Press Release

New Recommendations for Performing Autopsies of Humans with Suspected or Confirmed Rabies

New recommendations for autopsy procedures can increase opportunities to diagnose rabies and learn more about the disease, according to a study by the Centers for Disease Control and Prevention (CDC).

For the first time, CDC has outlined a series of measures that can help those conducting autopsies stay safe and establish a diagnosis when symptoms of the recently deceased are consistent with rabies.

"Autopsies are a critical part of recognizing and diagnosing human rabies, in addition to furthering our understanding of the disease," said Dr. Brett Petersen, lead author of the report and an EIS Officer in CDC’s Rabies Team. “Timely diagnosis by local pathologists can lead to a more rapid and precise response effort, which can help prevent further exposures to rabies."

As noted in the study, the recommendations were developed after CDC officials performed an autopsy on an Indiana man who died of rabies at a hospital in Kentucky. Local pathologists did not perform the autopsy due to concerns about the biosafety risk posed by infectious aerosols at autopsy and potential contamination of autopsy facilities.

"We often hear concerns about the risk of rabies virus exposure to pathologists and others who perform autopsies," said Dr. Petersen. "Following these recommendations can help ensure that the risk remains small and appropriate response efforts are initiated."

In this instance, autopsy specimens allowed for identification of a rabies virus variant associated with bats.  This resulted in recognition of the need to raise public awareness of rabies following exposures to bats and the importance of medical evaluation when such an exposure occurs.

Recommendations for conducting autopsies of humans with confirmed or suspected rabies:

• Use personal protective equipment including an N95 or higher respirator, full face shield, goggles, and gloves, as well as complete body coverage with protective wear
• Employ heavy or chain mail gloves to help prevent cuts or sticks from cutting instruments or bone fragments
• Minimize aerosol generation by using a handsaw (rather than an oscillating saw) and avoiding contact of the saw with brain tissue while removing the calvarium
• Limit participation to only those directly involved in the procedure and collection of specimens
• Use ample amounts of a 10 percent sodium hypochlorite solution during and after the procedure to ensure decontamination of all exposed surfaces and equipment
• Previous vaccination against rabies is not required for persons performing such autopsies. Post-exposure prophylaxis (PEP) of autopsy personnel is recommended only if contamination of a wound or mucous membrane with patient saliva or other potentially infectious material, such as neural tissue, occurs during the procedure

Rabies is a viral disease that is almost always fatal once symptoms appear. Each year in the United States, up to 40,000 persons receive PEP due to a rabies exposure. Worldwide, rabies results in an estimated 55,000 annual deaths - approximately 1 death every 10 minutes.

For more information on the study, Human Rabies — Kentucky/Indiana, 2009, visit www.cdc.gov/mmwr. For more information on rabies, visit www.cdc.gov/rabies.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES