Download - Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011
![Page 1: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/1.jpg)
Animal Bites and Other Potential Rabies Exposures
2nd Quarter DIDE Training
May 18, 2011
![Page 2: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/2.jpg)
Objectives
• Understand the public health burden of animal bites and the purpose of surveillance
• Describe the epidemiology of animal bites in WV
• Review animal bite case management• Review changes to animal bite form• Review current WVEDSS-related issues
![Page 3: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/3.jpg)
Background – Public Health Burden
• True incidence of animal bites is not known
• Estimated 3–6 million mammalian bites/year1
– 0.2–1.0% of ED visits (200,000–1,000,000 visits)2,3
• 10% result in sutures, follow-up visits
• 1–2% result in hospitalization
• Small number of deaths (dogs bites result in 10–20 deaths per year in U.S.)
1Gilchrist J, Sacks JJ, White D, Kresnow MJ. Dog bites: still a problem?. Inj Prev. Oct 2008;14(5):296-301.2Garcia, VF. Animal bites and pasturella infections. Pediatrics in Review. 1997;18:127-130. 3http://www.cdc.gov/nchs/fastats/ervisits.htm
![Page 4: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/4.jpg)
Biting Species
• Multiple animal species account for bites to humans– Dogs (80–90%) – Cats (5–15%) – Rodents (2–5%) – Others
![Page 5: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/5.jpg)
Background – Dog Bites
• Most bites are caused by dogs – Most opportunities for exposure
• 75 million dogs in U.S.• 37% of households own >1
– Jaw pressure (200+ Psi)
• $100 million in hospital expenses4
• $1 billion in homeowner’s claims per year4
4Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA 1998;2711:51–53.
![Page 6: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/6.jpg)
Potential Health Outcomes
• Psychological impact– Lifetime fear of animals– Nightmares/difficulty sleeping– Speech defects– Depression
• Physical damage/disfigurement– Avulsions– Lacerations– Punctures– Crushing
![Page 7: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/7.jpg)
Potential Health Outcomes
• Risk of infection due to microorganisms– In the biter’s saliva (rabies virus, Pasteurella multocida, P.
canis, etc.)– On the victim’s skin (Staphylococcus, Streptococcus spp., etc.)– In the environment (Clostridium tetani)
• Infection risk increases with– Species of animal (cat vs. dog, others)– Type of wound (puncture bites)– Delayed treatment (>24–48 hours)– Patient age >50 years
![Page 8: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/8.jpg)
Animal Bite Surveillance in WV
• Reportable event per §64-7-3 and §64-7-5– Animal bites and other potential
rabies exposures– Rabies post-exposure prophylaxis
(PEP)
• Local health dept – Follow-up of exposures– Case management– Report to DIDE via WVEDSS
![Page 9: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/9.jpg)
Animal Bite Case Definition
• “A bite or scratch from a vector species or the introduction of saliva or central nervous system (CNS) tissue from a vector species into an open, fresh wound or mucous membrane (eye, mouth, or nose) of a human being.”
• Note: this includes bat exposures where a bite or scratch cannot be ruled out
![Page 10: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/10.jpg)
Non-Exposures
• The following are examples of non-exposures– Petting an animal– Animal licking intact skin– Bite from an animal that had contact with a rabid animal– Contact with blood, urine and/or feces of an animal– Looking at a rabid animal…
![Page 11: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/11.jpg)
Purpose of Animal Bite Surveillance
• Mitigate human risk of rabies
• Monitor epidemiology of animal bites
• Monitor PEP use/misuse
![Page 12: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/12.jpg)
Epidemiology of Animal Bites Reported in WV, 2007–2009
![Page 13: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/13.jpg)
![Page 14: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/14.jpg)
![Page 15: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/15.jpg)
![Page 16: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/16.jpg)
![Page 17: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/17.jpg)
![Page 18: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/18.jpg)
![Page 19: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/19.jpg)
![Page 20: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/20.jpg)
![Page 21: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/21.jpg)
![Page 22: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/22.jpg)
RR*=0.1 (0.1–0.2)
RR*=10.9 (8.2–14.5)
RR*=9.4 (6.8–13.0)
*compared to having exposure to any other animal
![Page 23: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/23.jpg)
Rabies PEP
• Approximately 40,000 rabies PEP / yr in U.S.
