Rabies post-exposure prophylaxis started during or after travel: a GeoSentinel analysis

Gautret, Philippe, Angelo, Kristina M., Asgeirsson, Hilmir, Lalloo, David G., Shaw, Marc, Schwartz, Eli, Libman, Michael, Kain, Kevin C., Piyaphanee, Watcharapong, Murphy, Holly, Leder, Karin, Vincelette, Jean, Jensenius, Mogens, Waggoner, Jesse, Leung, Daniel, Borwein, Sarah, Blumberg, Lucille, Schlagenhauf, Patricia, Barnett, Elizabeth D., Hamer, Davidson H., and GeoSentinel Global Surveillance Network, (2018) Rabies post-exposure prophylaxis started during or after travel: a GeoSentinel analysis. PLoS Neglected Tropical Diseases, 12 (11). e0006951.

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Background Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5–20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel.

Methodology/Principal findings We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014–July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12–0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0–1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99–11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5–157.2; P = 0.01), were more likely to receive RIG in the country of exposure.

Conclusions/Significance This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.

Item ID: 56726
Item Type: Article (Research - C1)
ISSN: 1935-2735
Copyright Information: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Additional Information:

Members of the GeoSentinel network: Emilie Javelle, Marseille, France; Natasha Hochberg, Boston, USA; Nicholas Beeching, Liverpool, UK; Cedric Yansouni, Montreal, Canada; Andrea Boggild, Toronto, Canada; Udomsak Silachamroon, Bangkok, Thailand; Prativa Pandey, Kathmandu, Nepal; Joseph Torresi, Melbourne, Australia; Sapha Barkati, Montreal, Canada; Phyllis Kozarsky & Henry Wu, Atlanta, USA; Scott Benson, Salt Lake City, USA; Albie de Frey, Johannesburg, South Africa; Rainer Weber, Zurich, Switzerland; Shuzo Kanagawa & Yasuyuki Kato, Tokyo, Japan; Christophe Rapp & Cecile Ficko, Paris, France; Francois Chappuis, Geneva, Switzerland; Poh-Lian Lim, Singapore; Phi Truong Hoang Phu, Ho Chi Minh City, Vietnam; Yukihiro Yoshimura & Natsuo Tachikawa, Yokohama, Japan; Emmanuel Bottieau & Joannes Clerinx, Antwerp, Belgium; Rogelio Lopez-Velez & Francesca Norman, Madrid, Spain; Hugo Siu & Luis Manuel Valdez, Lima, Peru; Perry van Genderen, Rotterdam, the Netherlands; Jan Hajek, Wayne Ghesquiere, & Yazdan Mirzanejad, Vancouver, Canada; Jean Haulman & David Roesel, Seattle, USA; Carsten Schade Larsen & Christian Wejse, Aarhus, Denmark; William Stauffer & Pat Walker, St. Paul, USA; John Cahill & George McKinley, New York, USA; Johnnie Yates, Honolulu, USA.

Date Deposited: 26 Dec 2018 07:34
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3202 Clinical sciences > 320211 Infectious diseases @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 70%
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