Optimizing Rabies Post-Exposure Management: Assessing Immunoglobulin Use and Vaccination Follow Up Quartney Gilliam, Mckenzie Hodges, Bianca Rivera-Ramirez, Aayush Patel
Piedmont Columbus Regional Midtown, Columbus, GA
Background: Rabies is a viral infection that is fatal without timely and proper intervention. Transmission most commonly occurs through the bite of an infected animal, with dogs representing the predominant source of human exposure. Current guidelines emphasize rapid and comprehensive post-exposure prophylaxis (PEP), which includes immediate wound cleansing, prompt administration of human rabies immunoglobulin (HRIG), and initiation of the vaccine series. Although PEP is highly effective when given appropriately and on time, its real-world implementation is often challenged by system level and institutional barriers. These include delays in starting treatment, late or missed doses of HRIG or vaccines, variability in provider adherence to protocols, poor patient follow-up, as well as significant strain on both patients and the healthcare system when navigating multiple visits across different facilities, possibly leading to confusion and fragmented care. To help reduce unnecessary repeat emergency department visits and improve continuity of care, patients presenting to Piedmont Columbus Regional Midtown (PCRM) or Piedmont Columbus Northside (PCN) emergency departments may be referred to Midtown Medical Clinic (MMC), a transitional care clinic, for follow-up rabies vaccinations. This study aims to evaluate the effectiveness of the current institutional rabies PEP protocols implemented at both PCRM as well as PCN, identify gaps in its application, and explore strategies to improve adherence, timeliness, and patient outcomes after a potential rabies exposure.
Methodology: We conducted an IRB‑approved retrospective chart review of patients presenting to the emergency departments of PCRM or PCN from January 1, 2025, to December 31, 2025. This review included all patients who presented with a chief complaint of an animal-related bite or scratch. Patients were excluded if they transferred to another facility after evaluation or PEP initiation, left against medical advice, refused vaccination, or had insufficient documentation to determine exposure type, treatment, or follow‑up. The primary outcome measured adherence to CDC rabies PEP guidelines by determining whether eligible patients received indicated HRIG and/or vaccine and identifying both missed treatment and treatment given to patients who did not meet criteria. The secondary outcomes evaluated instances where clinical criteria for initiating rabies PEP were not met, follow-up compliance, and the rate and factors associated with referral to MMC for follow-up care. The outcomes were assessed using descriptive statistics.
Results: Among 200 screened patients (157 adults and 43 pediatric patients), eligibility for rabies post‑exposure prophylaxis (PEP) was identified in 42% of adults and 56% of pediatric patients. Among eligible patients, 77% of adults and 50% of pediatric patients were initiated on PEP, while 9% of ineligible adults and 10% of ineligible pediatric patients received PEP. Follow‑up after PEP initiation varied, with 25% of adults and 43% of pediatric patients completing the full vaccination series, and differences in follow‑up location observed based on the site of initial presentation.
Conclusions: In this evaluation adult rabies PEP initiation largely aligned with CDC guidance with most eligible adults receiving therapy and minimal use among those without indications. In contrast, initiation among pediatric patients meeting eligibility criteria was inconsistent. Across both age groups completion of the rabies vaccination series remained challenging, highlighting persistent barriers to follow‑up after initial PEP initiation.
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