Rabies postexposure prophylaxis in the United States: Opportunities to improve access, coordination, and delivery

• Published in: PLoS neglected tropical diseases 2021-07, Vol.15 (7), p.e0009461
• Main Authors: Howington, Gavin T, Nguyen, Huy-Binh, Bookstaver, P. Brandon, Akpunonu, Peter, Swan, Joshua T
• Format: Article
• Language: English
• Subjects: Access; Biology and life sciences; Chains; Coordination; Disease control; Disease prevention; Disease prophylaxis; Drug stores; Emergency medical care; Health care; Health care policy; Immunoglobulins; Inventory; Medical records; Medicine and Health Sciences; Methods; Pharmacy; Prevention; Prophylaxis; Public health; Public health administration; Rabies; Tropical diseases; Vaccines; Viewpoints; Wounds
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0009461

Commonly, patients with wounds from an animal encounter will seek initial wound care in the ED and may be reasonably initiated on rabies PEP during the same ED encounter. [...]many EDs maintain inventory of rabies vaccine and HRIG. Coordination of rabies PEP between care settings is lacking The US’ healthcare system lacks coordination in the chain of care for rabies PEP delivery that results in unnecessary ED visits, placing an undue burden on patients and payers. Since care settings outside of the ED provide limited access to HRIG, patients with minor wounds (or no wounds at all) are often referred to the ED to initiate rabies PEP (Fig 1A). Rates of correct and appropriate delivery of PEP (particularly HRIG) remain low, and many patients with anatomically feasible wounds may not receive HRIG wound infiltration in the ED [6,7]. [...]an opportunity may exist to optimize implementation of care delivery and coordination. [...]create a healthcare coordination system for rabies PEP chain of care to reduce unnecessary ED visits for (1) initiation of rabies PEP when severe wounds or other urgent conditions are not present and (2) subsequent rabies vaccine doses.