Rabies exposure in international travelers: do we miss the target?

Abstract

We suggest that rabies pre-exposure vaccination should be offered to individuals traveling regularly to North Africa to visit their relatives and who are at high risk of exposure to potentially rabid animal attacks. Pre-travel advice when addressing rabies prevention should consider the specific epidemiology of animal-related injuries in the traveled country, as well as the traveler's characteristics. Travelers should be advised about which species of animal are potentially aggressive in their destination country so that they can more easily avoid risk-contacts.

Report of the First Meeting of the Middle East and Eastern Europe Rabies Expert Bureau, Istanbul, Turkey (June 8-9, 2010)

“…They also noted the need for timely information for people travelling to rabies enzootic areas (i.e., travellers to their regions and/or people from their regions to other enzootic parts of the world). Recent studies showed that most animal-associated injuries requiring PEP in French travellers occur during visits to Thailand and Turkey—countries for which travellers do not usually seek advice since they are not associated with more conventional travel-associated diseases like malaria or yellow fever [20]. The majority of travellers bitten by animals do not receive adequate PEP, or else they experience a substantial delay before receiving it [20–23].…”

Risk for Rabies Importation from North Africa

“…In a recent study conducted among ≈424 international travelers seeking care for animal-associated injuries at the ARMC in Marseille, southern France, most (41.5%) had traveled to North Africa, and most injuries were from dogs and cats. A correlation was found between the country of exposure and the implicated species; in Algeria, the most implicated animals were dogs and in Tunisia, cats ( 32 ). During 2004–2010, among 90 patients exposed in North Africa and seeking care in Marseille, 53 (59%) had traveled for tourism and 35 (39%) had visited friends and relatives; however, 26 (69%) travelers injured in Algeria had visited friends and relatives (Table 5).…”

Rabies pretravel vaccination

“…d French survey (424 cases) [15]. Monkeys were the leading animal responsible for injuries leading to rabies PEP in travelers returning from Southeast Asia, notably from Bali in several recent studies [3,4,15]. Dogs, which are responsible for almost all rabies cases in developing countries, accounted for only 51% of cases in the largest available multicentric survey on animalrelated injuries requiring PEP in travelers; the remaining animals carry a lower risk of rabies transmission [14].…”

“…Tourists are also generally unaware of the danger of importing potentially rabid animals and of the rules governing the movement of pets. All recent studies addressing rabies PEP management in injured travelers [4,15,[36][37][38] indicate that less than 1 in 10 travelers received rabies immunoglobulin (RIG) in the country of injury. This situation imposes heavy social and economic costs and impedes rabies control in Europe [32].…”