People exposed to rabies are at risk of being “missed, lost to follow up or inappropriately managed” after a service providing biological treatment for such patients stopped operating, a senior HSE official has said.
Until the start of this month, a service operated out of Cherry Orchard Hospital, Dublin, was responsible for the assessment of patients and delivery of “critical” biologics to patients with acute post-exposure treatment of rabies, diphtheria and botulinum.
On July 3rd, Colm Henry, chief clinical officer at the HSE, wrote to the country’s regional executive officers and regional clinical directors following the retirement of the doctor who ran the Cherry Orchard service.
Following his retirement on July 4th, the service would cease to operate, Dr Henry said.
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“While this service had never been commissioned as a national service, it had, in effect, provided advice and treatment on management of potentially or actually exposed patients for many years from all over the country,” his letter said.
Dr Henry said in light of the “importance” of this service, the National Health Protection Office has been working with key partners and stakeholders to support implementation of a new regional service model.
“There are risks, while these discussions are taking place, of gaps in service and therefore potential for a person with a rabies prone exposure being missed, lost to follow up or inappropriately managed,” his letter said.
Dr Henry requested the regional executive officers to work with stakeholders and structures to “ensure provision of service and further development of same to address issues and risks identified”.
According to his letter, there are areas in which there has been consensus in relation to the establishment of regional services, including a proposed role for emergency departments, which will see and assess new presentations.
However, he also highlighted a number of “issues requiring further consideration/agreement” such as the provision of out-of-hours services or infectious diseases on-call hours for weekends and bank holidays.
In a statement, a spokesman for the HSE said the service for rabies exposure was “formally reorganised on a regional footprint to better meet the needs of local populations”.
The spokesman said a working group will work with implementation committees to “mitigate any risk relating to access to assessment and care for patients, potentially created by the standing down of a previously available service, which had been in place for many years”.
Rabies is a rare viral infection, but a person’s risk of contracting it becomes significant if they travel to parts of the world where rabies is common in land-based animals.
If a person is exposed to an animal in such countries, they must immediately seek medical advice and report this contact to a local hospital or clinic to enable assessment.
Diphtheria is an acute bacterial disease, mainly affecting the respiratory system. The most recent case of diphtheria in Ireland was in 2016.
Botulism is a rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria. There has been a surge in botulism poisonings in England over the past six weeks.
