1. Rabies enquiries in Cheshire & Merseyside Dr Alex Stewart CCDC Dr Katie Whiteway F2

2. Current HPA rabies guidance Vaccinate if exposure to terrestrial animal not in ‘no risk’ area OR from a bat in any area Ig recommended for unvaccinated + skin penetration Antibodies until vaccine response (1 st 7 days) Ig not necessary if minor scratches or bites by an apparently health animal

3. ?increase in C&M post-exposure calls HPZone search (March 2010-Dec2011): enquiries rabies enquiries rabies exposure enquiries bites case rabies case diagnosis rabies Discussion with Colindale Web review of traveller information

4. HPZone 46 enquiries 5 pre-exposure 27 enquiries post-exposure prophylaxis – 23 provided prophylaxis – 4 not bitten in at risk area March 2010-Feb 2011 9 cases for prophylaxis March 2011-Dec 2011 14 cases

5. PEP by month

6. PEP by animal u/k = referred

7. PEP by country u/k = referred 2 cases pre-exposure prophylaxis 1 unvaccinated works in UK quarantine facility

8. PEP 7 given human rabies Ig (HRIG) 4 not known if Ig given remainder not given: – 4 too minor an injury – 4 missed the 7-day window – 2 pre-exposure prophylaxis – 1 ‘as primates are low risk mode of transmission’, (not normally considered in the HPA guidelines)

9. Colindale National Ig issuing centre: “Number of calls has remained static this year”

10. Main websites NHS Choices National Travel Health Network and Centre (NaTHNaC) Well Travelled Clinic (Liverpool School of Tropical Medicine)

11. Advice slightly differs Who should receive pre-exposure prophylaxis Avoiding bites What to do if bitten Costs Timing Protection Animal contact Wound toilet

12. Other sources Travel agents – Thomas Cook - basic advice (e.g. avoid cats) – EasyJet – nothing – Thompson => FCO FCO => GP – Turkey page – rabies not mentioned Guide books – Lonely Planet “if you will be travelling off the beaten track you might want to consider an anti-rabies jab” BBC

13. Recommendations Continued good documentation on HPZone Adherence to HPA guidance for enquiries Monitor levels of enquiries Ensure health professionals aware of the need to educate the public on reducing the risk of rabies and seeking urgent help if any possible exposure occurs