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Health department: potential rabies exposures and PEP administration rose sharply; department urges ED education
Summary
McHenry County epidemiologist reported potential human rabies exposures rose from seven cases in 2021 to 73 in 2025 and that many people receive PEP when not clinically recommended; staff stressed ED education, faster testing and public outreach to limit unnecessary PEP and ED burden.
Nathan Roden, an epidemiologist with the McHenry County Department of Health, presented year‑to‑year data showing a marked increase in 'potential human exposures' and in people receiving rabies post-exposure prophylaxis (PEP) when it was not recommended.
Roden said potential exposures reported under the state reportable condition increased from 7 cases in 2021 to 73 in 2025 and that the discrepancy between 'potential exposures' and confirmed exposures suggests more people are receiving PEP out of caution or anxiety rather than clinical necessity. "From 7 cases in 2021 to 73 cases in 2025," Roden said, illustrating the magnitude of the change.
He explained PEP is time-consuming and costly—the treatment series is typically four doses (five doses if immunocompromised) and the emergency treatment cost, including human rabies immunoglobulin (HRIG), can approach the mid‑five figures for an individual: "It's costs on about about $26,000," he said, citing a state public‑health veterinary source. Roden also noted HRIG supply constraints nationally.
To reduce unnecessary PEP use, the department described three surveillance dashboards, ED education efforts (primarily for nursing staff), an algorithm for clinicians, 24/7 consult availability with the health department and targeted outreach during high‑season months (August is peak). Roden and board members discussed earlier involvement of ED physicians, pharmacy workflow, and the feasibility of checklists or screening algorithms so clinicians have better information before dispensing PEP.
Board members asked practical questions about testing turnaround and where to refer residents: staff said animal testing results typically return within about a day to a day and a half and reiterated animal control can be called to retrieve bats to allow testing rather than residents handling animals themselves.
The board encouraged continued outreach and cross‑system conversations with hospital systems and pharmacies to reduce unnecessary PEP use and ED burden.
