Animal-associated exposure to rabies virus among travelers, 1997-2012

Abstract

Among travelers, rabies cases are rare, but animal bites are relatively common. To determine which travelers are at highest risk for rabies, we studied 2,697 travelers receiving care for animal-related exposures and requiring rabies postexposure prophylaxis at GeoSentinel clinics during 1997-2012. No specific demographic characteristics differentiated these travelers from other travelers seeking medical care, making it challenging to identify travelers who might benefit from reinforced pretravel rabies prevention counseling. Median travel duration was short for these travelers: 15 days for those seeking care after completion of travel and 20 days for those seeking care during travel. This finding contradicts the view that preexposure rabies vaccine recommendations should be partly based on longer travel durations. Over half of exposures occurred in Thailand, Indonesia, Nepal, China, and India. International travelers to rabies-endemic regions, particularly Asia, should be informed about potential rabies exposure and benefits of pretravel vaccination, regardless of demographics or length of stay.

Keywords: GeoSentinel; animal-related exposure; rabies; rabies virus; travel; viruses.

Figure 1

Monthly distribution of animal-related exposure cases requiring rabies postexposure prophylaxis, by exposure species, according to date of initial visit to GeoSentinel clinics, 1997–2012.

Figure 2

Number of patients requiring rabies postexposure prophylaxis for animal-related exposure, by exposure species and by year and line of best fit for proportion of all GeoSentinel records accounted for by animal-related exposure requiring postexposure prophylaxis, 2003–2012. Limited to patients treated at GeoSentinel sites that were active contributors for the entire listed period. NHP, nonhuman primate. *Linear regression was used to calculate a line of best fit of y = 0.0015x + 0.006.