIP protocol) was estimated along with its 95% confidence interval. Of the 400 patients examined, providers disagreed with the ACIP directives at a rate of 13%, in which an important discrepancy was error in immunoglobulin dosage.