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

• Type of Material: Article
• Authors: Philippe Gautret, Aix Marseille University; Kristina Angelo, Emory University; Hilmir Asgeirsson, Karolinska University Hospital; David G. Lalloo, Liverpool School of Tropical Medicine; Marc Shaw, James Cook University; Eli Schwartz, Sheba Medical Center; Michael Libman, McGill University; Kevin C. Kain, University of Toronto; Watcharapong Piyaphanee, Mahidol University; Holly Murphy, CIWEC Hospital and Travel Medicine Center; Karin Leder, Monash University; Jean Vincelette, University of Montreal; Mogens Jensenius, Oslo University Hospital; Jesse Waggoner, Emory University; Daniel Leung, University of Utah; Sarah Borwein, TravelSafe Medical Centre; Lucille Blumberg, National Institute for Communicable Diseases; Patricia Schlagenhauf, University of Zurich; Elizabeth D. Barnett, Boston University; Davidson H. Hamer, Boston University
• Language: English
• Date: 2018-11-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2018, Public Library of Science. All rights reserved.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pntd.0006951
• Title of Journal or Parent Work: PLoS Neglected Tropical Diseases
• ISSN: 1935-2727
• Volume: 12
• Issue: 11
• Start Page: e0006951
• End Page: e0006951
• Grant/Funding Information: GeoSentinel is supported by a cooperative agreement (U50CK00189) between the CDC and the International Society of Travel Medicine; funding was also received by GeoSentinel from the International Society of Travel Medicine and the Public Health Agency of Canada.; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: EXPOSURE; AUSTRALIA; Parasitology; Life Sciences & Biomedicine; VACCINE; SURVEILLANCE; IMMUNE GLOBULIN; Infectious Diseases; NEW-ZEALAND; GLOBAL AVAILABILITY; CARE; Science & Technology; Tropical Medicine
• Research Categories: Health Sciences, Immunology; Biology, Parasitology

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.