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Rabies in Travelers

  • Tropical, Travel and Emerging Infections (L Chen, Section Editor)
  • Published:
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Abstract

Most cases of rabies in travelers are associated with dog bites and occur in adults who are commonly migrants. The incidence of injuries to travelers caused by potentially rabid animals is approximately 0.4 % per month of stay. Dogs account for 51 % of cases, but nonhuman primates are the leading animals responsible for injuries in travelers returning from Southeast Asia. Travel to Southeast Asia, India and North Africa, young age, and traveling for tourism are risk factors for potential exposure. More than 70 % of travelers are not immunized prior to departing and do not receive adequate care when injured. The intradermal vaccination route has been proven economical, safe and immunogenic in travelers. The immunity provided by the three-dose series is long-lasting and should be considered an investment for future travel. Abbreviated schedules may be used for last-minute travelers.

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References

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  1. World Health Organization. Rabies vaccines. WHO Expert Consultation on Rabies. Second report. WHO Technical Report Series. Geneva: World Health Organization; 2013.

  2. Wunner WH, Briggs DJ. Rabies in the 21 century. PLoS Negl Trop Dis. 2010;4(3):e591.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  3. Freedman DO, Weld LH, Kozarsky PE, et al. Spectrum of disease and relation to place of exposure among ill returned travelers. N Engl J Med. 2006;354:119–30.

    Article  PubMed  CAS  Google Scholar 

  4. Leder K, Torresi J, Libman MD, et al. GeoSentinel surveillance of illness in returned travelers, 2007-2011. Ann Intern Med. 2013;158:456–68.

    Article  PubMed  Google Scholar 

  5. Malerczyk C, Detora L, Gniel D. Imported human rabies cases in Europe, the United States, and Japan, 1990 to 2010. J Travel Med. 2011;18:402–7.

    Article  PubMed  Google Scholar 

  6. Carrara P, Parola P, Brouqui P, Gautret P. Imported human rabies cases worldwide, 1990–2012. PLoS Negl Trop Dis. 2013;7:e2209. This paper describes 60 cases of rabies in travelers, highlighting potential problems in the diagnosis and management of patients.

    Article  PubMed Central  PubMed  Google Scholar 

  7. International Society for Infectious Diseases. ProMED-mail. Rabies - Taiwan: ex Philippines. Archive Number: 20130515.1715913. Published date: 15 May 2013. http://www.promedmail.org. Accessed 15 Jan 2014

  8. International Society for Infectious Diseases. ProMED-mail. Rabies - USA (11): (Texas) ex Guatemala, human. Archive Number: 20130616.1775355. 16 Jun 2013. http://www.promedmail.org. Accessed 15 Jan 2014

  9. International Society for Infectious Diseases. ProMED-mail. Rabies - Netherlands: ex Haiti, canine, human. Archive Number: 20130625.1791201. 25 Jun 2013. http://www.promedmail.org. Accessed 15 Jan 2014

  10. Dacheux L, Wacharapluesadee S, Hemachudha T, et al. More accurate insight into the incidence of human rabies in developing countries through validated laboratory techniques. PLoS Negl Trop Dis. 2010;4:e765.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Rossi IA, Genton B. The reliability of pre-travel history to decide on appropriate counseling and vaccinations: a prospective study. J Travel Med. 2012;19:284–8.

    Article  PubMed  Google Scholar 

  12. Lankau EW, Montgomery JM, Tack DM, et al. Exposure of US travelers to rabid zebra, Kenya, 2011. Emerg Infect Dis. 2012;18:1202–4.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Gautret P, Parola P. Rabies vaccination for international travelers. Vaccine. 2012;30:126–33. This paper present a meta-analysis of more than 1 270 000 travelers injured by potentially rabid-animals.

  14. Gautret P, Schwartz E, Shaw M, et al. Animal-associated injuries and related diseases among returned travellers: a review of the GeoSentinel Surveillance Network. Vaccine. 2007;25:2656–63.

    Article  PubMed  Google Scholar 

  15. Gautret P, Shaw M, Gazin P, et al. Rabies postexposure prophylaxis in returned injured travelers from France, Australia, and New Zealand: a retrospective study. J Travel Med. 2008;15:25–30.

    Article  PubMed  Google Scholar 

  16. Gautret P, Lim PL, Shaw M, Leder K. Rabies post-exposure prophylaxis in travellers returning from Bali, Indonesia, November 2008 to March 2010. Clin Microbiol Infect. 2011;17:445–7.

