[Rabies post-exposure prophylaxis in travelers returning from endemic areas: A retrospective analysis of patients treated at Motol and Homolka University Hospital]

To characterize the demographic and exposure characteristics and management of rabies post-exposure prophylaxis (rPEP) among international travelers, and to identify deficiencies in pre-travel prevention, initial wound management, and subsequent post-exposure care.

A retrospective observational study was conducted at the Department of Infectious Diseases and Travel Medicine, Motol and Homolka University Hospital. The study included patients evaluated between December 2022 and December 2024 following animal-related exposures. Demographic data, exposure characteristics, wound management, and details of rPEP, including rabies vaccination and rabies immunoglobulin (RIG) administration, were anayzed. Exposures were classified according to the World Health Organization (WHO) categories. Data were analyzed using descriptive statistical methods.

A total of 134 patients were included, with a median age of 31 years. Exposures predominantly occurred in Southeast Asia (35.1%) and Western Asia (25.4%), particularly in Türkiye, Thailand, and Indonesia. Dogs were the most frequently implicated animals (46.3%), followed by cats (23.9%) and monkeys (20.9%). Bites accounted for 66.4% of exposures, while 65.7% of cases were classified as WHO category III exposures. Initial wound management was frequently suboptimal; only 54.9% of patients reported immediate wound washing, and 76.1% applied a disinfectant. Preexposure rabies vaccination had been received by only 6.7% of travelers. rPEP was initiated abroad in 62.7% of cases. However, among patients indicated for RIG administration, 77.8% did not receive it. Deviations from recommended rabies vaccination schedules were documented in 38.2% of patients. Wound infections developed in 4.5% of cases.

This study highlights significant gaps in rabies prevention and post-exposure management among international travelers. Low uptake of pre-exposure vaccination, frequent deviations from recommended rPEP protocols, and limited access to RIG in rabies-endemic settings represent major barriers to optimal prevention. These findings underscore the importance of comprehensive pre-travel counseling and broader implementation of pre-exposure rabies vaccination among travelers at increased risk of animal exposure.