Incomplete rabies post-exposure prophylaxis in international travelers: an analysis of incidence and risk factors

Abstract

Background Rabies remains a global public health issue, particularly in Southeast Asia. However, completing the full post-exposure prophylaxis (PEP) regimen is often challenging. Research focusing on international travelers is lacking. This study aimed to determine the barriers to timely and complete traveler rabies PEP. Methods This was a prospective, single-center, multi-site observational study conducted in Thailand. Data were collected from international travelers seeking rabies PEP following exposure to animals during July 2025 - March 2026. Data collection occurred in two phases: at the study site visit, and via an online follow-up questionnaire administered at the final PEP dose clinic visit. Univariate and multiple logistic regression were used to identify independent predictors. Results 141 participants were enrolled and 94 participants responded to the online follow-up and were included in the final analysis. The incidence of incomplete rabies PEP was 4.3%. Practice after exposure remains challenging due to difference in management between physicians. Regimen modifications occurred in 14.3% of cases who received initial treatment from other healthcare facilities. Furthermore, 47.9% of participants experienced a delay during their PEP course. Tourism was the independent factor associated with treatment delay (AOR: 5.9; 95%CI: (1.2-27.9); p = 0.025). Conclusion Incomplete and delayed rabies PEP is a significant issue among travelers. Discrepancies in wound categorization and management among physicians in different healthcare facilities may confuse patients and complicate management. There is an urgent need for international harmonization of PEP protocols and enhanced pre-travel counseling to promote awareness of rabies and the importance of strict adherence to vaccination schedules.