{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T10:50:36Z","timestamp":1788691836394,"version":"build-2803163510"},"update-to":[{"DOI":"10.1371\/journal.pntd.0009878","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000}}],"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T00:00:00Z","timestamp":1635120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>An evaluation of postexposure prophylaxis (PEP) surveillance has not been conducted in over 10 years in the United States. An accurate assessment would be important to understand current rabies trends and inform public health preparedness and response to human rabies.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methodology\/Principle findings<\/jats:title><jats:p>To understand PEP surveillance, we sent a survey to public health leads for rabies in 50 U.S. states, Puerto Rico, Washington DC, Philadelphia, and New York City. Of leads from 54 jurisdictions, 39 (72%) responded to the survey; 12 reported having PEP-specific surveillance, five had animal bite surveillance that included data about PEP, four had animal bite surveillance without data about PEP, and 18 (46%) had neither. Although 12 jurisdictions provided data about PEP use, poor data quality and lack of national representativeness prevented use of this data to derive a national-level PEP estimate.<\/jats:p><jats:p>We used national-level and state specific data from the Healthcare Cost &amp; Utilization Project (HCUP) to estimate the number of people who received PEP based on emergency department (ED) visits. The estimated annual average of initial ED visits for PEP administration during 2012\u20132017 in the United States was 46,814 (SE: 1,697), costing upwards of 165 million USD. State-level ED data for initial visits for administration of PEP for rabies exposure using HCUP data was compared to state-level surveillance data from Maryland, Vermont, and Georgia between 2012\u20132017. In all states, state-level surveillance data was consistently lower than estimates of initial ED visits, suggesting even states with robust PEP surveillance may not adequately capture individuals who receive PEP.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Our findings suggest that making PEP a nationally reportable condition may not be feasible. Other methods of tracking administration of PEP such as syndromic surveillance or identification of sentinel states should be considered to obtain an accurate assessment.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pntd.0009878","type":"journal-article","created":{"date-parts":[[2021,10,25]],"date-time":"2021-10-25T17:32:15Z","timestamp":1635183135000},"page":"e0009878","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Evaluating Surveillance for and Estimating Administration of Rabies Postexposure Prophylaxis in the United States, 2012\u20132018"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5158-0282","authenticated-orcid":true,"given":"Erin R.","family":"Whitehouse","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2460-0911","authenticated-orcid":true,"given":"Marissa K.","family":"Person","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1617-0798","authenticated-orcid":true,"given":"Sally","family":"Slavinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agam K.","family":"Rao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2634-355X","authenticated-orcid":true,"given":"Jesse D.","family":"Blanton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,25]]},"reference":[{"key":"pntd.0009878.ref001","doi-asserted-by":"crossref","first-page":"A6","DOI":"10.1016\/j.vaccine.2019.04.024","article-title":"Overview of rabies post-exposure prophylaxis access, procurement and distribution in selected countries in Asia and Africa, 2017\u20132018","volume":"37","author":"N Sreenivasan","year":"2019","journal-title":"Vaccine"},{"key":"pntd.0009878.ref002","unstructured":"World Health Organization (WHO). Rabies. [cited 2021 Jan 20]. Available from: https:\/\/www.who.int\/rabies\/human\/situation\/en\/"},{"issue":"RR-3","key":"pntd.0009878.ref003","first-page":"1","article-title":"Human rabies prevention\u2014United States, 2008: Recommendations of the Advisory Committee on Immunization Practices","volume":"57","author":"SE Manning","year":"2008","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"51","key":"pntd.0009878.ref004","doi-asserted-by":"crossref","first-page":"7156","DOI":"10.1016\/j.vaccine.2009.09.028","article-title":"Epidemiology of rabies post-exposure prophylaxis\u2013United States of America, 2006\u20132008","volume":"27","author":"KA Christian","year":"2009","journal-title":"Vaccine"},{"issue":"3","key":"pntd.0009878.ref005","doi-asserted-by":"crossref","first-page":"E24","DOI":"10.1097\/PHH.0000000000000125","article-title":"Animal bite and rabies postexposure prophylaxis reporting\u2013United States, 2013","volume":"21","author":"NM Vora","year":"2015","journal-title":"J Public Heal Manag Pract"},{"key":"pntd.0009878.ref006","volume-title":"WHO Expert Consultation on Rabies, third report","author":"World Health Organization","year":"2018"},{"key":"pntd.0009878.ref007","volume-title":"Advisory Committee on Immunization Practices (ACIP) Work Groups","author":"Centers for Disease Control and Prevention","year":"2021"},{"issue":"8","key":"pntd.0009878.ref008","first-page":"20","article-title":"CDC warns of temporary shortage of rabies vaccine","volume":"29","author":"American Academy of Pediatrics","year":"2008","journal-title":"AAP News"},{"key":"pntd.0009878.ref009","unstructured":"Healthcare Cost and Utilization Project (HCUP). HCUP Nationwide Emergency Department Sample (NEDS) [Internet]. Agency for Healthcare Research and Quality. Rockville, MD; Available from: www.hcup-us.ahrq.gov\/nedsoverview.jsp"},{"key":"pntd.0009878.ref010","unstructured":"Healthcare Cost and Utilization Project (HCUP). HCUP State Emergency Department Databases (SEDD) [Internet]. Agency for Healthcare Research and Quality. Rockville, MD; Available from: https:\/\/www.hcup-us.ahrq.gov\/seddoverview.jsp"},{"issue":"2","key":"pntd.0009878.ref011","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2460\/javma.256.2.195","article-title":"Rabies surveillance in the United States during 2018","volume":"256","author":"X Ma","year":"2020","journal-title":"J Am Vet Med Assoc"},{"issue":"23","key":"pntd.0009878.ref012","doi-asserted-by":"crossref","first-page":"524","DOI":"10.15585\/mmwr.mm6823e1","article-title":"Vital Signs: Trends in Human Rabies Deaths and Exposures\u2013United States, 1938\u20132018","volume":"68","author":"EG Pieracci","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pntd.0009878.ref013","unstructured":"Centers for Medicare & Medicaid Services. 