Risk of rabies exposure among travellers

In recent years, requests for rabies immunoglobulin have increased at Amsterdam's Academic Medical Center's travel clinic. Travellers who received rabies pre-exposure prophylaxis (PrEP) before travel departure have immunological memory that can quickly be activated by timely booster vaccinations after possible exposure to rabies. PrEP alleviates the need for costly and scarcely available rabies immunoglobulin in case of exposure. This study describes which travellers are at risk of rabies exposure and would benefit from PrEP. The secondary aim was to specify which factors influence decision-making on taking PrEP.

We reviewed electronic patient files of travellers attending our clinic for rabies post-exposure prophylaxis between January 2009 and February 2014. Demographic and travel characteristics were compared with a sample of patients who were seen for pre-travel advice at our clinic. To assess which factors had influenced the decision to take PrEP, a questionnaire survey was conducted.

A total of 161 travellers experienced animal-associated injury. Compared with travellers from the pre-travel database, more people travelled to Southeast Asia (49.5% vs. 30.9%, p = 0.035) for comparable time periods (median 21 vs. 21 days, p = 0.083). Transcutaneous injuries (type III) were common (73.9%), most often inflicted by dogs (45%). Only ten travellers (6.2%) had received PrEP. Barriers for PrEP were high costs and a short time interval between consultation and travel departure.

Travellers t o Southeast Asia should particularly be informed about rabies and the possibility of PrEP. Long-term travel was not associated with a higher risk of rabies exposure.