Objective: To describe a sample that received human rabies postexposure prophylaxis (PEP) in Virginia as a result of animal exposures in 2002 and 2003 and to determine the extent to which PEP decisions were appropriate.Methods: PEP surveillance data were requested from 35 Virginia health districts within 5 regions. Retrospective chart review was used to gather demographic, exposure and source animal data from patient records and animal exposure reports. Descriptive statistics are presented. True exposures and appropriateness of PEP were defined using the 2004 Virginia Rabies Control Guidelines and the Recommendations of the 1999 Advisory Committee on Immunization Practices. The 2003 sample was analyzed for appropriateness of PEP because it was more representative than the 2002 sample. Stepwise syntax was created in SPSS utilizing 3 key decision variables and the 2004 Virginia Rabies Control Guidelines Algorithm for PEP decisions to determine appropriateness of PEP. Results: The 2002 and 2003 sample consisted of 838 PEP records, (73.6%) of 1139 PEP reported to the Division of Zoonotic and Environmental Epidemiology (central office of the Virginia Department of Health). Most PEP patients were young (mean 32.3 years) and had true exposures during spring or summer that resulted from approaching and handling a potentially rabid animal. Over half of the source animals were not captured. For the analysis of appropriateness, 55.2% (270/489) of PEP was appropriate, 22.5% (110/489) was inappropriate and 22.3% (109/489) of PEP had missing data on key decision variables. Inappropriate PEP primarily resulted from not true exposures [79% (87/110)]. Group exposures represented 42% more inappropriate PEP than individual exposures.Conclusion: Much PEP could be avoided in Virginia if more source animals were captured. The majority of inappropriate PEP occurred because PEP was given for exposures that were not true. New educational strategies for health care providers, public health personnel and the public are recommended to reduce the number of inappropriate PEP. Standardization of data collection methods, linking human and source animal data, computerization and formation of a central database are recommended to improve human rabies PEP surveillance in Virginia.

This study showed that health equity must be achieved through education, awareness, and advocacy. A structured program must be put in place to provide accountability towards achieving health equity within organizations, communities, cites, and states. In Virginia, the Health Equity Campaign was a program put in place to provide such accountability to the citizens of Virginia. This study attempted to evaluate the Health Equity Campaign implemented by the Virginia Department of Health Office of Minority Health and Public Health Policy Division of Health Equity in order to get all Virginians to become advocates for health equity in their organizations, communities, neighborhoods. Organizational/group leaders were interviewed in addition to surveying various staff members. This study provides a detailed description of the strength of the Health Equity Campaign's ability to promote education and awareness about health equity and why many participants found it difficult to transition from motivation to advocacy. / Ph. D.