Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis

Gautret, Philippe, Angelo, Kristina, Asgeirsson, Hilmir, Lalloo, David ORCID: https://orcid.org/0000-0001-7680-2200, shaw, marc, Schwartz, Eli, Libman, Michael, Kain, Kevin, Watcharapong, P, Murphy, H, Leder, Karin, Vincelette, Jean, Jensenius, Mogens, Waggoner, J, Leung, D, Borwein, Sarah, Blumberg, Lucille, Schlagenhauf, P, Barnett, E and Hamer, Davidson (2018) 'Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis'. PLoS Neglected Tropical Diseases, Vol 12, Issue 11, e0006951.

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Abstract

Background
Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5–20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel.

Methodology/Principal findings
We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014–July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12–0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0–1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99–11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5–157.2; P = 0.01), were more likely to receive RIG in the country of exposure.

Conclusions/Significance
This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.

Item Type:	Article
Subjects:	WA Public Health > WA 20.5 Research (General) WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 550 Rabies
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pntd.0006951
Depositing User:	Stacy Murtagh
Date Deposited:	26 Nov 2018 12:21
Last Modified:	29 Nov 2018 10:29
URI:	https://archive.lstmed.ac.uk/id/eprint/9671

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