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Hochedez P, Jidar K, Taieb F, Itani O, Benabdelmoumen G, Parize P, Bourhy H, Consigny PH, Poujol P. Rabies exposure in international travellers: Experience from a single travel clinic in Paris, France, 2018-2022. Travel Med Infect Dis 2025; 64:102821. [PMID: 39993516 DOI: 10.1016/j.tmaid.2025.102821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 01/28/2025] [Accepted: 02/17/2025] [Indexed: 02/26/2025]
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.
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Affiliation(s)
- Patrick Hochedez
- Institut Pasteur, Centre médical, Centre antirabique, Paris, France.
| | - Kaoutar Jidar
- Institut Pasteur, Centre médical, Centre antirabique, Paris, France
| | - Fabien Taieb
- Institut Pasteur, Centre médical, Centre antirabique, Paris, France
| | - Oula Itani
- Institut Pasteur, Centre médical, Centre antirabique, Paris, France
| | | | - Perrine Parize
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | - Hervé Bourhy
- Institut Pasteur, Université Paris Cité, Unité Lyssavirus, Epidémiologie et Neuropathologie, WHO Collaborating Centre for Reference and Research on Rabies, F-75015, Paris, France
| | | | - Philippe Poujol
- Institut Pasteur, Centre médical, Centre antirabique, Paris, France
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Patane N, Eades O, Morris J, Mac O, McCaffery K, McGuinness SL. The Deadly Details: How Clear and Complete Are Publicly Available Sources of Human Rabies Information? Trop Med Infect Dis 2025; 10:16. [PMID: 39852667 PMCID: PMC11768519 DOI: 10.3390/tropicalmed10010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 12/22/2024] [Accepted: 12/26/2024] [Indexed: 01/26/2025] Open
Abstract
Human rabies is preventable but almost always fatal once symptoms appear, causing 59,000 global deaths each year. Limited awareness and inconsistent access to post-exposure prophylaxis hinder prevention efforts. To identify gaps and opportunities for improvement in online rabies information, we assessed the readability, understandability, actionability, and completeness of online public rabies resources from government and health agencies in Australia and similar countries, with the aim of identifying gaps and opportunities for improvement. We identified materials via Google and public health agency websites, assessing readability using the Simple Measure of Gobbledygook (SMOG) index and understandability and actionability with the Patient Education Materials Tool for Print materials (PEMAT-P). Completeness was assessed using a framework focused on general and vaccine-specific rabies information. An analysis of 22 resources found a median readability of grade 13 (range: 10-15), with a mean understandability of 66% and mean actionability of 60%; both below recommended thresholds. Mean completeness was 79% for general rabies information and 36% for vaccine-specific information. Visual aids were under-utilised, and critical vaccine-specific information was often lacking. These findings highlight significant barriers in rabies information for the public, with most resources requiring a high literacy level and lacking adequate understandability and actionability. Improving readability, adding visual aids, and enhancing vaccine-related content could improve accessibility and support wider prevention efforts.
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Affiliation(s)
- Natalie Patane
- Infectious Diseases Epidemiology Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.P.); (O.E.)
| | - Owen Eades
- Infectious Diseases Epidemiology Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.P.); (O.E.)
| | - Jennifer Morris
- Independent Consumer Advisor, Melbourne, VIC 3000, Australia
| | - Olivia Mac
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; (O.M.); (K.M.)
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW 2006, Australia; (O.M.); (K.M.)
| | - Sarah L. McGuinness
- Infectious Diseases Epidemiology Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia; (N.P.); (O.E.)
- Department of Infectious Diseases, Alfred Hospital, Melbourne, VIC 3004, Australia
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Arnecke AL, Schwarz S, Lübke-Becker A, Jensen KC, Bahramsoltani M. A Survey on Companion Animal Owners' Perception of Veterinarians' Communication About Zoonoses and Antimicrobial Resistance in Germany. Animals (Basel) 2024; 14:3346. [PMID: 39595398 PMCID: PMC11590884 DOI: 10.3390/ani14223346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/10/2024] [Accepted: 11/19/2024] [Indexed: 11/28/2024] Open
Abstract
The intimate bonds between humans and their pets create favourable conditions that support the mutual transmission of pathogens in either direction. In this context, veterinarians are essential in informing and educating pet owners about health risks linked to zoonotic pathogens and antimicrobial resistance (AMR). To effectively convey this information, veterinarians should have strong communication skills. To gather insights on pet ownership, veterinary consultations, and risk communication, an online questionnaire was used to survey dog and cat owners in Germany. The survey evaluated the frequency and perception of communication concerning zoonotic pathogens and AMR, deriving a communication score. The findings showed that pet owners rated veterinarian communication with a high average score, reflecting a high satisfaction level. The longer pet owners had been clients, the more frequently they received information on zoonoses and AMR, and the better they rated the communication. However, the results also indicated that the amount of information on zoonoses and/or AMR provided by veterinarians was still lower than desired by pet owners. Risk factors, including pathogen detection, vulnerable individuals, owning imported animals, and feeding them raw meat, fish, offal, or uncooked bones, were regularly present. These findings underscore the critical role of risk communication in preventing zoonoses and AMR.
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Affiliation(s)
- Amelie Lisa Arnecke
- Institute of Veterinary Anatomy, School of Veterinary Medicine, Freie Universität Berlin, Koserstraße 20, 14195 Berlin, Germany; (A.L.A.); (M.B.)
