Maine Uses Data from ED Visits to Evaluate Completeness of Postexposure Prophylaxis Administration and Reporting after Potential Exposure to Rabies

Updated October 20, 2023

Rabies text with syringe and medications

Rabies is nearly always fatal, yet it is preventable if postexposure prophylaxis (PEP) is administered quickly after exposure. The Maine Center for Disease Control and Prevention’s (Maine CDC) use of emergency department data to assess completeness of PEP reporting helped determine rabies PEP administration is underreported.

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Public Health Problem

Rabies, which affects the central nervous system, is nearly always fatal. It is preventable before symptoms begin, with prompt use of rabies postexposure prophylaxis (PEP) after a potential exposure. Rabies PEP administration is reportable in Maine. To determine if PEP administration was being reported accurately, the Maine CDC sought a method of checks and balances.  

Actions Taken

The Maine CDC turned to syndromic surveillance, which draws data from emergency department (ED) electronic health records in near real–time. Maine compared ED data to reports from health care providers (in Maine’s reportable disease database) from January 2018 through June 2022 to see if Maine’s PEP reporting system was capturing data accurately and completely. At the same time, Maine evaluated the feasibility of using syndromic surveillance to monitor ongoing rabies PEP administration. Maine searched ED data for diagnosis codes with suspected exposure to rabies and for use of rabies PEP, particularly the first dose in the series administered.


By comparing data from multiple sources, the Maine CDC concluded that rabies PEP administration was being underreported by health care providers and that ED data also do not identify every time that someone received rabies PEP. Although both the ED data and reportable disease database captured PEP use, the combination provides checks and balances because each one identifies events missing from the other system. Maine’s reportable disease database identified 536 (38%) rabies PEP administrations, including 220 not found in syndromic surveillance. Syndromic surveillance identified 1,192 (85%) rabies PEP administrations, including 876 not in the Maine CDC’s reportable disease database. Going forward, the Maine CDC aims to use ED data from syndromic surveillance in place of traditional rabies PEP reporting to better understand PEP usage statewide while decreasing the reporting burden on healthcare providers.


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Rabies is a fatal yet preventable viral disease. It can spread to people and pets if they are bitten or scratched by a rabid animal. In the United States, rabies is mostly found in wild animals like bats, raccoons, skunks, and foxes. However, in many other countries dogs still carry rabies, and most rabies deaths in people around the world are caused by dog bites.1
1. Rabies | CDC


Sara Robinson, MPH, Epidemiologist
Maine Center for Disease Control & Prevention
Centers for Disease Control and Prevention
Office of Public Health Data, Surveillance, and Technology
Detect and Monitor Division

This success story shows how NSSP

  • Improves Data Representativeness
  • Improves Data Quality, Timeliness, and Use
  • Strengthens Syndromic Surveillance Practice
  • Informs Public Health Action or Response

The findings and outcomes described in this syndromic success story are those of the authors and do not necessarily represent the official position of the National Syndromic Surveillance Program or the Centers for Disease Control and Prevention.