    Article  PubMed  CAS  Google Scholar 

  17. Mills DJ, Lau CL, Weinstein P. Animal bites and rabies exposure in Australian travellers. Med J Aust. 2011;195:673–5.

    Article  PubMed  Google Scholar 

  18. Carroll HJ, McCall BJ, Christiansen JC. Surveillance of potential rabies exposure in Australian travellers returning to South East Queensland. Commun Dis Intell Q Rep. 2012;36:E186–7.

    PubMed  Google Scholar 

  19. Gautret P, Adehossi E, Soula G, et al. Rabies exposure in international travelers: do we miss the target? Int J Infect Dis. 2010;14:e243–6.

    Article  PubMed  Google Scholar 

  20. Boggild AK, Costiniuk C, Kain KC, Pandey P. Environmental hazards in Nepal: altitude illness, environmental exposures, injuries, and bites in travelers and expatriates. J Travel Med. 2007;14:361–8.

    Article  PubMed  Google Scholar 

  21. Pandey P, Shlim DR, Cave W, Springer MF. Risk of possible exposure to rabies among tourists and foreign residents in Nepal. J Travel Med. 2002;9:127–31.

    Article  PubMed  Google Scholar 

  22. Menachem M, Grupper M, Paz A, Potasman I. Assessment of rabies exposure risk among Israeli travelers. Travel Med Infect Dis. 2008;6:12–6.

    Article  PubMed  Google Scholar 

  23. Piyaphanee W, Shantavasinkul P, Phumratanaprapin W, et al. Rabies exposure risk among foreign backpackers in Southeast Asia. Am J Trop Med Hyg. 2010;82:1168–71.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Piyaphanee W, Kittitrakul C, Lawpoolsri S, et al. Risk of potentially rabid animal exposure among foreign travelers in Southeast Asia. PLoS Negl Trop Dis. 2012;6:e1852.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Meslin FX. Rabies as a traveler's risk, especially in high-endemicity areas. J Travel Med. 2005;12 Suppl 1:S30–40.

    PubMed  Google Scholar 

  26. Blanton JD, Rupprecht CE. Travel vaccination for rabies. Expert Rev Vaccines. 2008;7:613–20.

    Article  PubMed  Google Scholar 

  27. Altmann M, Parola P, Delmont J, Brouqui P, Gautret P. Knowledge, attitudes, and practices of French travelers from Marseille regarding rabies risk and prevention. J Travel Med. 2009;16:107–11.

    Article  PubMed  Google Scholar 

  28. Gautret P, Tantawichien T, Vu Hai V, Piyaphanee W. Determinants of pre-exposure rabies vaccination among foreign backpackers in Bangkok, Thailand. Vaccine. 2011;29:3931–4.

    Article  PubMed  Google Scholar 

  29. Gautret P, Parola P. Rabies pretravel vaccination. Curr Opin Infect Dis. 2012;25:500–6.

    Article  PubMed  Google Scholar 

  30. Shaw MT, O'Brien B, Leggat PA. Rabies postexposure management of travelers presenting to travel health clinics in Auckland and Hamilton, New Zealand. J Travel Med. 2009;16:13–7.

    Article  PubMed  Google Scholar 

  31. Wijaya L, Ford L, Lalloo D. Rabies postexposure prophylaxis in a UK travel clinic: ten years' experience. J Travel Med. 2011;18:257–61.

    Article  PubMed  Google Scholar 

  32. Sibunruang S, Tepsumethanon S, Raksakhet N, Tantawichien T. Rabies immunization of travelers in a canine rabies endemic area. J Travel Med. 2013;20:159–64.

    Article  PubMed  Google Scholar 

  33. Hemachudha T, Ugolini G, Wacharapluesadee S, et al. Human rabies: neuropathogenesis, diagnosis, and management. Lancet Neurol. 2013;12:498–513.

    Article  PubMed  Google Scholar 

  34. Jentes ES, Blanton JD, Johnson KJ, et al. The global availability of rabies immune globulin and rabies vaccine in clinics providing direct care to travelers. J Travel Med. 2013;20:148–58.

    Article  PubMed  Google Scholar 

  35. Warrell MJ. Current rabies vaccines and prophylaxis schedules: preventing rabies before and after exposure. Travel Med Infect Dis. 2012;10:1–15. This paper review the existing data about intradermal vaccination against rabies.

  36. Gherardin AW, Scrimgeour DJ, Lau SC, et al. Early rabies antibody response to intramuscular booster in previously intradermally immunized travelers using human diploid cell rabies vaccine. J Travel Med. 2001;8:122–6.