- Institute of Veterinary Pathology, Faculty of Veterinary Medicine, Leipzig University, An den Tierkliniken 33, 04103 Leipzig, Germany
| | - Stefan Schwarz
- Institute of Microbiology and Epizootics, School of Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Straße 7, 14163 Berlin, Germany;
- Veterinary Centre for Resistance Research (TZR), School of Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Straße 8, 14163 Berlin, Germany
| | - Antina Lübke-Becker
- Institute of Microbiology and Epizootics, School of Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Straße 7, 14163 Berlin, Germany;
- Veterinary Centre for Resistance Research (TZR), School of Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Straße 8, 14163 Berlin, Germany
| | - Katharina Charlotte Jensen
- Institute for Veterinary Epidemiology and Biostatistics, School of Veterinary Medicine, Freie Universität Berlin, Königsweg 67, 14163 Berlin, Germany;
| | - Mahtab Bahramsoltani
- Institute of Veterinary Anatomy, School of Veterinary Medicine, Freie Universität Berlin, Koserstraße 20, 14195 Berlin, Germany; (A.L.A.); (M.B.)
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Braunstein M, Wörnle M. Rabies post-exposure prophylaxis in the emergency department: A monocentric retrospective observational study. Travel Med Infect Dis 2024; 61:102750. [PMID: 39122225 DOI: 10.1016/j.tmaid.2024.102750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Emergency departments (ED) are frequently visited after suspected rabies exposure (SRE) and the potential need for rabies post-exposure prophylaxis (R-PEP). However, data on the number of visits, patients' demographics, travel history and the medical treatment is still rare. Therefore, the aim of this study was to assess the number of R-PEP and the appropriateness of medical management including wound treatment, vaccination regime and immunoglobulin application following SRE in a university hospital ED. METHOD We conducted a monocentric retrospective observational study on emergency patients treated in the ED of the LMU University Hospital, Ludwig-Maximilians-University Munich, Germany, between June 1st, 2023 and January 31st, 2024. Patients requiring post-exposure prophylaxis due to SRE abroad or in Germany were included. Demographic data, travel history, clinical findings, wound treatment, and R-PEP vaccination regimen were recorded. RESULTS During the observation period of 245 days 43 patients presented to our ED for R-PEP. There was a total of 51 presentation appointments, as 5 patients returned for further treatment. Most patients (27, 52.9 %) presented at the ED on a Saturday, Sunday, or a public holiday. 17 (39.5 %) patients had a category II exposure, and 26 (60.5 %) had a category III exposure. In our ED, there were 28 (55.0 %) active vaccinations and 23 (45.0 %) both active and passive vaccinations. CONCLUSIONS Our data show that patients frequently present for R-PEP in ED. Therefore, there is a high need for education on indication for R-PEP and for implementation of precise R-PEP treatment guidelines in daily clinical practice.
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Affiliation(s)
- Mareen Braunstein
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich, LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany; Emergency Department, LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Wörnle
- Emergency Department, LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
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Overduin LA, Koopman JPR, Prins C, Verbeek-Menken PH, de Pijper CA, Heerink F, van Genderen PJJ, Grobusch MP, Visser LG. Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study. Travel Med Infect Dis 2024; 60:102739. [PMID: 39009201 DOI: 10.1016/j.tmaid.2024.102739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/06/2024] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Travellers visiting rabies-endemic countries are at risk of rabies infection. Assessing travellers' knowledge and risk perception of rabies and risk behaviour during travel can help identify knowledge gaps and improve pre-travel risk education. METHODS Cohort study in Dutch adult travellers, using two surveys: one before travel to assess knowledge and perception of rabies, and one after return to identify risk behaviour during travel. RESULTS The pre-travel and post-travel survey were completed by 301 and 276 participants, respectively. 222 participants had travelled to a high-risk rabies-endemic country. 21.6 % of the participants scored their rabies knowledge as poor. Some participants were unaware cats or bats can transmit rabies (26.6 % and 13.6 %, respectively), or that post-exposure prophylaxis (PEP) is required for certain exposures such as skin abrasions without bleeding or licks on damaged skin (35.5 % and 18.9 %, respectively), while 27.9 % of participants did not know PEP needs to be administered within one day. 115 participants (51.8 %) reported any form of contact with any animal during travel. Two participants reported animal exposure, of which one took adequate PEP measures. Risk factors for animal contact abroad were regularly touching cats or dogs at home or abroad, longer travel duration, having pets during childhood and being an animal lover. CONCLUSIONS Pre-travel rabies risk education currently does not meet travellers' needs, which is reflected in knowledge gaps and engagement in risk behaviour during travel. During pre-travel health advice, avoiding animal contact abroad should be emphasized, and additional education is required about indications for PEP.
