Bats in the Bedroom, Bats in the Belfry: Reanalysis of the Rationale for Rabies Postexposure Prophylaxis

Background. We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evi...

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Published in:Clinical infectious diseases 2009-06, Vol.48 (11), p.1493-1499
Main Authors: De Serres, Gaston, Skowronski, Danuta M., Mimault, Pierre, Ouakki, Manale, Maranda-Aubut, Renée, Duval, Bernard
Format: Article
Language:English
Subjects:
Analysis
Animal bites
Animals
Articles and Commentaries
Bats
Bedrooms
Biological and medical sciences
Canada - epidemiology
Chiroptera
Disease prevention
Human viral diseases
Humans
Immunization
Incidence
Infectious diseases
Medical sciences
Physical contact
Population estimates
Preventive medicine
Rabies
Rabies - economics
Rabies - epidemiology
Rabies - prevention & control
Rabies - transmission
Recommendations
Single status
United States - epidemiology
Vaccination
Viral diseases
Viral diseases of the nervous system
Zoonoses - transmission
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container_end_page 1499
container_issue 11
container_start_page 1493
container_title Clinical infectious diseases
container_volume 48
creator De Serres, Gaston
Skowronski, Danuta M.
Mimault, Pierre
Ouakki, Manale
Maranda-Aubut, Renée
Duval, Bernard
description Background. We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. Methods. The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households. Incidence was based on reported human cases in Canada and the United States, 1990–2007. Results. In the population surveyed, bedroom bat exposure while sleeping and without known physical contact occurred at an annual rate of 0.099%. We estimate that
doi_str_mv 10.1086/598998
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We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. Methods. The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households. Incidence was based on reported human cases in Canada and the United States, 1990–2007. Results. In the population surveyed, bedroom bat exposure while sleeping and without known physical contact occurred at an annual rate of 0.099%. We estimate that &lt;5% of eligible persons with bedroom exposure receive RPEP as recommended. The incidence of human rabies due to bedroom bat exposure without recognized contact was 1 case per 2.7 billion person-years. The number needed to treat to prevent a single case of human rabies in that context ranges from 314,000 to 2.7 million persons. A total of 293–2500 health care professionals working full-time for a full year would be required to prevent a single human case of bat rabies due to bedroom exposure without recognized contact. Amounts of Can $228 million to Can $2.0 billion are additionally required for associated material costs. Conclusions. Human rabies acquired through bedroom exposure to a bat while sleeping and without recognized contact is rare. Conversely, such exposures are not uncommon in the population, and the resources required for associated RPEP are orders of magnitude higher than those required for most interventions that are considered to be reasonable. Current RPEP recommendations related to occult bat contact should be reconsidered.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/598998</identifier><identifier>PMID: 19400689</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: The University of Chicago Press</publisher><subject>Analysis ; Animal bites ; Animals ; Articles and Commentaries ; Bats ; Bedrooms ; Biological and medical sciences ; Canada - epidemiology ; Chiroptera ; Disease prevention ; Human viral diseases ; Humans ; Immunization ; Incidence ; Infectious diseases ; Medical sciences ; Physical contact ; Population estimates ; Preventive medicine ; Rabies ; Rabies - economics ; Rabies - epidemiology ; Rabies - prevention &amp; control ; Rabies - transmission ; Recommendations ; Single status ; United States - epidemiology ; Vaccination ; Viral diseases ; Viral diseases of the nervous system ; Zoonoses - transmission</subject><ispartof>Clinical infectious diseases, 2009-06, Vol.48 (11), p.1493-1499</ispartof><rights>Copyright 2009 Infectious Diseases Society of America</rights><rights>2009 by the Infectious Diseases Society of America 2009</rights><rights>2009 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Jun 1, 2009</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c452t-778198326edb19f041e839626473149c5b58c0935472346207f698121ccbd24a3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40309354$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40309354$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,58238,58471</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21515838$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19400689$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De Serres, Gaston</creatorcontrib><creatorcontrib>Skowronski, Danuta M.