Estimating the risk of rabies transmission to humans in the U.S.: a delphi analysis

Vaidya, Sagar A.; Manning, Susan E.; Dhankhar, Praveen; Meltzer, Martin I.; Rupprecht, Charles; Hull, Harry F.; Fishbein, Daniel B.
January 2010
BMC Public Health;2010, Vol. 10 Issue 1, p278
Academic Journal
Background: In the United States, the risk of rabies transmission to humans in most situations of possible exposure is unknown. Controlled studies on rabies are clearly not possible. Thus, the limited data on risk has led to the frequent administration of rabies post-exposure prophylaxis (PEP), often in inappropriate circumstances. Methods: We used the Delphi method to obtain an expert group consensus estimate of the risk of rabies transmission to humans in seven scenarios of potential rabies exposure. We also surveyed and discussed the merits of recommending rabies PEP for each scenario. Results: The median risk of rabies transmission without rabies PEP for a bite exposure by a skunk, bat, cat, and dog was estimated to be 0.05, 0.001, 0.001, and 0.00001, respectively. Rabies PEP was unanimously recommended in these scenarios. However, rabies PEP was overwhelmingly not recommended for non-bite exposures (e.g. dog licking hand but unavailable for subsequent testing), estimated to have less than 1 in 1,000,000 (0.000001) risk of transmission. Conclusions: Our results suggest that there are many common situations in which the risk of rabies transmission is so low that rabies PEP should not be recommended. These risk estimates also provide a key parameter for cost-effective models of human rabies prevention and can be used to educate health professionals about situation-specific administration of rabies PEP.


Related Articles

  • Strategies to improve global influenza surveillance: a decision tool for policymakers. Moore, Melinda; Chan, Edward; Lurie, Nicole; Schaefer, Agnes Gereben; Varda, Danielle M; Zambrano, John A // BMC Public Health;2008, Vol. 8 Issue 1, p186 

    Background: Global pandemic influenza preparedness relies heavily on public health surveillance, but it is unclear that current surveillance fully meets pandemic preparedness needs. Methods: We first developed a conceptual framework to help systematically identify strategies to improve the...

  • Population, behavioural and environmental drivers of malaria prevalence in the Democratic Republic of Congo.  // Malaria Journal;2011, Vol. 10 Issue 1, p161 

    The article presents a research study on the behavioral, population and environmental drivers for high prevalence of malaria in the Democratic Republic of Congo (DRC). In this study, dried blood spots from the 2007 Demographic and Health Survey (DHS) in DRC were analyzed by high-throughput PCR,...

  • Human Rabies.  // Clinical Infectious Diseases;12/1/2010, Vol. 51 Issue 11, pi 

    The article reports on the cases of human rabies in the U.S. It states that the cases of human rabies are associated with traveling to rabies-endemic countries in which bite exposure from dogs represents the frequent risk to travelers. It notes that reported cases were acquired from countries...

  • Candidate polyanion microbicides inhibit HIV-1 infection and dissemination pathways in human cervical explants. Fletcher, Patricia S.; Wallace, Gregory S.; Mesquita, Pedro M. M.; Shattock, Robin J. // Retrovirology;2006, Vol. 3, p46 

    Background: Heterosexual intercourse remains the major route of HIV-1 transmission worldwide, with almost 5 million new infections occurring each year. Women increasingly bear a disproportionate burden of the pandemic, thus there is an urgent need to develop new strategies to reduce HIV-1...

  • Update on Research and Development Pipeline: Tuberculosis Vaccines. Beresford, Belinda; Sadoff, Jerald C. // Clinical Infectious Diseases;May2010 Supplement 3, Vol. 50, pS178 

    Current tuberculosis (TB)-control methods, which do not include an adequate vaccine, do not effectively block transmission of TB. Modeling studies show that mass vaccination campaigns using new vaccines could prevent 85.9 million new cases and 14.5 million deaths from 2015 through 2050 in...

  • Molecular epidemiology of a hepatitis C virus epidemic in a haemodialysis unit: outbreak investigation and infection outcome. Lanini, Simone; Abbate, Isabella; Puro, Vincenzo; Soscia, Fabrizio; Albertoni, Franceso; Battisti, Walter; Ruta, Amilacare; Capobianchi, Maria R.; Ippolito, Giuseppe // BMC Infectious Diseases;2010, Vol. 10 Issue 1, p257 

    Background: HCV is a leading cause of liver chronic diseases all over the world. In developed countries the highest prevalence of infection is reported among intravenous drug users and haemodialysis (HD) patients. The present report is to identify the pathway of HCV transmission during an...

  • Epidemiology of forest malaria in central Vietnam: a large scale cross-sectional survey. Erhart, Annette; Ngo Duc Thang; Phan Van Ky; Ta Thi Tinh; Van Overmeir, Chantal; Speybroeck, Niko; Obsomer, Valerie; Le Xuan Hung; Le Khanh Thuan; Coosemans, Marc; D'alessandro, Umberto // Malaria Journal;2005, Vol. 4, p58 

    In Vietnam, a large proportion of all malaria cases and deaths occurs in the central mountainous and forested part of the country. Indeed, forest malaria, despite intensive control activities, is still a major problem which raises several questions about its dynamics. A large-scale malaria...

  • Mis-reporting, previous health status and health status of family may seriously bias the association between food patterns and disease. Hörnell, Agneta; Winkvist, Anna; Hallmans, Göran; Weinehall, Lars; Johansson, Ingegerd // Nutrition Journal;2010, Vol. 9, p48 

    Background: Food pattern analyses are popular tools in the study of associations between diet and health. However, there is a need for further evaluation of this methodology. The aim of the present cross-sectional study was to evaluate the relationship between food pattern groups (FPG) and...

  • Region of Difference 1 Antigen--Specific CD4+ Memory T Cells Correlate with a Favorable Outcome of Tuberculosis. Goletti, Delia; Butera, Ornella; Bizzoni, Federica; Casetti, Rita; Girardi, Enrico; Poccia, Fabrizio // Journal of Infectious Diseases;10/1/2006, Vol. 194 Issue 7, p984 

    Background. Interferon (IFN)-γ response to region of difference (RD) 1 proteins (culture filtrate 10 and early secreted antigenic target 6) or overlapping peptides is a novel diagnostic marker of tuberculosis (TB) infection. Because we have recently shown that the response to certain peptides...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics