Fig 1.
(a) Currently, patients with suspected rabies exposures routinely present or are referred to EDs regardless of whether they have extensive or minor/no wounds. Ambulatory patients may be referred by less acute healthcare settings and other stakeholders such as veterinarians, poison control and public health authorities, etc. Patients may be subsequently referred to community settings to complete PEP regimen of follow-up vaccine doses, but if community barriers to accessing care exist, patients will be referred back to the initiating ED. (b) Increasing access to PEP initiation in settings such as urgent, primary, and specialty care could be made possible by local availability or on-demand provision of HRIG. Patients with minor or no wounds could be adequately initiated on PEP at less acute settings, reducing burden on EDs. Availability of follow-up vaccination in community settings could further optimize the care chain and reduce burden on EDs. Boxes with a bold outline indicate a facility that can provide rabies PEP as a clinical service. ED, emergency department; HRIG, human rabies immunoglobulin; PEP, postexposure prophylaxis.
Table 1.
Examples of rabies PEP quality programs in the US.