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Title: Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis
Authors: Philippe Gautret
Kristina M. Angelo
Hilmir Asgeirsson
David G. Lalloo
Marc Shaw
Eli Schwartz
Michael Libman
Kevin C. Kain
Watcharapong Piyaphanee
Holly Murphy
Karin Leder
Jean Vincelette
Mogens Jensenius
Jesse Waggoner
Daniel Leung
Sarah Borwein
Lucille Blumberg
Patricia Schlagenhauf
Elizabeth D. Barnett
Davidson H. Hamer
Oslo University Hospital
Aix Marseille Université
National Institute for Communicable Diseases
University of Utah, School of Medicine
Centers for Disease Control and Prevention
Liverpool School of Tropical Medicine
James Cook University, Australia
Monash University
Karolinska University Hospital
Boston University School of Public Health
University of Toronto
Mahidol University
University of Zurich
Centre Hospitalier de L'Universite de Montreal
Boston University School of Medicine
Tel Aviv University, Sackler Faculty of Medicine
McGill University
Emory University School of Medicine
CIWEC Travel Medicine Centre
Central Health Medical Practice
Worldwise Travellers Health Centres of New Zealand
Keywords: Medicine
Issue Date: 1-Nov-2018
Citation: PLoS Neglected Tropical Diseases. Vol.12, No.11 (2018)
Abstract: © 2018, Public Library of Science. All rights reserved. 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.
ISSN: 19352735
Appears in Collections:Scopus 2018

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