Defense Date

2011

Document Type

Thesis

Degree Name

Master of Public Health

Department

Epidemiology & Community Health

First Advisor

Elizabeth Eustis Turf

Abstract

Objective: To describe a sample that received human rabies postexposure prophylaxis (PEP) in Virginia as a result of animal exposures in 2002 and 2003 and to determine the extent to which PEP decisions were appropriate.Methods: PEP surveillance data were requested from 35 Virginia health districts within 5 regions. Retrospective chart review was used to gather demographic, exposure and source animal data from patient records and animal exposure reports. Descriptive statistics are presented. True exposures and appropriateness of PEP were defined using the 2004 Virginia Rabies Control Guidelines and the Recommendations of the 1999 Advisory Committee on Immunization Practices. The 2003 sample was analyzed for appropriateness of PEP because it was more representative than the 2002 sample. Stepwise syntax was created in SPSS utilizing 3 key decision variables and the 2004 Virginia Rabies Control Guidelines Algorithm for PEP decisions to determine appropriateness of PEP. Results: The 2002 and 2003 sample consisted of 838 PEP records, (73.6%) of 1139 PEP reported to the Division of Zoonotic and Environmental Epidemiology (central office of the Virginia Department of Health). Most PEP patients were young (mean 32.3 years) and had true exposures during spring or summer that resulted from approaching and handling a potentially rabid animal. Over half of the source animals were not captured. For the analysis of appropriateness, 55.2% (270/489) of PEP was appropriate, 22.5% (110/489) was inappropriate and 22.3% (109/489) of PEP had missing data on key decision variables. Inappropriate PEP primarily resulted from not true exposures [79% (87/110)]. Group exposures represented 42% more inappropriate PEP than individual exposures.Conclusion: Much PEP could be avoided in Virginia if more source animals were captured. The majority of inappropriate PEP occurred because PEP was given for exposures that were not true. New educational strategies for health care providers, public health personnel and the public are recommended to reduce the number of inappropriate PEP. Standardization of data collection methods, linking human and source animal data, computerization and formation of a central database are recommended to improve human rabies PEP surveillance in Virginia.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

March 2011

Included in

Epidemiology Commons

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