EVALUATING AND STRENGTHENING PUBLIC HEALTH COMMUNICATION STRATEGIES RELATED TO RABIES IN VERMONT

Abstract

Rabies is a nearly universally fatal zoonotic disease once symptoms develop, requiring timely exposure assessment and post-exposure prophylaxis (PEP) to prevent mortality. Although human rabies is rare in the United States, wildlife reservoirs are the only natural hosts of the rabies virus, particularly bats, and continue to drive human exposure risk in the country. In 2024 and 2025, Vermont reported sustained wildlife rabies activity and substantial post-exposure prophylaxis (PEP) utilization, with 61% of administrations associated with bat exposures. The purpose of this Integrative Learning Experience (ILE) was to evaluate rabies communication strategies used by the Vermont Department of Health (VDH) and to identify opportunities to strengthen clarity, consistency, emphasis on proportional risk, and decision support for exposure management. The objectives were to identify and organize publicly available rabies materials, evaluate communication quality and alignment, and identify opportunities to enhance Vermont’s rabies communication framework. This Applied Practice Experience (APE) was conducted at VDH in Waterbury, Vermont, over approximately 260 hours. A structured qualitative review of nine (9) publicly accessible rabies-related documents was conducted between January and April 2026. Materials were categorized across surveillance reporting, public education, clinical guidance, laboratory coordination, reporting forms, and website content. Documents were assessed using predefined criteria informed by health literacy principles, behavioral theory, and elements of the Centers for Disease Control and Prevention (CDC) Program Evaluation Framework. Cross-document analysis identified patterns in terminology, risk framing, action-step clarity, and alignment across communication domains. Findings indicate that Vermont’s rabies communication system is comprehensive and operationally strong within the context of sustained bat-associated exposure burden. However, variability in exposure definitions, reporting terminology, and procedural sequencing was observed across materials. Bat-associated exposure risk was acknowledged but varied in specificity and emphasis. Notably, no consolidated provider reference tool existed; clinical guidance and reporting information were dispersed across documents, potentially limiting rapid usability in time-sensitive scenarios. To address this gap, a concise provider-focused rabies exposure and PEP quick-reference guide was developed to standardize terminology, clarify stepwise actions, integrate reporting requirements, and emphasize bat-associated risk. Adoption of this tool and incorporation of routine cross-document communication review into rabies program operations may enhance clinical efficiency, reporting consistency, and evidence-based rabies prevention practice in wildlife-endemic settings.