185090 Investigation of a Potential Mass Rabies Exposure

Monday, October 27, 2008: 12:35 PM

Kirstin Short, MPH , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
David Persse, MD , Emergency Medical Services, City of Houston, Houston, TX
Adebowale Awosika-Olumo, MD, MS, MPH , Bureau of Epidemiology, City of Houston, Department of Health and Human Services, Houston, TX
Melanie Ramon, MS , Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, TX
Paul Grunenwald, DVM , Texas Department of State Health Services, Region 6/5S, Houston, TX
Gary Johnson, BS , Texas Department of State Health Services, Region 6/5S, Houston, TX
     
Background: In general, when considering outbreaks, infectious diseases with person-to-person transmission such as salmonella, are the first to come to mind. However, outbreak investigations cover all instances of an increase or possible increase in disease incidence. This presentation will discuss a multi-jurisdictional outbreak investigation in response to a potential mass rabies exposure.

Methods: In September 2007, the Houston Department of Health and Human Services (HDHHS) was notified of a bat colony infestation of the dormitory of a local university that housed over 200 students. HDHHS, in collaboration with partners from Texas Department of State Health Services Zoonosis Control, conducted an investigation, which included a site visit and the development of a definition for rabies exposure. An education briefing was provided for the students. Individual risk assessments of exposure to bats were conducted for the purpose of prophylaxis initiation.

Results: Nineteen students elected to initiate prophylaxis. Of these, 18 met the exposure definition. Two of the 19 students experienced mild adverse events associated with vaccine administration.

Conclusion: Outbreak investigations are initiated when a large volume of information is unknown. Investigations of rabies exposures are particularly complex as they include an analysis of animal behavior and there is no laboratory test for human disease. In this investigation of a bat exposure in a dormitory, the outbreak team planned for a prophylaxis response that could have included over 200 individuals. Efficient communication between jurisdictions facilitated the development of a risk assessment tool and rapid mobilization of vaccine to prepare for a worst-case scenario.

Learning Objectives:
1. Describe an outbreak investigation for a potential mass rabies exposure. 2. Develop a risk assessment tool for rabies exposure. 3. Discuss the benefits of establishing relationships between jurisdictions prior to outbreak investigations.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was awarded an MPH with a concentration in Epidemiology in 2001. My initial experience as an epidemiologist was formed via a fellowship position with the Air Force Institute for Operational Health. For the last four years I have worked in the Bureau of Epidemiology in the Houston Department of Health and Human Services. During this time I served as the epidemiologist for environmental public health tracking, the team leader for the zoonotic and chronic disease investigation team, and recently I was promoted to the position of epidemiologist supervisor. In the past year I also lead the multi-jurisdictional response to a potential mass rabies exposure at a local university.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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