Open Access Highly Accessed Research article

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

Sagar A Vaidya13*, Susan E Manning23, Praveen Dhankhar4, Martin I Meltzer4, Charles Rupprecht5, Harry F Hull67 and Daniel B Fishbein38

Author Affiliations

1 Combined Internal Medicine-Pediatrics Program, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10128 USA

2 Preventive Medicine Residency, Career Development Division, Office of Workforce and Career Development, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333 USA

3 Immunization Services Division, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333 USA

4 Division of Emerging Infections and Surveillance Services, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333 USA

5 Division of Viral and Rickettsial Diseases, National Center for Zoonotic, Vector-Borne and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333 USA

6 Minnesota Department of Health, P.O. Box 64975, St. Paul, MN 55164 USA

7 H. F. Hull & Associates, LLC, 1140 St. Dennis Court, St. Paul, MN 55116 USA

8 Division of Global Migration and Quarantine, National Center for Preparedness, Detection, & Control of Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333 USA

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BMC Public Health 2010, 10:278  doi:10.1186/1471-2458-10-278

Published: 26 May 2010

Abstract

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.