</creatorcontrib><creatorcontrib>Mimault, Pierre</creatorcontrib><creatorcontrib>Ouakki, Manale</creatorcontrib><creatorcontrib>Maranda-Aubut, Renée</creatorcontrib><creatorcontrib>Duval, Bernard</creatorcontrib><title>Bats in the Bedroom, Bats in the Belfry: Reanalysis of the Rationale for Rabies Postexposure Prophylaxis</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. Methods. The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households. Incidence was based on reported human cases in Canada and the United States, 1990–2007. Results. In the population surveyed, bedroom bat exposure while sleeping and without known physical contact occurred at an annual rate of 0.099%. We estimate that &lt;5% of eligible persons with bedroom exposure receive RPEP as recommended. The incidence of human rabies due to bedroom bat exposure without recognized contact was 1 case per 2.7 billion person-years. The number needed to treat to prevent a single case of human rabies in that context ranges from 314,000 to 2.7 million persons. A total of 293–2500 health care professionals working full-time for a full year would be required to prevent a single human case of bat rabies due to bedroom exposure without recognized contact. Amounts of Can $228 million to Can $2.0 billion are additionally required for associated material costs. Conclusions. Human rabies acquired through bedroom exposure to a bat while sleeping and without recognized contact is rare. Conversely, such exposures are not uncommon in the population, and the resources required for associated RPEP are orders of magnitude higher than those required for most interventions that are considered to be reasonable. 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Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De Serres, Gaston</au><au>Skowronski, Danuta M.</au><au>Mimault, Pierre</au><au>Ouakki, Manale</au><au>Maranda-Aubut, Renée</au><au>Duval, Bernard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bats in the Bedroom, Bats in the Belfry: Reanalysis of the Rationale for Rabies Postexposure Prophylaxis</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2009-06-01</date><risdate>2009</risdate><volume>48</volume><issue>11</issue><spage>1493</spage><epage>1499</epage><pages>1493-1499</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. We assessed the scientific basis and practical implications of recommendations made since the late 1990s to offer rabies postexposure prophylaxis (RPEP) for occult bat encounters, including recommendations to offer RPEP to persons with bedroom exposure to a bat while sleeping without evidence of direct physical contact. Methods. The number needed to treat after bedroom exposure to a bat was calculated as the percentage of population exposed multiplied by the inverse of crude rabies incidence. Bedroom exposure was estimated in a population survey of 14,453 households. Incidence was based on reported human cases in Canada and the United States, 1990–2007. Results. In the population surveyed, bedroom bat exposure while sleeping and without known physical contact occurred at an annual rate of 0.099%. We estimate that &lt;5% of eligible persons with bedroom exposure receive RPEP as recommended. The incidence of human rabies due to bedroom bat exposure without recognized contact was 1 case per 2.7 billion person-years. The number needed to treat to prevent a single case of human rabies in that context ranges from 314,000 to 2.7 million persons. A total of 293–2500 health care professionals working full-time for a full year would be required to prevent a single human case of bat rabies due to bedroom exposure without recognized contact. Amounts of Can $228 million to Can $2.0 billion are additionally required for associated material costs. Conclusions. Human rabies acquired through bedroom exposure to a bat while sleeping and without recognized contact is rare. Conversely, such exposures are not uncommon in the population, and the resources required for associated RPEP are orders of magnitude higher than those required for most interventions that are considered to be reasonable. Current RPEP recommendations related to occult bat contact should be reconsidered.</abstract><cop>Oxford</cop><pub>The University of Chicago Press</pub><pmid>19400689</pmid><doi>10.1086/598998</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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source JSTOR Archival Journals and Primary Sources Collection; Oxford Journals Online
subjects Analysis
Animal bites
Animals
Articles and Commentaries
Bats
Bedrooms
Biological and medical sciences
Canada - epidemiology
Chiroptera
Disease prevention
Human viral diseases
Humans
Immunization
Incidence
Infectious diseases
Medical sciences
Physical contact
Population estimates
Preventive medicine
Rabies
Rabies - economics
Rabies - epidemiology
Rabies - prevention & control
Rabies - transmission
Recommendations
Single status
United States - epidemiology
Vaccination
Viral diseases
Viral diseases of the nervous system
Zoonoses - transmission
title Bats in the Bedroom, Bats in the Belfry: Reanalysis of the Rationale for Rabies Postexposure Prophylaxis
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