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Affiliation(s)
- Lisanne A Overduin
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Jan Pieter R Koopman
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Corine Prins
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Petra H Verbeek-Menken
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | - Cornelis A de Pijper
- Centre for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Fiona Heerink
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Martin P Grobusch
- Centre for Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Leo G Visser
- Leiden University Center for Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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Banović P, Mijatović D, Simin V, Vranješ N, Meletis E, Kostoulas P, Obregon D, Cabezas-Cruz A. Real-world evidence of rabies post-exposure prophylaxis in Serbia: Nation-wide observational study (2017-2019). Travel Med Infect Dis 2024; 58:102697. [PMID: 38369074 DOI: 10.1016/j.tmaid.2024.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/04/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Rabies remains a deadly zoonotic disease, primarily prevalent in Eastern European countries, with a significant global burden in Asia and Africa. Post-exposure prophylaxis (PEP) is critical to prevent clinical rabies. Serbia, a country with a relatively low animal rabies incidence, has been implementing a 4-dose Essen PEP regimen for 13 years. This real-world study aimed to assess the effectiveness of the 4-dose Essen regimen, considering demographic and clinical factors, after WHO Category III exposure. METHOD The study included 601 patients who received the 4-dose Essen PEP and 79 who received an additional 5th dose. RESULTS Age emerged as a critical factor influencing seroconversion rates after the 4-dose regimen, with older individuals exhibiting lower RVNA titers. Logistic regression indicated a 3.18% decrease in seroconversion odds for each added year of age. The Cox proportional hazards mixed model highlighted age-related risks, with age groups 45-60 and 75-92 at the highest risk of non-seroconversion. Human Rabies Immune Globulin (HRIG) administration was associated with lower RVNA values after the 4-dose regimen, suggesting interference with vaccine immunogenicity among people who received larger doses of HRIG. CONCLUSIONS This study provides valuable real-world evidence for rabies PEP in a non-homogeneous population with potential comorbidities. The results underscore the importance of optimizing PEP strategies, particularly in older individuals, and reconsidering HRIG dosing to improve seroconversion rates.
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Affiliation(s)
- Pavle Banović
- Department for Prevention of Rabies and Other Infectious Diseases, Pasteur Institute Novi Sad, Novi Sad 21000, Serbia; Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, Novi Sad 21000, Serbia.
| | - Dragana Mijatović
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Verica Simin
- Department of Microbiology, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Nenad Vranješ
- Department for Research & Monitoring of Rabies & Other Zoonoses, Pasteur Institute Novi Sad, 21000 Novi Sad, Serbia
| | - Eleftherios Meletis
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Polychronis Kostoulas
- Faculty of Public and One Health, School of Health Sciences, University of Thessaly, 24410 Karditsa, Greece
| | - Dasiel Obregon
- School of Environmental Sciences University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - Alejandro Cabezas-Cruz
- ANSES, INRAE, Ecole Nationale Vétérinaire d'Alfort, UMR BIPAR, Laboratoire de Santé Animale, Maisons-Alfort F-94700, France
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Nomoto H, Yamamoto K, Kutsuna S, Asai Y, Kasamatsu Y, Shirano M, Sahara T, Nakamura F, Katsuragi Y, Yamato M, Shinohara K, Sakamoto N, Hase R, Ogawa T, Nagasaka A, Miyata N, Ohmagari N. Evaluation of potential rabies exposure among Japanese international travelers: A retrospective descriptive study. PLoS One 2023; 18:e0287838. [PMID: 37595010 PMCID: PMC10437812 DOI: 10.1371/journal.pone.0287838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 06/14/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Although Japan has been a rabies-free country for >50 years, a few cases have been reported among people traveling abroad. This study aimed to investigate animal exposure among Japanese travelers using the Japanese Registry for Infectious Diseases from Abroad (J-RIDA). METHOD In this retrospective analysis, we examined Japanese overseas travelers with animal exposure, as included the J-RIDA database, reported from October 1, 2017, to October 31, 2019, with a focus on pre-exposure prophylaxis (PrEP) administration and the animals to which the patients were exposed. RESULTS Among the 322 cases included in the analysis, 19 (5.9%) patients received PrEP and 303 did not. The most common purpose of travel was a non-package tour (n = 175, 54.3%). Most trips (n = 213, 66.1%) were to a single country for <2 weeks. Most patients (n = 286, 87.9%) traveled to countries with a rabies risk. The majority of patients with and without PrEP were injured in rabies-risk countries [n = 270 (89.1%) for non-PrEP and n = 16 (84.2%) for PrEP]. Animals associated with injuries included dogs (55.0%), cats (25.5%), and monkeys (15.5%). Most patients were classified as World Health Organization Category II/III for contact with suspected rabid animals (39.5% and 44.1% for categories II and III, respectively) and had exposure within 5 days of travel. Southeast Asia (n = 180, 55.9%) was the most common region in which travelers were exposed to animals. CONCLUSIONS Japanese overseas travelers had contact with animals that could possibly transmit the rabies virus, even on short trips. Promoting pre-travel consultation and increasing awareness of the potential for rabies exposure are important for prevention of rabies among Japanese international travelers.
