Rabies exposure in international travellers: Experience from a single travel clinic in Paris, France, 2018-2022

Abstract

Background: Rabies is a vaccine-preventable zoonotic disease which causes thousands of deaths every year, mainly in Asia and Africa, and dogs are the main source of human cases. Although rabies is rare in international travellers, rabies exposure is relatively frequent and the number of travellers seeking post-exposure treatment may rise as international travel continues to increase. We aimed to better understand the characteristics of travellers exposed to rabies abroad, in order to deliver targeted advice and rabies vaccination during pre-travel clinics.

Methods: During 2018-2022, we studied all returning travellers who attended a single travel clinic in Paris, France, for animal exposures abroad and requiring rabies post-exposure prophylaxis (n = 2916).

Results: During the study period, 2916 returning travellers were included, and 59.7 % of exposures occurred in Southeast Asia (mainly Thailand and Indonesia) and North-Africa. Dogs were predominantly responsible for exposures, but the animals involved varied significantly according to the region visited and the age of the traveller. Monkey exposures were more frequently reported in Asia, and cat exposures in North Africa and among children. Exposures were reported as unprovoked in 22.9 % of cases, and 91 % of travellers had not received anti-rabies vaccines before travelling.

Conclusions: Travellers to rabies endemic countries should benefit from more targeted information based on the region visited, the animals they are likely to encounter, and the age of the travellers. Critically, they should be counselled on the importance of avoiding contact with animals, the long-lasting benefit of pre-travel rabies vaccination, and the need for adequate post-exposure prophylaxis.

Keywords: Animal bite; Post-exposure prophylaxis; Rabies exposure; Rabies immunoglobulin; Travel medicine.