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

Philippe Gautret, Kristina M Angelo, Hilmir Asgeirsson, David G Lalloo, Marc Shaw, Eli Schwartz, Michael Libman, Kevin C Kain, Watcharapong Piyaphanee, Holly Murphy, Karin Leder, Jean Vincelette, Mogens Jensenius, Jesse Waggoner, Daniel Leung, Sarah Borwein, Lucille Blumberg, Patricia Schlagenhauf, Elizabeth D Barnett, Davidson H Hamer, GeoSentinel Global Surveillance Network, Philippe Gautret, Kristina M Angelo, Hilmir Asgeirsson, David G Lalloo, Marc Shaw, Eli Schwartz, Michael Libman, Kevin C Kain, Watcharapong Piyaphanee, Holly Murphy, Karin Leder, Jean Vincelette, Mogens Jensenius, Jesse Waggoner, Daniel Leung, Sarah Borwein, Lucille Blumberg, Patricia Schlagenhauf, Elizabeth D Barnett, Davidson H Hamer, GeoSentinel Global Surveillance Network

Abstract

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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Number of international travelers receiving…
Fig 1. Number of international travelers receiving RPEP reported to GeoSentinel, September 2014–July 2017 (RIG: Rabies immunoglobulin; RPEP: Rabies post-exposure prophylaxis).

References

    1. Gautret P and Parola P. Rabies vaccination for international travelers. Vaccine. 2012. January 5; 30(2):126–33.
    1. Gautret P, Harvey K, Pandey P, Lim PL, Leder K, Piyaphanee W, Shaw M, McDonald SC, Schwartz E, Esposito DH, Parola P; GeoSentinel Surveillance Network. Animal-associated exposure to rabies virus among travelers, 1997–2012. Emerg Infect Dis. 2015. April; 21(4):569–77.
    1. World Health Organization expert consultation on rabies. Second report, World Health Organization, 2013, (982), 1–139.
    1. Gautret P, Shaw M, Gazin P, Soula G, Delmont J, Parola P, Soavi MJ, Brouqui P, Matchett DE, Torresi J. Rabies postexposure prophylaxis in returned injured travelers from France, Australia, and New Zealand: a retrospective study. J Travel Med. 2008. Jan-Feb;15(1):25–30.
    1. Wijaya L, Ford L, Lalloo D. Rabies postexposure prophylaxis in a UK travel clinic: ten years’ experience. J Travel Med. 2011. Jul-Aug; 18(4):257–61.
    1. Shaw MT, Visser J, Edwards C. Rabies postexposure consultations in New Zealand from 1998 to 2012. J Travel Med. 2015. Jan-Feb; 22(1):31–8.
    1. Christiansen AH, Rodriguez AB, Nielsen J, Cowan SA. Should travellers to rabies-endemic countries be pre-exposure vaccinated? An assessment of post-exposure prophylaxis and pre-exposure prophylaxis given to Danes travelling to rabies-endemic countries 2000–12. J Travel Med. 2016. May; 4;23(4).
    1. Gautret P, Lim PL, Shaw M, Leder K. Rabies post-exposure prophylaxis in travellers returning from Bali, Indonesia, November 2008 to March 2010. Clin Microbiol Infect. 2011. March; 17(3):445–7.
    1. Park JH, Lee CH, Won YK, Chin BS, Shin HS, Kim JY. Rabies post-exposure prophylaxis of overseas travelers in the international travel clinic of the national medical center from 2006 to 2012, Korea. Infect Chemother. 2014. March; 46(1):13–20.
    1. Kardamanidis K, Cashman P, Durrheim DN. Travel and non-travel associated rabies post exposure treatment in New South Wales residents, Australia, 2007–2011: a cross-sectional analysis. Travel Med Infect Dis. 2013. Nov-Dec; 11(6):421–6.
    1. Carroll HJ, McCall BJ, Christiansen JC. Surveillance of potential rabies exposure in Australian travellers returning to South East Queensland. Commun Dis Intell Q Rep. 2012. June 30; 36(2):E186–7.
    1. Mills DJ, Lau CL, Weinstein P. Animal bites and rabies exposure in Australian travellers. Med J Aust. 2011. December 19; 195(11–12):673–5.
    1. Harvey K, Esposito DH, Han P, Kozarsky P, Freedman DO, Plier DA, Sotir MJ; Centers for Disease Control and Prevention (CDC). Surveillance for travel-related disease—GeoSentinel Surveillance System, United States, 1997–2011. MMWR Surveill Summ. 2013. July 19; 62:1–23.
    1. Abela-Ridder B, Martin S, Gongal G, Engels D. Rabies vaccine stockpile: fixing the supply chain. Bull World Health Organ. 2016. September; 94(9):635–635A.
    1. Jentes ES, Blanton JD, Johnson KJ, Peterson BW, Lamias MJ, Robertson K, Franka R, Briggs D, Costa P, Lai I, Quarry D, Rupprecht CE, Marano N, Brunette GW. The global availability of rabies immune globulin and rabies vaccine in clinics providing direct care to travelers. J Travel Med. 2013; 20(3):148–58.
    1. Jentes ES, Blanton JD, Johnson KJ, Petersen BW, Lamias MJ, Robertson K, Franka R, Muhm D, Rupprecht CE, Marano N, Brunette GW. The global availability of rabies immune globulin and rabies vaccine in clinics providing indirect care to travelers. J Travel Med. 2014. Jan-Feb;21(1):62–6.
    1. WHO. Rabies vaccines: WHO position paper—April 2018. Wkly Epidemiol Rec. 2018. April 20;93(16):201–220.
    1. Altmann M, Parola P, Delmont J, Brouqui P, Gautret P. Knowledge, attitudes, and practices of French travelers from Marseille regarding rabies risk and prevention. J Travel Med. 2009. Mar-Apr;16(2):107–11.
    1. Walker XJ, Barnett ED, Wilson ME, Macleod WB, Jentes ES, Karchmer AW, Hamer DH, Chen LH; Boston Area Travel Medicine Network (BATMN). Characteristics of travelers to Asia requiring multidose vaccine schedules: Japanese encephalitis and rabies prevention. J Travel Med. 2015. Nov-Dec;22(6):403–9.
    1. Gautret P, Parola P. Rabies in travelers. Curr Infect Dis Rep. 2014. March;16(3):394
    1. Peterson BW, Wallace RM, Shlim DR. Rabies In Yellow Book (pp. 287–296). New York, NY: Oxford University Press; 2018.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel