Travel-related potential rabid animal post-exposure consultation at the Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok, Thailand

Abstract

Background: Rabies exposure remains a significant public health concern in South and Southeast Asia. Despite the disease being vaccine-preventable, international travelers remain at risk of rabies infection due to the limited access to vaccines and immunoglobulin. This retrospective review aims to analyze post-exposure rabies consultations at the Thai Travel Clinic providing insights into epidemiology, risk factors, and post-exposure management for international travelers. Methods: A retrospective study included international travelers of all ages who visited the Thai Travel Clinic at the Hospital for Tropical Diseases in Bangkok, Thailand for potential rabid animal post-exposure management between January 1, 2019, and March 31, 2024. Results: Among 306 international travelers, 91.5 % were healthy with no underlying medical conditions. Approximately 30.9 % traveled in Southeast Asia for less than one month, 46.6 % for one to six months, and 20.8 % for over six months. The majority of bites were from dogs (46.3 %), followed by monkeys (23.9 %) and cat (23.5 %). Common exposure locations included streets (40.1 %), followed by islands or beaches (20.5 %). The median time from arrival in Thailand to animal exposure was 30 days, with 14.7 % bitten within the first week. World Health Organization (WHO) category III rabies wounds accounted for 59.8 % (176/294) of cases. Only 47.5 % (144/303) received the first dose of the rabies vaccine on the day of exposure, and 57.9 % (70/121) experienced delays in receiving rabies immunoglobulin. Additionally, two travelers (2/149; 1.3 %) refused rabies immunoglobulin despite it being clinically indicated. Only 35.3 % (108/306) had pre-travel consultations, and 9.5 % (29/306) of all travelers completed rabies pre-exposure vaccination. Conclusions: Over half of the international travelers delayed initiating rabies vaccine or immunoglobulin after potential rabid animal exposure. As rabies is a fatal yet preventable disease, this review underscores the urgent need to raise awareness about the importance of prompt post-exposure management. Strengthening traveler education and advocating for pre-exposure immunization are critical strategies to mitigate risks and improve outcomes.