MMWR Morb Mortal Wkly Rep. 2020 Jul 24;69(29):956-959. doi: 10.15585/mmwr.mm6929a3.
On November 7, 2018, the Utah Department of Health (UDOH) reported the first confirmed human rabies death in the state since 1944 (1). The case occurred in a person who had been treated over a period of 19 days at four health care facilities and an emergency medical transport service across three counties and two states. Human rabies is preventable through preexposure or postexposure vaccination but is invariably fatal upon symptom onset. Timely identification of persons who might have been exposed to rabies virus is therefore crucial to administer postexposure prophylaxis (PEP). Because of the large number of health care workers who had been involved in the patient's care, a standardized online risk assessment survey was developed by UDOH based on Advisory Committee on Immunization Practices recommendations (2). This online tool was evaluated for accuracy, acceptability, and administrative obligation by reviewing the results from the tool and conducting focus group discussions and a follow-up survey. Among 90 health care workers initially identified by the online risk assessment as being potentially exposed to infectious material, 74 were classified as exposed. All 74 health care workers received PEP following consultation with occupational health staff members, indicating a positive predictive value of the assessment tool of 82%. In a follow-up survey, 42 (76%) of the 55 respondents reported that they were satisfied with the assessment process. In focus group discussions, participants suggested that the survey could be improved by providing additional information about rabies exposures because many of them were unfamiliar with human-to-human rabies transmission. This evaluation highlighted the importance of adopting clear communication strategies, demonstrated the benefits of using an online risk assessment during a mass rabies exposure, and provided specific feedback for CDC to improve resources available for states and health care facilities after mass rabies exposures.
2018 年 11 月 7 日，犹他州卫生署（UDOH）报告了自 1944 年以来该州首例确诊的人类狂犬病死亡病例（1）。该病例发生在一名患者身上，该患者在四个医疗保健机构和两个州的三个县的紧急医疗运输服务中接受了 19 天的治疗。通过暴露前或暴露后疫苗接种可以预防人类狂犬病，但一旦出现症状，狂犬病总是致命的。因此，及时识别可能接触过狂犬病病毒的人对于进行暴露后预防（PEP）至关重要。由于有大量的医疗保健工作者参与了患者的护理，UDOH 根据免疫实践咨询委员会的建议（2）开发了一个标准化的在线风险评估调查。通过审查该工具的结果，并进行焦点小组讨论和后续调查，评估了该在线工具的准确性、可接受性和行政义务。在最初通过在线风险评估确定的 90 名有潜在暴露于传染性材料风险的医疗保健工作者中，有 74 人被归类为暴露者。所有 74 名医疗保健工作者在与职业健康工作人员协商后都接受了 PEP，表明评估工具的阳性预测值为 82%。在后续调查中，55 名受访者中有 42 名（76%）表示对评估过程感到满意。在焦点小组讨论中，参与者建议可以通过提供有关狂犬病暴露的更多信息来改进调查，因为他们中的许多人对人与人之间的狂犬病传播不熟悉。这项评估强调了采用明确沟通策略的重要性，展示了在大规模狂犬病暴露期间使用在线风险评估的好处，并为 CDC 提供了具体反馈，以改善大规模狂犬病暴露后各州和医疗机构的可用资源。