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Affiliation(s)
- Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yu Kasamatsu
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Michinori Shirano
- Department of Infectious Diseases, Osaka City General Hospital, Osaka, Japan
| | - Toshinori Sahara
- Department of Infectious Diseases, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Fukumi Nakamura
- Department of Infectious Diseases, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Yukiko Katsuragi
- Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center, Osaka, Japan
| | - Masaya Yamato
- Department of General Internal Medicine and Infectious Diseases, Rinku General Medical Center, Osaka, Japan
| | - Koh Shinohara
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto, Japan
- Department of Clinical Laboratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Naoya Sakamoto
- Department of Infectious Diseases, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Ryota Hase
- Department of Infectious Diseases, Japanese Red Cross Narita Hospital, Chiba, Japan
| | - Taku Ogawa
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Atsushi Nagasaka
- Department of Infectious Diseases, Sapporo City General Hospital, Hokkaido, Japan
| | - Nobuyuki Miyata
- Department of Infectious Disease, Yokohama Municipal Citizen’s Hospital, Kanagawa, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
- Department of Infection Control, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Saffar F, Heinemann M, Heitkamp C, Stelzl DR, Ramharter M, Schunk M, Rothe C, Bühler S. Rabies post-exposure prophylaxis of international travellers - Results from two major German travel clinics. Travel Med Infect Dis 2023; 53:102573. [PMID: 37087082 DOI: 10.1016/j.tmaid.2023.102573] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Travel to regions with rabies risk has increased. However, data on adequate rabies post exposure prophylaxis (PEP) abroad is scarce. The aim of this study was to assess the appropriateness of medical management following suspected rabies exposure (SRE) in international travellers. METHOD A cross-sectional questionnaire-based study in returning travellers with reported SRE who sought post-exposure medical care was conducted in two large German travel clinics. RESULTS The 75 included SRE cases had a median age of 34 years (range 26-43) and showed a female predominance (59%, 44/75). Most participants returned from Asia (47%, 34/72). About 28% had received pre-exposure prophylaxis (PrEP, ≥2 vaccine doses) (20/71). In 51% the animal was actively approached (34/67). All patients had category II/III exposure according to the World Health Organization (65% category III, 49/75). With 78% (52/67), most patients cleaned the wound after SRE; 36% (24/67) used water and soap. Only 57% (41/72) of participants sought medical care during their trip. Overall, 45% (33/74) received rabies vaccination abroad which corresponds to 80% out of those who sought healthcare (33/41). CONCLUSIONS Awareness for appropriate first aid and the urgency of seeking timely professional treatment including PEP after an SRE seems to be insufficient in German travellers. Travel practitioners need to educate travellers about rabies risk, prevention measures and the correct behaviour after SRE including adequate wound treatment and seeking immediate medical help for PEP. PrEP should be offered generously especially to travellers with high rabies-exposure risk and those visiting areas with limited healthcare access.
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Affiliation(s)
- Farah Saffar
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Melina Heinemann
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Schunk
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the LMU Munich, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Hygiene and Infectious Diseases, Institute for Hygiene and Environment, Hamburg, Germany; Postgraduate Training for Applied Epidemiology (PAE), Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
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Predictors of possible exposure to rabies in travellers: A case-control study. Travel Med Infect Dis 2022; 47:102316. [DOI: 10.1016/j.tmaid.2022.102316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022]
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Heitkamp C, Stelzl DR, Ramharter M, Bühler S. Rabies exposure in travellers to Asia, the Middle East, Africa, South and Central America-a German Airport study. J Travel Med 2020; 27:5822104. [PMID: 32307548 DOI: 10.1093/jtm/taaa058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rabies causes thousands of deaths worldwide and trips to rabies endemic countries are popular. Travellers are often uncertain whether pre-exposure prophylaxis (PrEP) is advisable since they find it difficult to estimate the exposure risk during travel and the availability of post-exposure prophylaxis in endemic regions. The aim of this study was to determine the potential rabies exposures in travellers and to assess their knowledge on rabies. Secondly, we explored the access to appropriate post-exposure medical care in respective countries. METHODS We conducted a cross-sectional study at Frankfurt Airport. Returning adult travellers arriving from Asia, the Middle East, Africa, South and Central America were invited to participate in this questionnaire-based study while waiting in the baggage claim area. RESULTS Over a one-month recruitment phase in March 2019, we enrolled 3066 travellers; 2929 were included in the analysis. The gender ratio was balanced; the median age was 42 years (range 18-83 years). Participants arrived from Asia (46%), Africa (29%), Central/South America (13%), the Middle East (8%) and the Caribbean (8%). Forty-five per cent sought pretravel advice and 22% received ≥2 injections of rabies PrEP. Travellers with pretravel advice from tropical medicine specialists reached significantly higher knowledge scores than others. We found that potential rabies exposure occurred in 2.0% (57/2915) of travellers with 31% (13/42) of the contacts being unprovoked; 19% (8/42) of the exposed sought medical care and 3/8 were adequately treated before returning to Germany. Risk factors for animal exposure were: male sex, young age, trips to Asia and a long stay abroad (>4 weeks). CONCLUSIONS A total of 2% of returning travellers (n = 2915) experienced a potential rabies exposure during their journey. A majority of the exposed individuals did not seek medical care; those seeking medical care were often treated inadequately. Rabies information must be emphasised during pretravel counselling and PrEP should be offered generously, especially to travellers with high exposure risks.
