Factors associated with patient delay in rabies postexposure prophylaxis initiation in Puerto Rico, 2008-2009 (Proceedings)

Brenda Rivera-Garcia2, Ruby Serrano-Rodriguez2, Alexis Oquendo2, Jesse Blanton1, John Rullán2, Charles E Rupprecht1

1Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention (CDC), 1600 Clifton Rd NE, Atlanta, Georgia, 30333

2Office of Epidemiology, Puerto Rico Department of Health, San Juan, Puerto Rico

Disclaimer statement: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Abstract

     • Background: Timely initiation of rabies postexposure prophylaxis (PEP) is critical to preventing disease in persons exposed to rabid animals.

     • Purpose: A retrospective cohort study was conducted to identify factors for post-referral delay in rabies PEP initiation in Puerto Rico (PR).

     • Methods: Participants were individuals who had experienced a potential rabies exposure in PR between September 2008 and August 2009 and were referred for rabies PEP during the same 12-month period. In September 2009, patient data was obtained from health department records and through telephone interview. The interval of time between referral and PEP initiation (defined as patient delay) and its relationship with independent variables was measured using hazard ratios (HRs) which were estimated via Cox proportional hazards regression. Bivariate analysis was used to compare PEP recipients with non-recipients.

     • Results: During the study period, 497 patients were referred for rabies PEP. For the 351 (71%) who initiated PEP, median patient delay was 15 days (range: 0-140). Risk of patient delay was independently found to increase with low level of self-reported rabies knowledge (HR 1.6, 95% CI 1.0-2.5), compliance difficulty (HR 1.7, 95% CI 1.1-2.8), and exposure to animals other than mongoose (HR 6.3, 95% CI 3.6-11.1).

     • Conclusions: Patient delay in rabies PEP initiation is an important problem in PR. Campaigns to educate the public about rabies in companion animals, outreach to healthcare providers, and strategies to minimize barriers to access are recommended strategies to improve the timeliness of rabies PEP.