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AFHSB Surveillance Case Definitions
ANIMAL BITES
Includes Mammal Bites Only. Includes Methodology for Determining Rabies Exposure and
Rabies Post-Exposure Prophylaxis
Background
This case definition was developed by the Armed Forces Health Surveillance Branch (AFHSB) for the purpose of epidemiological surveillance of a condition important to military-associated populations.
Clinical Description
Human animal-bite injuries are a relatively common occurrence among members of the U.S. Armed Forces. They represent a significant public health problem because of the associated risk of rabies virus exposure, skin infection, and tissue damage. Most animal bites produce only minor injuries; however, depending on the size and type of biting animal, wounds can range from minimal to life-threatening. Risk of infectious complications increases if animal bites are left untreated or if treatment is delayed.^1 Wound treatment involves vigorous irrigation, exploration for tendon or bone injury and foreign bodies and antibiotic prophylaxis when there is a high risk of infection. Tetanus vaccination is recommended after an animal bite if it has been more than five years since the patient has was immunized. Rabies post- exposure prophylaxis is indicated in all persons who have been possibly exposed to a rabid animal.^2
(^1) Armed Forces Health Surveillance Branch. Animal Bites and Rabies Post-exposure Prophylaxis, Active
and Reserve Components, U.S. Armed Forces, 2011-2018. Medical Surveillance Monthly Report (MSMR). 2019 October; Vol 26(10): 13-20. (^2) Ellis, R, Ellis, C. Dog and Cat Bites. American Family Physician. 2014 Aug 15; Vol 90(4): 239-243.
Available at: https://www.aafp.org/afp/2014/0815/p239.html. Accessed October 2019.
Case Definition and Incidence Rules
For surveillance purposes, a case of “animal bite” is defined as:
One hospitalization or outpatient medical encounter with a case defining diagnosis of animal bite (see ICD9 and ICD10 code lists below) in any diagnostic position.
Incidence rules:
For individuals who meet the case definition:
The incidence date is considered the date of the first hospitalization or outpatient medical encounter that includes a case defining diagnosis of animal bite.
An individual is considered an incident case only once per calendar year.
For individuals with more than one animal bite diagnosis in a calendar year, diagnoses associated with deployments to overseas theaters of operations (Theater Medical Data Store) are prioritized over those from non-deployed settings (Defense Medical Surveillance System)
Exclusions:
None
AFHSB Surveillance Case Definitions
Codes
The following ICD9 and ICD10 codes are included in the case definition:
Condition ICD-10-CM Codes ICD-9-CM Codes
Rodent bites W53.01 (bitten by mouse …) E906.1 (rat bite)
- W53.01X [A,S,D] (initial, subsequent, and sequela encounters)
W53.11 (bitten by rat …)
- W53.11X [A,S,D] (initial, subsequent, and sequela encounters)
W53.21 (bitten by squirrel …) E906.3 (bite of other animal except arthropod)
- W53.21X [A,S,D] (initial, subsequent, and sequela encounters)
W53.81 (bitten by other rodent …)
- W53.81X [A,S,D] (initial, subsequent, and sequela encounters)
- Dog bites W54.0 (bitten by dog …) E906.0 (dog bite)
- W54.0XX [A,S,D] (initial, subsequent, and sequela encounters)
- Other mammal bites
W55.01 (bitten by cat …) E906.3 (above)
(continued on next page)
- W55.01X [A,S,D] (initial, subsequent, and sequela encounters)
W55.11 (bitten by horse …)
- W55.11X [A,S,D] (initial, subsequent, and sequela encounters)
W55.21 (bitten by cow …)
- W55.21X [A,S,D] (initial, subsequent, and sequela encounters)
W55.31 (bitten by other hoof stock …)
- W55.31X [A,S,D] (initial, subsequent, and sequela encounters)
W55.41 (bitten by pig …)
- W55.41X [A,S,D] (initial, subsequent, and sequela encounters)
W55.51 (bitten by raccoon …)
- W55.51X [A,S,D] (initial, subsequent, and sequela encounters)
AFHSB Surveillance Case Definitions
Periodic MSMR reports
Review
Nov 2019 Case definition reviewed and updated by the AFHSB Surveillance Methods and Standards (SMS) working group.
