title: Risk assessment for healthcare workers after a sentinel case of rabies and review of the literature.
abstract: BACKGROUND
  After a case of rabies, healthcare workers (HCWs) had fear of contagion from the infected patient. Although transmission of rabies to HCWs has never been documented, high-risk exposures theoretically include direct contact of broken skin and/or mucosa with saliva, tears, oropharyngeal secretions, cerebrospinal fluid, and neural tissue. Urine/kidney exposure posed a concern, as our patient's renal transplant was identified as the infection source.
  
  
  METHODS
  Our risk assessment included (1) identification of exposed HCWs; (2) notification of HCWs; (3) risk assessment using a tool from the local health department; (4) supplemental screening for urine/kidney exposure; and (5) postexposure prophylaxis (PEP) when indicated.
  
  
  RESULTS
  A total of 222 HCWs including diverse hospital staff and medical trainees from university affiliates were evaluated. Risk screening was initiated within 2 hours of rabies confirmation, and 95% of HCWs were assessed within the first 8 days. There were 8 high-risk exposures related to broken skin contact or mucosal splash with the patient's secretions, and 1 person without high-risk contact sought and received PEP outside our hospital. Nine HCWs (4%) received PEP with good tolerance. Due to fear of rabies transmission, additional HCWs without direct patient contact required counseling. There have been no secondary cases after our sentinel rabies patient.
  
  
  CONCLUSIONS
  Rabies exposure represents a major concern for HCWs and requires rapid, comprehensive risk screening and counseling of staff and timely PEP. Given the lack of human-to-human rabies transmission from our own experience and the literature, a conservative approach seems appropriate for providing PEP to HCWs.
authors.affiliation: Infectious Diseases Section George Washington University, Washington, District of Columbia.
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Kan
authors.affiliation: Occupational Health.
authors.forename: Patrick
authors.initials: P
authors.lastname: Joyce
authors.affiliation: Infectious Diseases Section George Washington University, Washington, District of Columbia.
authors.forename: Debra
authors.initials: D
authors.lastname: Benator
authors.affiliation: Infection Control, Veterans Affairs Medical Center.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Agnes
authors.affiliation: Infection Control, Veterans Affairs Medical Center.
authors.forename: Janet
authors.initials: J
authors.lastname: Gill
authors.affiliation: Infection Control, Veterans Affairs Medical Center.
authors.forename: Monica
authors.initials: M
authors.lastname: Irmler
authors.affiliation: Infection Control, Veterans Affairs Medical Center.
authors.forename: Arlene
authors.initials: A
authors.lastname: Clark
authors.affiliation: Occupational Health.
authors.forename: George
authors.initials: G
authors.lastname: Giannakos
authors.affiliation: Occupational Health.
authors.forename: Audrey
authors.initials: A
authors.lastname: Gabourel
authors.affiliation: Infectious Diseases Section George Washington University, Washington, District of Columbia.
authors.forename: Fred M
authors.initials: FM
authors.lastname: Gordin
mesh_terms: D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D016030:Kidney Transplantation; D056990:Post-Exposure Prophylaxis; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission*; D018570:Risk Assessment; D012463:Saliva; D012867:Skin / Q000293:injuries
keywords: healthcare worker; rabies exposure; rabies postexposure prophylaxis; risk assessment