Philippe GautretKristina M. AngeloHilmir AsgeirssonDavid G. LallooMarc ShawEli SchwartzMichael LibmanKevin C. KainWatcharapong PiyaphaneeHolly MurphyKarin LederJean VinceletteMogens JenseniusJesse WaggonerDaniel LeungSarah BorweinLucille BlumbergPatricia SchlagenhaufElizabeth D. BarnettDavidson H. HamerOslo University HospitalAix Marseille UniversitéNational Institute for Communicable DiseasesUniversity of Utah, School of MedicineCenters for Disease Control and PreventionLiverpool School of Tropical MedicineJames Cook University, AustraliaMonash UniversityKarolinska University HospitalBoston University School of Public HealthUniversity of TorontoMahidol UniversityUniversity of ZurichCentre Hospitalier de L'Universite de MontrealBoston University School of MedicineTel Aviv University, Sackler Faculty of MedicineMcGill UniversityEmory University School of MedicineCIWEC Travel Medicine CentreCentral Health Medical PracticeWorldwise Travellers Health Centres of New Zealand2019-08-232019-08-232018-11-01PLoS Neglected Tropical Diseases. Vol.12, No.11 (2018)19352735193527272-s2.0-85057273821https://repository.li.mahidol.ac.th/handle/20.500.14594/46235© 2018, Public Library of Science. All rights reserved. https://creativecommons.org/publicdomain/zero/1.0/. 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.Mahidol UniversityMedicineArticleSCOPUS10.1371/journal.pntd.0006951