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Affiliation(s)
- Christian Heitkamp
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Daniel Robert Stelzl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
| | - Silja Bühler
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany
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11
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Hiranrusme T, Piyaphanee W, Kaewkungwal J, Silachamroon U, Leowattana W, Chatapat L, Matsee W. Risk perception of health problems among travelers visiting a travel clinic in Bangkok, Thailand. Trop Dis Travel Med Vaccines 2020; 6:7. [PMID: 32477584 PMCID: PMC7238588 DOI: 10.1186/s40794-020-00108-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Effective pre-travel consultations cannot be achieved only through individual risk assessment and advice on vaccinations and chemoprophylaxis. Travelers' perceptions of the risk of health problems represent another key factor in successful risk communication and co-operation with pre-travel advice. The objective of this study was to determine perception of travel-related health risks among Thais and westerners visiting the Thai Travel Clinic for consultation before visiting developing countries. METHODS A novel pictorial scale questionnaire-based study was conducted with both Thai and western travelers who visited the Thai Travel Clinic for pre-travel consultation. All participants were approached before and after completing the consultation, and were asked about their demographic data and perceptions of travel-related health risk. The perceptions of risk before and after consultation were compared using the McNemar test, and were also compared with the actual estimated risk. RESULTS During May to November 2019, 594 travelers (330 Thais and 264 Westerners) were enrolled and completed the pictorial scale questionnaires. Most Thai travelers visited Africa/South America (63%), and 20% had previously received counseling. Westerners were mostly backpackers (37.5%), traveling for > 30 days (71.6%), while 43.6% had previously received counseling. Overall, the westerners (n = 264) changed their risk perceptions slightly after counseling in contrast with the Thais. The change in perception of most health problems was observed statistically significant (p-value < 0.05) after receiving pre-travel consultation among both groups of travelers. Risk perception among western travelers after consultation compared with estimated actual risk showed accurate risk perception toward most of health problems especially in travelers who had previously received counseling in ones' home countries. CONCLUSIONS Risk perception of health problems plays an important role in successful risk communication and their response to pre-travel advices. Differences in risk perceptions were evident between the two groups. Therefore, this highlight the importance of obtaining pre-travel advice in one's home country before travelling. Raised awareness of the risks should be emphasized during consultations for underestimated health risks, especially for rabid animal exposure and sexually transmitted diseases.
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Affiliation(s)
- Thanyapat Hiranrusme
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Jaranit Kaewkungwal
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Udomsak Silachamroon
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Lapakorn Chatapat
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
| | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Bangkok, 10400 Thailand
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12
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Neevel AMG, Urias E, Claassen E, van de Burgwal LHM. Quantity vs. quality: an assessment of the current pipeline for rabies. Trop Med Int Health 2019; 25:397-407. [PMID: 31872495 DOI: 10.1111/tmi.13367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To gain insight in the potential of the current pipeline for rabies to decrease the burden of disease by evaluating its relevance to high-risk countries. METHODS Rabies-related patent documents and clinical trials were retrieved from Espacenet and the WHO ICTRP, respectively. Data were cleaned, modulated and categorised into a pre-defined set of indicators those were used for (statistical) analyses on the number of patent applications, patent quality and type of stakeholders involved for different geographical areas. RESULTS Analysis of 583 unique patent families applied for in the period 1954-2017 showed a steep growth in the yearly number of patent applications. A significant portion of new patent applications concern Chinese patents with relatively low quality that are filed by a dispersed group of applicants. Excluding these patents, the number of patent applications has been virtually stable over the years. A shift is seen in public stakeholders becoming more prolific as patent applicants. This shift is also reflected in clinical trials; key sponsors of clinical trials include public and private stakeholders originating from high-risk rabies countries. The majority of clinical trials investigate adjustments to existing vaccines that may improve accessibility. CONCLUSION The results show a discrepancy between the quantity and quality of rabies patent applications that reflects national patent regulations rather than real progress in decreasing the burden of disease. This is in contrast to clinical trials, which focus on incremental innovations that are tested in clinical trials but may nevertheless have a potentially strong impact in high-risk countries.
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Affiliation(s)
- Anne M G Neevel
- Athena Institute, VU University, Amsterdam, The Netherlands.,Viroclinics Biosciences, Rotterdam, The Netherlands
| | - Eduardo Urias
- Athena Institute, VU University, Amsterdam, The Netherlands.,UNU-MERIT, Maastricht, The Netherlands.,Elabora Consultoria, São Paulo-SP, Brazil
| | - Eric Claassen
- Athena Institute, VU University, Amsterdam, The Netherlands
| | - Linda H M van de Burgwal
- Athena Institute, VU University, Amsterdam, The Netherlands.,Artemis One Health, Utrecht, The Netherlands
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13
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Pisutsan P, Soonthornworasiri N, Matsee W, Phumratanaprapin W, Punrin S, Leowattana W, Mansanguan C, Leshem E, Piyaphanee W. Incidence of health problems in travelers to Southeast Asia: a prospective cohort study. J Travel Med 2019; 26:taz045. [PMID: 31218345 DOI: 10.1093/jtm/taz045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/14/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND There are few studies of the incidence of health problems among travelers to Southeast Asia. The current study sought to determine the incidence of self-reported health problems among travelers visiting the region. METHODS A prospective questionnaire-based study was conducted among travelers from high-income countries who visited Southeast Asia. Participants were enrolled at time of their pre-travel visit at Mahidol University, Bangkok, Thailand. Travelers were prospectively followed by self-administered questionnaires 2 weeks after arrival, upon return to their home country and 2 weeks after return. RESULTS During January 2018-February 2019, 359 travelers were enrolled in Bangkok, Thailand, and the first questionnaire was administered. Follow-up questionnaires were returned by 191, 96 and 64 participants 2 weeks later, at the end of the trip and 2 weeks after return, respectively. A total of 6094 travel days were included in the final analysis. The incidence of acute diarrhea per month per 1000 travelers was 217 [95% confidence interval (CI), 189-248] episodes; skin problems, 197 (95% CI, 170-227); respiratory symptoms, 133 (95% CI, 111-158); fever, 49 (95% CI, 36-65); and potential rabies exposure, 34 (95% CI, 24-48). The incidence of acute diarrhea episodes per month per 1000 travelers was significantly higher during the first 2 weeks of travel compared with subsequent weeks of travel: 325 (95% CI, 291-362) vs 132 (95% CI, 110-1157) (P < 0.05). The incidence of outpatient visits and hospitalizations per month per 1000 travelers was 49 (95% CI, 36-65) and 5 (95% CI, 2-10), respectively. CONCLUSIONS In this prospective cohort study we observed substantial burden of acute diarrhea and skin and respiratory symptoms among travelers to Southeast Asia. The higher incidence of diarrhea in the first 2 weeks of travel should be further investigated.
