Ireland's Rabies Treatment Service Shutdown Raises Public Health Concerns

In a significant public health concern, the Health Service Executive (HSE) of Ireland announced the cessation of its biological treatment service for rabies, which has left many exposed individuals at risk of inadequate care. This service, previously operated out of Cherry Orchard Hospital in Dublin, was responsible for assessing patients and delivering critical biologics for rabies, diphtheria, and botulism treatments. The closure follows the retirement of the physician who managed the service, effective July 4, 2025.

Colm Henry, Chief Clinical Officer at the HSE, communicated the developments in a letter to regional executive officers and clinical directors, expressing concerns about potential gaps in care during the transition to a new service model. "While this service had never been commissioned as a national service, it had, in effect, provided advice and treatment on management of potentially or actually exposed patients for many years from all over the country," Dr. Henry noted. He emphasized the importance of establishing a new regional service model to ensure that individuals at risk of rabies exposure receive timely and adequate medical care.

Rabies is a viral infection that poses a severe threat, particularly in regions where rabies is endemic. The cessation of the treatment service raises fears that individuals exposed to rabies may "be missed, lost to follow up or inappropriately managed," as highlighted in Dr. Henry's correspondence. He urged regional executives to collaborate with stakeholders to ensure the continuity of care and address the identified risks.

The HSE has indicated that it is working toward implementing a new regional service model that includes proposed roles for emergency departments to assess new cases. However, challenges remain, particularly regarding the provision of services outside regular hours and the management of infectious diseases during weekends and bank holidays.

In a statement, a spokesperson for the HSE acknowledged that the service for rabies exposure had been "formally reorganised on a regional footprint to better meet the needs of local populations." The spokesperson assured the public that a working group would be established to mitigate risks associated with the disruption of this long-standing service.

Rabies is predominantly found in regions with high rabies prevalence among animals, notably in parts of Africa and Asia. Individuals traveling to these areas must seek immediate medical advice if they encounter potentially infected animals. The HSE's decision to discontinue the rabies treatment service could exacerbate this risk, as timely intervention is critical in preventing the onset of rabies once exposure occurs.

In addition to rabies, the service also addressed cases of diphtheria and botulism, both of which can have serious health implications. The last documented case of diphtheria in Ireland was in 2016, and there has been a notable rise in botulism cases in England recently, indicating a growing concern about these infectious diseases.

Experts have weighed in on the implications of the service's closure. Dr. Sarah Johnson, Professor of Public Health at Trinity College Dublin, stated, "The discontinuation of this service could lead to severe public health repercussions, especially for vulnerable populations who may not receive the necessary post-exposure treatment for rabies. It is imperative that the HSE acts swiftly to establish a reliable replacement service."

Similarly, Dr. Michael Smith, an epidemiologist at the University of Galway, warned of the potential consequences. "Rabies is a preventable disease, but once symptoms appear, it is almost always fatal. The HSE must prioritize the re-establishment of this service to protect public health and ensure timely treatment for those at risk."

As of now, the HSE's plans for a new service model remain in the discussion phase, and stakeholders across the health sector are urged to collaborate effectively to ensure that there are no further disruptions to care. The implications of this service closure extend beyond immediate health concerns, highlighting broader issues related to healthcare accessibility and public health preparedness in Ireland.

As discussions continue, the urgency of addressing these gaps becomes increasingly apparent, underscoring the need for robust health infrastructure to handle infectious disease threats effectively. The future of rabies treatment in Ireland hangs in the balance, awaiting decisive action from health authorities to safeguard the well-being of its citizens.