    Article  PubMed  CAS  Google Scholar 

  37. Lau C, Sisson J. The effectiveness of intradermal pre-exposure rabies vaccination in an Australian travel medicine clinic. J Travel Med. 2002;9:285–8.

    Article  PubMed  Google Scholar 

  38. Roukens AH, Vossen AC, van Dissel JT, Visser LG. Reduced dose pre-exposure primary and booster intradermal rabies vaccination with a purified chick embryo cell vaccine (PCECV) is immunogenic and safe in adults. Vaccine. 2008;26:3438–42.

    Article  PubMed  CAS  Google Scholar 

  39. Shaw MM, Leggat PA, Williams ML. Intradermal pre-exposure rabies immunisation in New Zealand. Travel Med Infect Dis. 2006;4:29–33.

    Article  PubMed  Google Scholar 

  40. Lau CL, Hohl N. Immunogenicity of a modified intradermal pre-exposure rabies vaccination schedule using a purified chick embryo cell vaccine: an observational study. Travel Med Infect Dis. 2013;11:427–30.

    Article  PubMed  Google Scholar 

  41. Mills DJ, Lau CL, Fearnley EJ, Weinstein P. The immunogenicity of a modified intradermal pre-exposure rabies vaccination schedule – a case series of 420 travelers. J Travel Med. 2011;18:327–32.

    Article  PubMed  Google Scholar 

  42. Suwansrinon K, Wilde H, Benjavongkulchai M, et al. Survival of neutralizing antibody in previously rabies vaccinated subjects: a prospective study showing long lasting immunity. Vaccine. 2006;24:3878–80.

    Article  PubMed  CAS  Google Scholar 

  43. Brown D, Featherstone JJ, Fooks AR, et al. Intradermal pre-exposure rabies vaccine elicits long lasting immunity. Vaccine. 2008;26:3909–12.

    Article  PubMed  CAS  Google Scholar 

  44. Fayaz A, Simani S, Janani A, et al. Antibody persistence, 32 years after post-exposure prophylaxis with human diploid cell rabies vaccine (HDCV). Vaccine. 2011;29:3742–5.

    Article  PubMed  Google Scholar 

  45. Strady A, Lang J, Lienard M, et al. Antibody persistence following preexposure regimens of cell-culture rabies vaccines: 10-year follow-up and proposal for a new booster policy. J Infect Dis. 1998;177:1290–5.

    Article  PubMed  CAS  Google Scholar 

  46. World Health Organization. The immunological basis for immunization series, module 17: Rabies. Geneva: World Health Organization; 2011.

    Google Scholar 

  47. Leder K, Chen LH, Wilson ME. Aggregate travel vs. single trip assessment: arguments for cumulative risk analysis. Vaccine. 2012;30:2600–4. This paper highlights the interest of rabies vaccination in travelers who visit rabies endemic countries frequently, given its long-term efficacy.

  48. Wieten RW, Leenstra T, van Thiel PP, et al. Rabies vaccinations: are abbreviated intradermal schedules the future? Clin Infect Dis. 2013;56:414–9. This paper reviews the published literature about abbreviated schedules for rabies pre-exposure vaccination.

  49. Khawplod P, Wilde H, Benjavongkulchai M, et al. Immunogenicity study of abbreviated rabies preexposure vaccination schedules. J Travel Med. 2007;14:173–6.

    Article  PubMed  Google Scholar 

  50. Khawplod P, Jaijaroensup W, Sawangvaree A, et al. One clinic visit for pre-exposure rabies vaccination (a preliminary one year study). Vaccine. 2012;30:2918–20.

    Article  PubMed  Google Scholar 

  51. Lembo T, Attlan M, Bourhy H, et al. Renewed global partnerships and redesigned roadmaps for rabies prevention and control. Vet Med Int. 2011;2011:923149.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Lankau EW, Cohen NJ, Jentes ES, et al. Prevention and control of rabies in an age of global travel: a review of travel- and trade-associated rabies events – United States, 1986-2012. Zoonoses Public Health. 2013. doi:10.1111/zph.12071.

    PubMed  Google Scholar 

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Dr. Gautret and Dr. Parola have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

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Correspondence to Philippe Gautret.

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This article is part of the Topical Collection on Tropical, Travel and Emerging Infections

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Gautret, P., Parola, P. Rabies in Travelers. Curr Infect Dis Rep 16, 394 (2014). https://doi.org/10.1007/s11908-014-0394-0

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  • DOI: https://doi.org/10.1007/s11908-014-0394-0

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