Oct 2019 Case definition developed and reviewed by AFHSC MSMR staff.
Comments
Case Definition for Rabies Exposure: An individual is considered exposed to rabies if they meet the case defining criteria for an animal bite AND they have an associated case defining code for rabies exposure (see ICD9 and ICD10 codes below).
Condition ICD-10-CM Codes ICD-9-CM Codes
- Rabies exposure Z20.3 (contact with and [suspected] exposure to rabies)
V01.5 (contact with or exposure to rabies)
Case Definition for Rabies Post-exposure Prophylaxis (PEP): An individual is considered to have received rabies post-exposure prophylaxis if they meet the case defining criteria for an animal bite AND they have one medical encounter with evidence of rabies vaccination and / or human rabies immune globulin (HRIG) administration within 90 days after the case-defining encounter; or one record of a Reportable Medical Event (RME) of confirmed rabies PEP with a date of onset documented in a reportable medical event report within 90 days after the case-defining encounter.
Evidence of rabies vaccination and/or HRIG administration is indicated by an immunization record containing at least one of following vaccine administered (CVX) codes, Current Procedure Terminology (CPT) codes or ICD9/ICD10 procedure codes.
In addition, evidence of rabies vaccination and/or HRIG administration is indicated if the DRUG- NAME field in the Pharmacy Data Transaction Service (PDTS) or the Theater Medical Data Store (TMDS_MEDS) contains one or more of the terms listed in the table below.
Rabies Vaccination
- CVX codes 01 8 (rabies vaccine, for intramuscular injection) – retired code. Replaced by
CVX 175 or CVX 176.
040 (rabies vaccine, for intradermal injection) – inactive code
090 (rabies vaccine, unspecified formulation) – inactive code, allow reporting of a vaccination when formulation is unknown.
175 (human rabies vaccine from human diploid cell culture)
176 (human rabies vaccine from chicken fibroblast culture)
- CPT codes 90675 (rabies vaccine, intramuscular use)
90676 (rabies vaccine, intradermal use)
AFHSB Surveillance Case Definitions
Pharmacy Data Transaction Service (PDTS)
DRUG_NAME field contains "RABIES VACCINATION," "RABIES VACCINE," or "RABIES VIRUS VACCINE"
Theater Medical Data Store (TMDS_MEDS)
DRUG_NAME field contains "RABIES VACCINATION," "RABIES VACCINE," or "RABIES VIRUS VACCINE"
Immune Globulin Administration
- CVX codes (^0) 34 (rabies immune globulin / RIG)
0 14 (immune globulin, unspecified formulation) – inactive
086 (immune globulin, intramuscular/ IG)
087 (immune globulin, intravenous)
- CPT codes 90375 (rabies immune globulin / RIG, human, for intramuscular and/or
subcutaneous use)
90376 (rabies immune globulin, heat-treated / RIG-HT, human, for intramuscular and/or subcutaneous use)
- ICD9 and ICD codes
ICD10: Z29.14 (encounter for prophylactic rabies immune globulin)
ICD9: Too broad for inclusion
- Pharmacy Data Transaction Service (PDTS)
DRUG_NAME field contains "RABIES IGB," "RABIES IMM GLOB," "RABIES IMMUNE GLOB," "RABIES IMMGLOB," or "RABIES IMMUNE GLOBULIN; or
DRUG_NAME field contains "IMMUNE GLOB" or "GLOBULIN IMMUNE."
- Theater Medical Data Store (TMDS_MEDS)
DRUG_NAME field contains "RABIES IGB," "RABIES IMM GLOB," "RABIES IMMUNE GLOB," "RABIES IMMGLOB," or "RABIES IMMUNE GLOBULIN; or
DRUG_NAME field contains "IMMUNE GLOB" or "GLOBULIN IMMUNE."
