Evaluation of Surveillance for Suspected Human Exposure to Rabies, Washington State, 2018-2023

We evaluated the data quality, acceptability, sensitivity, simplicity, and representativeness of the surveillance system for suspected human rabies exposure in Washington State to understand current surveillance practices and areas for improvement.

We conducted a mixed-methods evaluation of the state's surveillance system for suspected rabies exposures. Specifically, we compared the number of suspected rabies exposures in the Washington Disease Reporting System (WDRS) with (1) the number of possible rabies exposures captured by syndromic surveillance (Rapid Health Information NetwOrk [RHINO]) and (2) the number of rabies postexposure prophylaxis administrations in the Washington Immunization Information System (WA IIS) from January 2018 through May 2023. We interviewed local health jurisdiction (LHJ) representatives about investigation and reporting of suspected rabies exposure.

From January 2018 through May 2023, there were 1766 reports of suspected rabies exposure in WDRS, 5054 events in RHINO, and 2378 events in WA IIS; we found substantial differences among LHJs in the ratio of WDRS reports to events in RHINO and WA IIS. Interview data confirmed variability in reporting practices and data management. LHJ partners identified common barriers and weaknesses of the surveillance system, including staff turnover, system complexity, and a lack of resources for data modernization.

Suspected rabies exposures may not be consistently captured by the existing surveillance system. Variation among data entry procedures and storage systems across LHJs could be attributed to resource availability, population size, and capacity for data modernization. These data will be used to develop recommendations for improvements in rabies exposure surveillance in Washington State.