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Affiliation(s)
- Phimphan Pisutsan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Wasin Matsee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suda Punrin
- Queen Saovabha Memorial Institute, The Thai Red Cross Society, Bangkok, Thailand
| | - Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Chayasin Mansanguan
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Eyal Leshem
- Sackler School of Medicine, Tel Aviv University, Sheba Medical Center, Ramat Gan, Israel
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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14
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Marano C, Moodley M, Melander E, De Moerlooze L, Nothdurft HD. Perceptions of rabies risk: a survey of travellers and travel clinics from Canada, Germany, Sweden and the UK. J Travel Med 2019; 26:S3-S9. [PMID: 30476212 PMCID: PMC6377182 DOI: 10.1093/jtm/tay062] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extensive global experience shows that rabies pre-exposure prophylaxis (PrEP) through vaccination is effective and well tolerated, yet many travellers opt not to be vaccinated when travelling to rabies-endemic countries. Previous research has identified several factors influencing the choices travellers make to reduce the risk of rabies, including cost, time constraint and perspective on the importance of vaccination. The objectives of this study were to assess travellers' awareness of rabies and advice-seeking attitudes and to evaluate travel clinics practices regarding rabies pre-travel advice. METHODS We surveyed individuals aged 18-65 years residing in the UK, Germany, Canada and Sweden who had travelled to rabies-endemic countries between 2013 and 2016 and defined this as the rabies visit-risk sample. The first 850 respondents from the visit-risk sample who had undertaken pre-defined at-risk activities (e.g. contact with animals during the trip) completed an additional 15-min online questionnaire and were included in the activity-risk subsample. We also interviewed travel clinic personnel using a 25-min online or phone questionnaire. RESULTS The visit-risk sample included 4678 individuals. Many sought pre-travel health information online (33%) or talked to a family doctor (24%). Within the activity-risk subsample, 83% of travellers were aware of at least a few basic facts about rabies, and 84% could identify at least one correct rabies prevention measure; 49% were aware of a rabies vaccine, however, only 8% reported receiving PrEP vaccination within the past 3 years. Among 180 travel clinic respondents, 21% reported recommending PrEP against rabies to all travellers to rabies-endemic countries. Travel clinics estimated that 81% of travellers complete their travel vaccination schedules and reported sending reminders by e-mails (38%), text (38%), phone calls (37%) or by using vaccination cards (37%). CONCLUSIONS These findings suggest that although travellers had frequently heard of rabies, awareness of the risks of this serious infectious disease was relatively low. 5975671594001tay062media15975671594001.
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Affiliation(s)
| | | | | | | | - Hans D Nothdurft
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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15
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Bonny-Noach H. The evolution of Israeli public policy for drug-using backpackers. Isr J Health Policy Res 2018; 7:23. [PMID: 29728124 PMCID: PMC5935993 DOI: 10.1186/s13584-018-0223-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 04/30/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Over the past 20 years, the young-adult backpacking trip has emerged as a significant social phenomenon in Israeli society. This has received attention from scholars specializing in anthropology and tourism research, but only a few analytical studies exist on the drug policy processes and few provide Israeli social and health perspectives. The interaction of policymakers, media, and health deviancy is an important focus of inquiry. This study charts the establishment of a drug policy for Israeli backpackers. It covers the period from the emergence of the problem in the early 1990s until the present. METHODS This study employs content analysis of newspaper articles and official documents, protocols, and reports written by policymakers and professionals. The latter were mostly produced by the Israel Anti-Drug Authority (IADA) and the Special Committee on Drug and Alcohol Abuse (SCDAA) in the Israeli Knesset. These are the two major Israeli agencies responsible for drug policy. RESULTS Three periods in the establishment of backpacker drug policy can be identified. First period - until late 1995: No drug problem was recognized. The subject was not part of the public agenda. Even so, many backpackers were actually taking drugs. Second Period - late 1995 to 2000: The Israeli media started to report intensively on backpacker drug use. The issue then flared up into a significant 'social problem' demanding health and social solutions. In this phase, policymakers capitalized on a window of opportunity, and formulated a policy emphasizing prevention. Third period - from 2001 until the present: A sea change in institutional attitude occurred. In this period, drug-policy emphasis shifted from prevention to therapeutic-treatment approaches. As a result, harm reduction and unique treatment strategies were developed. RECOMMENDATIONS Policymakers should continue to improve health prevention, treatment, and harm reduction resources. It is recommended that the Ministry of Health set up consultation centers at clinics for travelers. These would provide support and assistance to backpackers before, during, and after their trips. The attention that Israel's drug policy for backpackers gives to prevention, treatment, and harm reduction is the first of its kind and unique. It can therefore serve as a model for other countries.
