Animal-Associated Exposure to Rabies Virus among Travelers, 1997–2012
Rabies is a continuing public health concern and causes approximately 60,000 deaths annually, primarily in Asia and Africa. Travelers are at continued risk of rabies exposure when visiting endemic areas; however, the rate of rabies is still low, with an average of 3.7 cases documented annually. Because of the high mortality rate of rabies and high cost of the rabies vaccine, it is essential to identify individuals at increased risk of rabies exposure for prevention counseling and possible preexposure prophylaxis administration. The purpose of this study was to determine which travelers were at highest risk of rabies exposure from 1997 to 2012.
GeoSentinel Surveillance sites are clinics specializing in travel medicine, and they are located in 24 countries in 6 continents. The GeoSentinel database serves as an important public health surveillance tool for rabies and is reviewed by the US Centers for Disease Control and Prevention (CDC). This retrospective study reviewed records from 2697 travelers who received rabies postexposure prophylaxis at GeoSentinel clinics from 1997 to 2012, performing both descriptive epidemiological analysis and establishing temporal trends. Of all travelers receiving rabies postexposure prophylaxis, 74% received care in their country of residence and 25% received care in the destination country. The average age of the exposed traveler was 30 years, and the most common animals responsible for rabies exposure were dogs (60%), non-human primates (24%), cats (10%), and bats (2%). Although the CDC currently recommends the rabies vaccine for long travel periods, the median travel period in this study was only 15 days. The countries with the highest rates of animal exposures in descending order were Thailand, Indonesia, Nepal, and China. There were 3 cases of confirmed rabies within this database that all resulted in death.
This study identified characteristics of travelers and countries at higher risk for rabies exposure and can be used to guide prevention counseling. High-risk traveling features include a young adult (15–44 years old) traveling to rabies-endemic countries and exposure to specific animals responsible for exposures.
(Emerg Infect Dis. 2015;21:569–577) P Gautret, K Harvey, P Pandey, et al.
Prepared by Matthew Stewart, MD, FAWM, University of Utah Emergency Medicine Global Health Fellow, Salt Lake City, UT, USA.