title: Imported episodic rabies increases patient demand for and physician delivery of antirabies prophylaxis.
abstract: BACKGROUND
  Imported cases threaten rabies reemergence in rabies-free areas. During 2000-2005, five dog and one human rabies cases were imported into France, a rabies-free country since 2001. The Summer 2004 event led to unprecedented media warnings by the French Public Health Director. We investigated medical practice evolution following the official elimination of rabies in 2001; impact of subsequent episodic rabies importations and national newspaper coverage on demand for and delivery of antirabies prophylaxis; regular transmission of epidemiological developments within the French Antirabies Medical Center (ARMC) network; and ARMC discussions on indications of rabies post-exposure prophylaxis (RPEP).
  
  
  RESULTS
  Annual data collected by the National Reference Center for Rabies NRCR (1989-2006) and the exhaustive database (2000-2005) of 56 ARMC were analyzed. Weekly numbers of patients consulting at ARMC and their RPEP- and antirabies-immunoglobulin (ARIG) prescription rates were determined. Autoregressive integrated moving-average modeling and regression with autocorrelated errors were applied to examine how 2000-2005 episodic rabies events and their related national newspaper coverage affected demand for and delivery of RPEP. A slight, continuous decline of rabies-dedicated public health facility attendance was observed from 2000 to 2004. Then, during the Summer 2004 event, patient consultations and RPEP and ARIG prescriptions increased by 84%, 19.7% and 43.4%, respectively. Moreover, elevated medical resource use persisted in 2005, despite communication efforts, without any secondary human or animal case.
  
  
  CONCLUSIONS
  Our findings demonstrated appropriate responsiveness to reemerging rabies cases and effective newspaper reporting, as no secondary case occurred. However, the ensuing demand on medical resources had immediate and long-lasting effects on rabies-related public health resources and expenses. Henceforth, when facing such an event, decision-makers must anticipate the broad impact of their media communications to counter the emerging risk on maintaining an optimal public health organization and implement a post-crisis communication strategy.
authors.affiliation: INSERM, U657 and Institut Pasteur, PhEMI, Paris, France.
authors.forename: Zélie
authors.initials: Z
authors.lastname: Lardon
authors.forename: Laurence
authors.initials: L
authors.lastname: Watier
authors.forename: Audrey
authors.initials: A
authors.lastname: Brunet
authors.forename: Claire
authors.initials: C
authors.lastname: Bernède
authors.forename: Maryvonne
authors.initials: M
authors.lastname: Goudal
authors.forename: Laurent
authors.initials: L
authors.lastname: Dacheux
authors.forename: Yolande
authors.initials: Y
authors.lastname: Rotivel
authors.forename: Didier
authors.initials: D
authors.lastname: Guillemot
authors.forename: Hervé
authors.initials: H
authors.lastname: Bourhy
mesh_terms: D000818:Animals; D018563:Disease Notification; D004285:Dogs; D005602:France; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D056990:Post-Exposure Prophylaxis / Q000706:statistics & numerical data / Q000600:supply & distribution*; D011818:Rabies / Q000188:drug therapy / Q000517:prevention & control / Q000628:therapy*; D011819:Rabies Vaccines / Q000008:administration & dosage* / Q000600:supply & distribution; D012044:Regression Analysis
chemical_list: D011819:Rabies Vaccines