Brief report Risk of rabies transmission and adverse effects of postexposure prophylaxis in health care workers exposed to a fatal case of human rabies Aba Mahamat MD, PhD a, * , Jean-Baptiste Meynard MD, PhD b , Felix Djossou MD a , Philippe Dussart Pharm, PhD b , Magalie Demar MD, PhD a , Jean-Michel Fontanella MD c , Didier Hommel MD d , Claude Flamand MSc e , Herve Bourhy PhD f , Andre Spiegel MD b a Infectious Diseases and Hygiene Unit, Andree Rosemon Hospital, Cayenne, French Guiana b Anti-Rabies Treatment Centre, Institut Pasteur de Guyane, Cayenne, French Guiana c Emergency Department, Andree Rosemon Hospital, Cayenne, French Guiana d Intensive Care Unit, Andree Rosemon Hospital, Cayenne, French Guiana e Regional Office of the French Institute for Public Health Surveillance, Cayenne, French Guiana f National and World Health Organization Collaborative Center for Reference and Research on Rabies, Pasteur Institute, Paris, France Key Words: Risk management Rabies Hospital-acquired infection Isolation precautions Vaccination On May 27, 2008, a patient died from rabies at the Cayenne Hospital in French Guiana. Postexposure prophylaxis vaccination was implemented for all health care workers exposed to this patient. Examining the management of such a rare risk reveals important factors in the education of personnel who may have contact with a patient with rabies, to permit appropriate risk assessment and reduce unnecessary postexposure prophylaxis, taking into account the risks and costs of adverse events. Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Rabies is a serious zoonotic disease transmitted to humans through a bite. Human-to-human transmission of rabies has been documented only rarely in cases of organ or tissue transplan- tation. 1,2 Rabies exposure risks for health care workers (HCWs) who care for patients with rabies include exposure of mucous membranes or open wounds to infectious body fluids or tissues. Adherence to standard and isolation precautions, such as wearing face shields when performing procedures that can produce aerosols of saliva minimize the risk for HCWs. 3 Human rabies is a reemerg- ing disease in northern South America 4,5 but was not described before 2008 in French Guiana, a French overseas department located on the northeast coast of South America. On May 27, 2008, a 42-year-old male died in the intensive care unit (ICU) of Cayenne Hospital, Cayenne, French Guiana, from rabies. He sought care 3 times between May 14 and May 20, 2008 in the Emergency Department (ED) before his hospitalization in the ICU and was in contact with a number of HCWs. The infection control team became involved to investigate the potential risk of HCW exposure. Our objectives were to examine the infection control strategies implemented with the use of postexposure prophylaxis (PEP) and to record any adverse effects (AEs) of PEP. METHODS The investigation focused on HCWs who had possible contact with the patient and to evaluate the indications for prophylaxis vaccination in these HCWs. Investigation of HCWs and relatives with suspected contact A list of potential exposures was generated using the schedules of ED staff, radiology technicians, laboratory staff, and cleaning staff who worked on May 14-15 and May 19-20, 2008, and of ICU staff and laboratory and radiology technicians who worked on May 20-27, 2008. A face-to-face questionnaire was created to record the body fluids (blood, urine, feces, saliva, sputum, bronchial or tracheal secretions, cerebrospinal fluid, and lachrymal fluids) to which the HCW could have been exposed, and the type of exposure (ie, injured skin or mucous membranes). We also explored the possibility of inadvertent contact related to neglect of standard or isolation precaution practices. * Address correspondence to Aba Mahamat, MD, PhD, Andree Rosemon Hospital, UMIT, Avenue des Flamboyants, 97300 Cayenne, French Guiana. E-mail address: mahamataba@gmail.com (A. Mahamat). Presented in part as an oral communication at the 10th Jounées Nationales d’Infectiologie, Marseille, France, June 10-12, 2009. Conflict of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2012 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. doi:10.1016/j.ajic.2011.05.021 American Journal of Infection Control 40 (2012) 456-8