• Cost is approximately $2,500
• Risk of rabies is often uncertain but very low– High case-fatality of rabies with this
uncertainty influences inappropriate administration of PEP
![Page 24: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/24.jpg)
PEP Recommendations
• Zero risk (for true exposures) does not exist
– Patient with healthcare provider make ultimate decision
• PEP recommendations should take into account:
– Availability of animal for confinement or testing (and outcomes)
– Circumstances of exposure
– Type of exposure
– Type of animal
– Behavior of animal
– Vaccination status of biting animal
– Local rabies epidemiology
![Page 25: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/25.jpg)
Case Management
![Page 26: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/26.jpg)
Case Management
• Each case is a potential legal record• The following should be documented– Patient demographics– Exposure information– Outcome of animal– Outcome of patient
![Page 27: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/27.jpg)
Case Management
• Each case is a potential legal record• The following should be documented– Patient demographics– Exposure information– Outcome of animal– Outcome of patient
Public Health Actions
![Page 28: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/28.jpg)
Report received
![Page 29: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/29.jpg)
Report received
Verify victim info
![Page 30: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/30.jpg)
Report received
Verify victim info
Ensure minimal patient info present: •Name•Address•Age/DOB •Sex •Contact info•Rabies vaccination status (previous to exposure)
![Page 31: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/31.jpg)
Report received
Verify victim info
Verify exposure info
![Page 32: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/32.jpg)
Report received
Verify victim info
Verify exposure info
Ensure critical info present: •Exposure date •Exposure type•Exposing species
![Page 33: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/33.jpg)
Report received
Verify victim info
Verify exposure info
Ensure critical info present: •Exposure date •Exposure type•Exposing species
Determine other details: •Owned vs. non-owned animal•Vaccinated vs. unvaccinated•Provoked or unprovoked•Normal or abnormal behavior•County of exposure
![Page 34: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/34.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
![Page 35: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/35.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Animal Dead
Lost to Follow-
up
![Page 36: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/36.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Cat/dog/ferret: 10 days from exposure date
Livestock: 14 days from exposure date
Others: confine/observe not appropriate
Animal Dead
Lost to Follow-
up
![Page 37: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/37.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Document Outcome:•Verified healthy•Died•Lost to follow-up
Animal Dead
Lost to Follow-
up
![Page 38: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/38.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Animal Dead
Tested for rabiesNot tested
Lost to Follow-
up
![Page 39: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/39.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Animal Dead
Document Test Result:•Positive•Negative•Indeterminate
Lost to Follow-
up
![Page 40: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/40.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Confine / Observe
Animal Dead
Lost to Follow-
up
(Document)
![Page 41: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/41.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Status of victim
![Page 42: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/42.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Status of victim
Document Outcome:•Hospitalization•Death•Rabies PEP
![Page 43: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/43.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Status of victim
Document Outcome:•Hospitalization•Death•Rabies PEP
RIG dateVaccine dates
![Page 44: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/44.jpg)
Report received
Verify victim info
Verify exposure info
Management of animal
Status of victim
Document recommendations,attempts to contact
![Page 45: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/45.jpg)
Data Quality (2009)
• Completeness
• Timeliness
• Accuracy
![Page 46: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/46.jpg)
Completeness of Demographic Fields (2009)
Variable Percent Complete
Patient name 100%Date of birth 100%County of residence 99.8%Gender 97.9%Race 56.0%Ethnicity 42.4%
![Page 47: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/47.jpg)
Completeness of Exposure Fields (2009)
Variable Percent Complete
Exposure type 99.8%Exposure date 100.0%Exposure time of day 62.7%Body location 98.2%Exposure provoked 85.9%
![Page 48: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/48.jpg)
Completeness of Species Fields (2009)
Variable Percent CompleteSpecies involved 99.9%Ownership (pet, stray or wild) 97.4%Animal final outcome/status 91.7%Breed (canine only) 74.4%Vaccination history (pet only) 50.7%Specimen submitted 89.1%Specimen result (if submitted) 95.5%
![Page 49: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/49.jpg)
Completeness of Outcome Fields (2009)
Variable Percent CompletePatient death 100.0%Patient hospitalization 96.2%PEP initiated 85.8%PEP status 46.2%
![Page 50: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/50.jpg)
Transition to NBS
• As we move from WVEDSS to NBS we are making changes to forms – Shorter (most are one page front/back)– Disease-specific (no more “general”
forms)• Animal bite form revised early 2011, reviewed
by NBS task team
![Page 51: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/51.jpg)
Structure of New Forms
• Patient demographics
• Investigation summary
• Report Source/ Healthcare provider
• Clinical• Vaccination
• Treatment• Laboratory results• Infection timeline• Epidemiologic
exposures• Public health issues• Public health actions
![Page 52: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/52.jpg)
Page 1
![Page 53: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/53.jpg)
Page 1 (continued)
![Page 54: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/54.jpg)
Page 2
![Page 55: Animal Bites and Other Potential Rabies Exposures 2 nd Quarter DIDE Training May 18, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062421/56649ce45503460f949b0b77/html5/thumbnails/55.jpg)
Page 2 (continued)