Rabies post-exposure prophylaxis in Germany - What are the challenges?

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Emergency Medicine

Background:

• Germany is officially free of terrestrial rabies, with rabies primarily found in bats.
• Physicians in emergency departments (A&E) are frequently consulted regarding the necessity of rabies post-exposure prophylaxis (R-PEP).
• International travel increases the risk of rabies exposure, necessitating R-PEP even in rabies-free regions.

Purpose of the Study:

• To retrospectively analyze the application and adherence to R-PEP guidelines in an A&E department.
• To identify deviations from established R-PEP protocols.
• To assess the need for improved education and guideline implementation for R-PEP.

Main Methods:

• Retrospective analysis of patients receiving R-PEP at University Hospital Bonn between January 2013 and June 2019.
• Data collection included demographics, travel history, clinical findings, previous vaccinations, and R-PEP regimens.
• Evaluation of adherence to wound treatment, rabies immunoglobulin (RIG) administration, and vaccination schedules.

Main Results:

• 90 patients received R-PEP, with 10 cases lacking indication.
• Deviations from R-PEP guidelines were observed in 51% of cases (41/80).
• Incorrect RIG infiltration (36 patients), vaccination scheme errors (11 patients), and deficiencies in wound washing (14%) and tetanus status documentation (63%) were noted.

Conclusions:

• Despite Germany's rabies-free status, R-PEP consultations are common, mainly for patients returning from foreign travel.
• Significant deviations from R-PEP guidelines indicate a critical need for enhanced physician education on indications and protocol implementation.
• Improved adherence to R-PEP guidelines is essential to ensure effective rabies prevention.