CDC Reports 17% Summer Rabies Rise After 8 States Flag Treatment Problems

Q: What critical mistake are doctors making when administering life-saving rabies treatments this summer?

Doctors are making several preventable administration errors with rabies post-exposure prophylaxis, the CDC says, and the most critical are giving the vaccine in the wrong place and mishandling human rabies immune globulin. The CDC specifically warned that some clinicians are injecting the rabies vaccine into the gluteal area, which is not recommended because it can reduce how well the vaccine works. The vaccine should be given intramuscularly in the deltoid for adults, or the deltoid or anterolateral thigh for children. Another major mistake is failing to infiltrate human rabies immune globulin, or HRIG, into and around all identifiable wounds. For patients who have never been vaccinated against rabies, HRIG is supposed to be given once at the start of treatment, with as much of the dose as anatomically feasible placed directly into and around the bite or scratch. Any remaining amount should be injected at a different site from the vaccine. The CDC also cautioned against giving HRIG to people who were previously vaccinated, or giving HRIG and the first vaccine dose in the same syringe or the same anatomical site. Previously vaccinated patients generally need only two vaccine doses and should not receive HRIG. These errors matter because rabies is almost always fatal once symptoms begin, while properly administered treatment is nearly 100% effective when started promptly.

3 articles · Updated · The Washington Post · Sep 10

A 17% year-over-year increase in U.S. rabies cases in July and August prompted the CDC to issue a health alert, citing several high-profile outbreaks and exposure events.
Eight state health departments reported increased use of post-exposure treatment, administration errors, or both during the two-month period, raising concern about how exposures are being handled.
Maryland and North Carolina incidents helped drive the alert: rabid beavers attacked two people in a state park, while a petting zoo said several baby goats tested positive and nearly 300 people may have been exposed.
Rabies is spread mainly through bites or scratches from infected wildlife and is nearly 100% fatal once symptoms begin, making immediate medical care and a vaccine series critical after suspected exposure.
About 1.4 million Americans seek care each year after possible contact with a rabid animal, around 100,000 receive post-exposure treatment, and fewer than 10 rabies deaths are reported annually.