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Affiliation(s)
- Hagit Bonny-Noach
- Department of Criminology, Ariel University and Board member of the Israeli society of Addiction Medicine (ILSAM), Ariel, Israel.
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16
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Lee HS, Thiem VD, Anh DD, Duong TN, Lee M, Grace D, Nguyen-Viet H. Geographical and temporal patterns of rabies post exposure prophylaxis (PEP) incidence in humans in the Mekong River Delta and Southeast Central Coast regions in Vietnam from 2005 to 2015. PLoS One 2018; 13:e0194943. [PMID: 29634746 PMCID: PMC5892892 DOI: 10.1371/journal.pone.0194943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/13/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In Vietnam, rabies has been a notifiable disease for more than 40 years. Over the last five years, on average, more than 350,000 people per year have been bitten by dogs and cats while more than 80 human deaths have been reported yearly. No studies have been conducted to evaluate the geographical and temporal patterns of rabies in humans in Vietnam. Therefore, the main objective of this study was to assess the geographical and temporal distributions of rabies post exposure prophylaxis (PEP) incidence in humans in Vietnam from 2005 to 2015. METHODS Average incidence rabies (AIR) PEP rates for every 3 or 4 years (2005-2008, 2009-2012 and 2013-2015) were calculated to describe the spatial distribution of rabies PEP. Hotspot analysis was implemented to identify patterns of spatial significance using the Getis-Ord Gi statistic. For temporal pattern analysis, two regions [Mekong River Delta (MRD) and Southeast Central Coast (SCC)], with the highest incidence rates, and the seasonal-decomposition procedure based on loess (STL), were compared to assess their temporal patterns of rabies PEP. FINDINGS We found hotspots in southern Vietnam and coldspots in northern Vietnam during the study period. Rabies cases were limited to specific areas. In addition, the hotspot analysis showed that new risk areas were identified in each period which were not observed in incidence rate maps. The seasonal plots showed seasonal patterns with a strong peak in February/July and a minor peak in October/December in the MRD region. However, in the SCC, a small peak was detected at the early part of each year and a strong peak in the middle of each year. CONCLUSION Our findings provide insight into understanding the geographical and seasonal patterns of rabies PEP in Vietnam. This study provides evidence to aid policy makers when making decisions and investing resources. Such information may also be utilized to raise public awareness to prevent rabies exposures and reduce unnecessary PEP.
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Affiliation(s)
- Hu Suk Lee
- International Livestock Research Institute, Hanoi, Vietnam
- * E-mail:
| | - Vu Dinh Thiem
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Dang Duc Anh
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Tran Nhu Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Mihye Lee
- Medical Microbiology Department, The Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Delia Grace
- International Livestock Research Institute, Nairobi, Kenya
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17
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Kong LY, Vincelette J, Laplante G, Duchesne JA, Libman M, Barkati S. Intradermal pre-exposure rabies vaccination in a Canadian travel clinic: 6-year retrospective observational study. CMAJ Open 2018; 6:E168-E175. [PMID: 29636332 PMCID: PMC7869659 DOI: 10.9778/cmajo.20170147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination. METHODS We conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses. RESULTS The proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism. INTERPRETATION The introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.
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Affiliation(s)
- Ling Yuan Kong
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jean Vincelette
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Gaétan Laplante
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jo-Anne Duchesne
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Michael Libman
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Sapha Barkati
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
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18
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Selcuk EB, Kayabas U, Binbasioglu H, Otlu B, Bayindir Y, Bozdogan B, Karatas M. Travel health attitudes among Turkish business travellers to African countries. Travel Med Infect Dis 2016; 14:614-620. [PMID: 27663283 DOI: 10.1016/j.tmaid.2016.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The number of international travellers is increasing worldwide. Although health risks related to international travel are important and generally well-understood, the perception of these risks was unclear among Turkish travellers. We aimed to evaluate the attitudes and health risk awareness of Turkish travellers travelling to African countries. METHOD A survey was performed of Turkish travellers bound for Africa from Istanbul International Ataturk Airport in July 2013. RESULTS A total of 124 travellers were enrolled in the study. Among them, 62.9% had information about their destination but only 11.3% had looked for information on health problems related to travel and their destination. Of all travellers, 53.2% had at least one vaccination before travelling. The most commonly administered vaccine was for typhoid. Among the travellers, 69.3% and 80.6% had "no idea" about yellow fever vaccination and malaria prophylaxis, respectively. A positive correlation was found between a higher level of travellers' education and receiving the recommended vaccination for the destination. CONCLUSIONS Our study revealed significant gaps in the vaccination and chemoprophylaxis uptake of Turkish travellers departing to Africa. An awareness and training program should be developed for travellers, as well as public health workers, to address health risks related to travel.
