I spend a lot of time answering questions about rabies exposures, and sometimes trying to clear up misinformation. Rabies is a very important infectious disease but in many regions (like here) it’s fortunately rare in domestic animals and people. However, rarity can breed complacency or lack of (or loss of) knowledge. That creates problems when people are thrust into the middle of a potential rabies exposure situation, in which they are frequently worried and stressed, without a lot of experience.
A recent study in Zoonoses and Public Health looked at rabies knowledge amongst 125 vets and 952 physicians in Washington, DC (Hennenfent et al. 2018).
Results were mixed, and there were (unsurprisingly) some differences between the professions.
- Vets were more likely to correctly answer questions about animal vectors and disease in animals.
- 88-89% of respondents said raccoons and bats are sources. That’s a high number but it’s concerning that it’s not 100% since those are very common and important rabies reservoirs. If people don’t know what species are of concern, they might not identify potential exposure scenarios.
Physicians were more likely to get transmission questions right.
- However, they were also more likely to say you could be exposed by stepping on feral cat feces (for the record, you can’t).
- 5% of physicians said that pigeons can transmit rabies virus. That’s a big “no” since rabies transmission only involves mammals.
Veterinarians were more likely to correctly identify rabies-free countries.
- This is of relevance for querying and assessing risk for people (and animals) that have traveled or are planning to travel.
Knowledge of post-exposure prophylaxis regimens wasn’t great, with only 39% of physicians getting that right.
- That’s a bit concerning, but maybe not a big deal because once the decision is made to give a patient post-exposure prophylaxis, presumably there would be a check of what to do, and public health involvement would help ensure the appropriate course (I hope). The key is determining whether a patient needs treatment and having support mechanisms in place.
Veterinarians were more likely to know the appropriate response to exposure of a person that has been previously vaccinated (i.e. you still get post-exposure prophylaxis, just a different course).
- I can vouch for that with my own rabies exposure experience – I had to explain the post-exposure regimen for a vaccinated person myself.
Only 50% of veterinarians identified the proper quarantine period for exposed vaccinated dogs, and even fewer (19%) got the answer right for unvaccinated dogs.
- That’s maybe not a big deal either IF there is a good public health/animal health support structure to help let veterinarians and owners know what needs to be done, or IF veterinarians simply look up the information after encountering a case. Just because they don’t know offhand doesn’t mean they won’t act appropriately. However, better baseline knowledge is ideal.
- As with physicians, identifying when to act is the most important, since the what component should be easy to determine.
Why is rabies knowledge sub-optimal?
- It’s probably because of a few factors. One is there’s not much focus on the disease in veterinary or medical curricula. Those programs are already jam-packed, and everyone’s crying for more time for their subject area. The applied aspects of rabies exposure are probably variably and minimally covered (if covered at all). I focus on rabies response in an infection control lecture to 2nd year veterinary students, but that’s just part of one lecture, a couple of years before they graduate.
- Rarity results in knowledge loss and complacency. Even if a veterinarian or physician knows about rabies when they graduate, if they don’t have to think about it for years, that knowledge is probably gone (or very fuzzy… which may be worse).
Does baseline knowledge matter?
- Yes and no.
- It’s most important to be able to identify an issue. As long as veterinarians and physicians have knowledge that triggers thoughts of rabies exposure, that’s the key. If you don’t think about rabies, you can’t act. If you think about it and are diligent, there are resources to help guide the response in both animals and humans. Public health can (hopefully) help with the response if there is potential human exposure (if they have the right knowledge and interest, which can also be variable).
More rabies knowledge would be great. How to get that is a challenge. We’re unlikely to get more time in student curricula. We can sneak information into continuing education seminars but it’s hard to focus on rabies because people are unlikely to attend a talk on what they perceive to be a rare topic or one that doesn’t really apply to them (especially when there are lots of competing talks about things they have to deal with on a day-to-day basis). When I talk about rabies to veterinary or physician groups, it’s usually part of a broader zoonotic disease or one health topic. Even then, it’s still a niche topic, and as with lots of continuing education, many people who really need the information are less likely to show up because it’s not something they care about or realize they don’t understand.
The study results are interesting, and rabies knowledge among physicians and veterinarians would ideally be better. However, we’re better off focusing on things that help these professionals think about rabies and making sure there are good support systems, rather than trying to cram more specific, automatic recall knowledge into their heads. The former is feasible and the latter is unlikely to happen.