2020 ASP Drug Pricing Files. 2020. Available from: https:\/\/www.cms.gov\/medicare\/medicare-part-b-drug-average-sales-price\/2020-asp-drug-pricing-files"},{"issue":"5","key":"pntd.0009878.ref014","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1097\/00124784-199809000-00009","article-title":"Causes, costs, and estimates of rabies postexposure prophylaxis treatments in the United States","volume":"4","author":"JW Krebs","year":"1998","journal-title":"J Public Health Manag Pract"},{"issue":"2","key":"pntd.0009878.ref015","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3201\/eid0302.970216","article-title":"Rabies Postexposure Prophylaxis Survey\u2013Kentucky, 1994","volume":"3","author":"M Auslander","year":"1997","journal-title":"Emerg Infect Dis"},{"key":"pntd.0009878.ref016","article-title":"Multi-System Comparison for Evaluation of the Vermont Rabies Post-Exposure Prophylaxis Surveillance System","author":"A Wade","year":"2018","journal-title":"Poster Presented at the Counsel of State and Terroritorial Epidemiologists"},{"issue":"1","key":"pntd.0009878.ref017","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1080\/21645515.2019.1632680","article-title":"Adherence to guideline recommendations for human rabies immune globulin patient selection, dosing, timing, and anatomical site of administration in rabies postexposure prophylaxis","volume":"16","author":"GS Hwang","year":"2020","journal-title":"Hum Vaccines Immunother"},{"issue":"5","key":"pntd.0009878.ref018","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1016\/j.vaccine.2010.11.052","article-title":"Five-year (January 2004-December 2008) surveillance on animal bite and rabies vaccine utilization in the Infectious Disease Hospital, Dhaka, Bangladesh","volume":"29","author":"M Hossain","year":"2011","journal-title":"Vaccine"},{"key":"pntd.0009878.ref019","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.4103\/ijph.IJPH_377_19","article-title":"Appraisal of surveillance of human rabies and animal bites in seven states of India","volume":"63","author":"MK Sudarshan","year":"2019","journal-title":"Indian J Public Health"},{"key":"pntd.0009878.ref020","doi-asserted-by":"crossref","first-page":"A14","DOI":"10.1016\/j.vaccine.2018.10.011","article-title":"Descriptive assessment of rabies post-exposure prophylaxis procurement, distribution, monitoring, and reporting in four Asian countries: Bangladesh, Bhutan, Cambodia, and Sri Lanka, 2017\u20132018","volume":"37","author":"AJ Li","year":"2019","journal-title":"Vaccine"},{"issue":"1","key":"pntd.0009878.ref021","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-018-5888-5","article-title":"Epidemiology and surveillance of human animal-bite injuries and rabies post-exposure prophylaxis, in selected counties in Kenya, 2011\u20132016","volume":"18","author":"JN Ngugi","year":"2018","journal-title":"BMC Public Health"},{"issue":"9","key":"pntd.0009878.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0006597","article-title":"Improving systematic rabies surveillance in Cameroon: A pilot initiative and results for 2014\u20132016","volume":"12","author":"CL Sofeu","year":"2018","journal-title":"PLOS Negl Trop Dis"},{"issue":"9","key":"pntd.0009878.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0006367","article-title":"Bolstering human rabies surveillance in Africa is crucial to eliminating canine-mediated rabies","volume":"12","author":"A Broban","year":"2018","journal-title":"PLOS Negl Trop Dis"},{"key":"pntd.0009878.ref024","first-page":"1","article-title":"Using Surveillance of Animal Bite Patients to Decipher Potential Risks of Rabies Exposure From Domestic Animals and Wildlife in Brazil","volume":"8","author":"JA Benavides","year":"2020","journal-title":"Front Public Heal"},{"issue":"4","key":"pntd.0009878.ref025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pmed.1002002","article-title":"Mobile Phones As Surveillance Tools: Implementing and Evaluating a Large-Scale Intersectoral Surveillance System for Rabies in Tanzania","volume":"13","author":"Z Mtema","year":"2016","journal-title":"PLOS Med"},{"key":"pntd.0009878.ref026","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.1017\/S0950268821000601","article-title":"Rabies post-exposure prophylaxis in Germany-what are the challenges?","volume":"149","author":"P Meyerhoff","year":"2021","journal-title":"Epidemiol Infect"},{"issue":"11","key":"pntd.0009878.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1371\/journal.pntd.0004245","article-title":"Establishment of a Canine Rabies Burden in Haiti through the Implementation of a Novel Surveillance Program","volume":"9","author":"RM Wallace","year":"2015","journal-title":"PLOS Negl Trop Dis"}],"updated-by":[{"DOI":"10.1371\/journal.pntd.0009878","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,11,4]],"date-time":"2021-11-04T00:00:00Z","timestamp":1635984000000}}],"container-title":["PLOS Neglected Tropical Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,11]],"date-time":"2023-11-11T18:36:18Z","timestamp":1699727778000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pntd.0009878"}},"subtitle":[],"editor":[{"given":"Jakob","family":"Zinsstag","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,25]]},"references-count":27,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pntd.0009878","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pntd.0009878","asserted-by":"object"}]},"ISSN":["1935-2735"],"issn-type":[{"value":"1935-2735","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,25]]}}}