Officials linked the surge to attacks by river otters in Lake Tahoe and Anchorage, beavers in New Jersey and Maryland, and bats in various national parks. This trend was anticipated by a Clinician Outreach webinar held by the agency in April.
Guidance on Treatment
The agency addressed the trend through a Clinician Outreach webinar in April, which highlighted that roughly 4,000 animals are confirmed to have rabies annually in the United States. The presenters considered a range of topics, including the difficulty in determining when post-exposure prophylaxis (PEP) is necessary, and the risk assessment that can be applied. A subsequent Health Alert Network advisory on September 10 confirmed the spike and detailed the two licensed rabies vaccines and two rabies immunoglobulin products available for treatment.
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Health officials noted a 33 percent rise in rabies vaccine usage and a 76 percent increase in human rabies immunoglobulin (HRIG) administration. The advisory warns that a standard course of post-exposure prophylaxis can cost between $11,000 and $14,000 per person. This cost pressure highlights the need for accurate risk assessment, as medical professionals can often determine that rabies PEP is unnecessary if the animal is available for a ten-day observation period or if test results come back negative. Following rabies PEP administration guidance helps ensure that lifesaving vaccines are available for persons who need it and extraneous costs are avoided.
Correct dosing depends heavily on the patient’s vaccination history. If a person has not previously received the rabies vaccine, the regimen must include both HRIG and the vaccine. However, HRIG should not be given to those who have already been vaccinated. In cases where HRIG is unavailable, vaccination should not be delayed, as the immunoglobulin can be administered up to the day of the third vaccination dose.
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