Perceptions and Practices of Mass Bat Exposure Events in the Setting of Rabies Among U.S. Public Health Agencies

Abstract

Summary Current guidelines in the setting of exposures to potentially rabid bats established by the Advisory Committee on Immunization Practices (ACIP) address post-exposure prophylaxis (PEP) administration in situations where a person may not be aware that a bite or direct contact has occurred and the bat is not available for diagnostic testing. These include instances when a bat is discovered in a room where a person awakens from sleep, is a child without an adult witness, has a mental disability or is intoxicated. The current ACIP guidelines, however, do not address PEP in the setting of multiple persons exposed to a bat or a bat colony, otherwise known as mass bat exposure (MBE) events. Due to a dearth of recommendations for response to these events, the reported reactions by public health agencies have varied widely. To address this perceived limitation, a survey of 45 state public health agencies was conducted to characterize prior experiences with MBE and practices to mitigate the public health risks. In general, most states (69% of the respondents) felt current ACIP guidelines were unclear in MBE scenarios. Thirty-three of the 45 states reported prior experience with MBE, receiving an average of 16.9 MBE calls per year and an investment of 106.7 person-hours annually on MBE investigations. PEP criteria, investigation methods and the experts recruited in MBE investigations varied between states. These dissimilarities could reflect differences in experience, scenario and resources. The lack of consistency in state responses to potential mass exposures to a highly fatal disease along with the large contingent of states dissatisfied with current ACIP guidance warrants the development of national guidelines in MBE settings.

Post‐exposure rabies prophylaxis for mass bat exposures: Case series and systematic review

“…Mass bat exposures are common across the United States as evidenced by a survey of 45 state public health agencies in which 33 states reported prior experience with MBEs. In these events, jurisdictions reported receiving an average of 17 phone calls per year (range 0–300) and investing 107 person‐hours annually on investigations (Hsu et al, 2017). The three RI MBEs experienced in the past 5 years involved a tremendous amount of time and resources from the hospitals, department of health and the facilities involved in the exposures.…”

“…However, the current guidelines do not address PEP in the setting of MBEs. The state public health agency survey demonstrated that there is great variability in criteria for providing PEP following MBEs (Hsu et al, 2017). Forty‐two of 45 public health agencies surveyed reported that they did not have protocols for MBE.…”

“…Forty‐two of 45 public health agencies surveyed reported that they did not have protocols for MBE. Additionally, 20 public health agencies responded that PEP recommendations in the setting of MBE were either unclear or moderately clear (Hsu et al, 2017). Each time Rhode Island experienced an MBE, CDC was contacted for guidance in response efforts.…”

“…In most instances, this was assessed for up to 1‐year prior to the incidents. The public health survey also evaluated this and found that some jurisdictions would administer PEP for exposures up to six months prior, others up to 12 months and still others with no time limit (Hsu et al, 2017). Indeed, the WHO guidance states that patients presenting for rabies PEP, even months after having been bitten, should be treated as if the contact had recently occurred; however, the exact timeline was not specified (Grill, 2009).…”

“…One of the most significant issues related to mass bat exposures (MBEs) is the lack of standardization in exposure evaluation and PEP recommendation methodologies used in each event. A survey of 45 state public health agencies found that 31 states (69%) felt that current CDC guidelines for PEP were unclear in MBE scenarios (Hsu et al, 2017). Thus, guidance for MBEs is needed to inform uniform guidance and provide further evidence for the need.…”