Document Type
Journal Article
Publication Date
10-2014
Journal
Clinical Infectious Diseases
Volume
Volume 60, Issue 3
Inclusive Pages
341-348
DOI
10.1093/cid/ciu850
Keywords
Infectious Disease Transmission, Patient-to-Professional--prevention & control; Post-Exposure Prophylaxis; Rabies--transmission
Abstract
Background. After a case of rabies, healthcare workers (HCWs) had fear of contagion from the infected patient. Although transmission of rabies to HCWs has never been documented, high-risk exposures theoretically include direct contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, cerebrospinal fluid, and neural tissue. Urine/kidney exposure posed a concern, as our patient's renal transplant was identified as the infection source.
Methods. Our risk assessment included (1) identification of exposed HCWs; (2) notification of HCWs; (3) risk assessment using a tool from the local health department; (4) supplemental screening for urine/kidney exposure; and (5) postexposure prophylaxis (PEP) when indicated.
Results. A total of 222 HCWs including diverse hospital staff and medical trainees from university affiliates were evaluated. Risk screening was initiated within 2 hours of rabies confirmation, and 95% of HCWs were assessed within the first 8 days. There were 8 high-risk exposures related to broken skin contact or mucosal splash with the patient's secretions, and 1 person without high-risk contact sought and received PEP outside our hospital. Nine HCWs (4%) received PEP with good tolerance. Due to fear of rabies transmission, additional HCWs without direct patient contact required counseling. There have been no secondary cases after our sentinel rabies patient.
Conclusions. Rabies exposure represents a major concern for HCWs and requires rapid, comprehensive risk screening and counseling of staff and timely PEP. Given the lack of human-to-human rabies transmission from our own experience and the literature, a conservative approach seems appropriate for providing PEP to HCWs.
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APA Citation
Kan, V.L., Joyce, P., Benator, D., Agnes, K., Gill, J. et al. (2014). Risk assessment for healthcare workers after a sentinel case of rabies and review of the literature. Clinical Infectious Diseases, 60(3), 341-348.
Peer Reviewed
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Open Access
1
Supplementary Data
ciu850supp_references.docx (20 kB)
Supplementary References
Comments
Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.