Delays in rabies post-exposure prophylaxis abroad.

Area of Science:

• Travel Medicine
• Infectious Disease Prevention
• Public Health

Background:

• Animal-associated injuries (AAIs) pose a rabies risk to travellers.
• World Health Organization (WHO) recommends post-exposure prophylaxis (PEP) within 24 hours of AAI.
• Significant PEP delays (60%) occur, leading to health risks and anxiety.

Purpose of the Study:

• To identify factors contributing to post-exposure prophylaxis (PEP) delays in travellers abroad.
• To analyze the impact of specific treatments like rabies immunoglobulins (RIG) on PEP timelines.
• To understand geographical variations in PEP access and timeliness.

Main Methods:

• Quantitative observational study using Dutch traveller case records (2019-2024).
• Analysis of data from the Eurocross Assistance database.
• Multivariable logistic regression to identify factors associated with PEP delay.

Main Results:

• 59.4% of travellers requiring PEP experienced delays.
• Higher odds of delay were associated with needing RIG and travel to the Americas, Europe, Africa, Eastern Mediterranean, and Western Pacific regions compared to Southeast Asia.
• Conflicting medical advice and treatment unavailability were primary reasons for delay; 7.8% of travellers were repatriated due to lack of RIG.

Conclusions:

• Travellers to Central and South America face the highest risk of PEP delay, often due to issues with RIG availability and conflicting medical advice.
• Destination-specific pre-exposure prophylaxis recommendations are needed.
• Improving PEP timeliness can enhance rabies prevention outcomes for international travellers.