CDC Issues PPE Recommendations for Rabies Autopsies
Its work in the investigation of an Indiana man's death from rabies last October has caused CDC to issue recommendations for pathologists who perform autopsies on people who had suspected or confirmed cases.
The Centers for Disease Control and Prevention has issued recommendations advising pathologists about PPE they should wear and best practices to follow when conducting an autopsy of someone thought or known to have died of rabies. The recommendations were prompted by an Indiana man's death from rabies last October; clinicians in Kentucky, where he was treated before his death Oct. 20, contacted CDC, and the Kentucky Department for Public Health asked CDC staffers to come to the commonwealth to conduct the autopsy because they were concerned about biosafety risk and potential contamination of autopsy facilities, according to the study by personnel from both agencies that was published in CDC's MMWR publication April 9.
This was only the second rabies death of an Indiana resident since 1959 and only the 31st reported U.S. human case since 2000; tissue collected during the autopsy was typed as a variant common to the tricolor bat, the report states. CDC and WHO say the infection risk to health care personnel from human rabies patients is no higher than the risk from patients with other viral or bacterial infections, but the recommended precautions are advisable because rabies is almost always fatal once symptoms are seen. No confirmed case of rabies has ever been reported in someone who performed a postmortem examination of people or animals, CDC noted.
Still, the precautions are thorough:
- Use PPE, including an N95 or higher respirator, a full faceshield, goggles, gloves, and complete body coverage with protective wear.
- Use heavy or chain mail gloves to prevent cuts or sticks from cutting instruments or bone fragments.
- Use a hand saw rather than an oscillating saw to minimize aerosol generation, and avoid contact of the saw blade with brain tissue.
- Limit the number of people involved in the procedure and specimen collections.
- Use "ample amounts" of a 10 percent sodium hypochlorite solution during and after the procedure to ensure decontamination of surfaces and equipment
- Previous vaccination against rabies is not required for those performing these autopsies, and post-exposure prophylaxis is recommended only if contamination of a wound or mucous membrane with patient saliva or other potentially infectious material occurs during the procedure.
The man who died was a mechanic living in a farming community in southern Indiana; he had told friends that he saw a bat in late July after removing a tarp from a tractor near his home, but he did not report being bitten. Investigators identified 159 people who'd had contact with him before and during the two-week duration of his illness -- 147 of them were health care providers -- and 18 of the 159 completed the vaccination series. None of the 159 has become sick, the report says.