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Affiliation(s)
- Engin Burak Selcuk
- Department of Family Medicine, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Uner Kayabas
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, 44280, Malatya, Turkey.
| | - Hulisi Binbasioglu
- Department of Tourism and Hotel Management, Inonu University Kale Vocational School, Malatya, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yasar Bayindir
- Department of Infectious Diseases and Clinical Microbiology, Inonu University Faculty of Medicine, 44280, Malatya, Turkey
| | - Bulent Bozdogan
- Department of Medical Microbiology, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Mehmet Karatas
- Department of Medical History and Ethics, Inonu University Faculty of Medicine, Malatya, Turkey
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Mansanguan C, Matsee W, Petchprapakorn P, Kuhakasemsin N, Chinnarat N, Olanwijitwong J, Piyaphanee W. Health problems and health care seeking behavior among adult backpackers while traveling in Thailand. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2016; 2:9. [PMID: 28883953 PMCID: PMC5530955 DOI: 10.1186/s40794-016-0026-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
Background Health problems among travelers in developing countries are not uncommon. Little is known about the occurrence of health problems and their impacts among backpackers in Thailand. The objective of this study was to assess the health problems and the health seeking behavior among adult backpackers who visited Thailand. Methods This was a cross-sectional questionnaire-based study. Data were collected from foreign adult backpackers in Khao San Road, Bangkok. They were asked about their demographic data, health problems (if any), and health-care seeking behavior if they became ill. Results During May to July 2015, 420 backpackers were enrolled in this study. Of these, 51.4 % were male with a median age of 26.4 years. Up to 66.9 % were of European origin, while 17.4 % were North American. Fifty-eight percent sought pre-travel consultation before traveling. In this study, 10.2 % (43/420) of the participants reported at least health problem during travel. Most of them (79.1 %) had single episode of illness. Of this, diarrhea was the most common health problem (30.4 %), followed by abdominal pain (14.3 %), skin problems (8.9 %), respiratory problems (8.9 %), accident-associated injury (7.1 %), and febrile illness (7.1 %). One third of backpackers with health problems spontaneously recovered without any treatment, while nearly a quarter treated themselves with standby medication, and one in five had to buy over the counter medication. Just over 9 % of backpackers with a health problem sought medical care at a hospital. Among travellers with health problems, 72.1 % reported that their health problems did not significantly impact to their trip, while 23.3 % had to delay or postpone their trip for at least 1 day, and 4.7 % had to cancel some trip and/or activity. Longer duration of stay was significantly related to higher occurrence of health problems while traveling. Conclusions Approximately 10 % of adult backpackers experienced some health problems during their trip in Thailand. Although most of their health problems were mild, up to 22 % of backpackers with health problems need to seek medical care either in a clinic or in a hospital.
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Affiliation(s)
- Chayasin Mansanguan
- Department of Clinical Tropical Medicine, Travel Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wasin Matsee
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Peyawadee Petchprapakorn
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nujareenart Kuhakasemsin
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Niracha Chinnarat
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jutarmas Olanwijitwong
- Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Travel Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Christiansen AH, Rodriguez AB, Nielsen J, Cowan SA. Should travellers to rabies-endemic countries be pre-exposure vaccinated? An assessment of post-exposure prophylaxis and pre-exposure prophylaxis given to Danes travelling to rabies-endemic countries 2000-12. J Travel Med 2016; 23:taw022. [PMID: 27147729 DOI: 10.1093/jtm/taw022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since 2000, a steady increase of vaccines used for both rabies Post-exposure prophylaxis (PEP) and rabies Pre-exposure prophylaxis (PrEP) given to Danish travellers was observed. This study aims to evaluate whether the increase of PEP and PrEP was due to increased travelling, increased awareness of the need for PrEP, or more animal bites per travel, leading to more PEP being administered, in order to assess the need for changing the recommendations. We also described in which countries Danish travelers most frequently reported possible exposure to rabies, and evaluated the timeliness of rabies PEP, including rabies immunoglobulin (RIG). METHODS We included all Danes reported to the National Database for Rabies Treatment as having started rabies PEP either abroad or after returning to Denmark, between 2000 and 2012. Data on the yearly number of Danish travelers from 2004 to 2012 to Thailand were collected to calculate the incidence of animal bites at this destination. We also included data on rabies vaccines sold for PrEP or for booster vaccination in Denmark. RESULTS PEP after possible exposure to rabies abroad increased yearly by 8.8 %. Likewise vaccines sold for PrEP increased by 8.2% annually. The number of Danish travelers to Thailand increased by 7.3% per year, resulting in a stable incidence of animal bites per 100,000 travelers. Seventy-five % started PEP in the country of exposure, while only 10 % received RIG. CONCLUSIONS The yearly increase in PEP and PrEP are parallel to the yearly increase in number of travelers, and can thus be explained by the increased rate of traveling, and not by a rise in awareness of rabies risk or more bites per traveler.Even short term travelers should be given the option of including PrEP in their travel immunisation program, as PEP and especially RIG is not always available in rabies-endemic countries.
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Affiliation(s)
- Annette H Christiansen
- Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark
| | - Anna B Rodriguez
- Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark
| | - Jens Nielsen
- Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark
| | - Susan A Cowan
- Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark
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Haditsch M, Klee SR. Xenophilus feline species goes human.-Watch out for neglected zoonotic pathogens when treating animal bites. Travel Med Infect Dis 2015; 13:503-4. [PMID: 26616308 DOI: 10.1016/j.tmaid.2015.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - Silke R Klee
- Robert Koch-Institut, Zentrum für Biologische Gefahren und Spezielle Pathogene (ZBS 2), Germany
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Epidemiological characteristics of human rabies in Henan province in China from 2005 to 2013. J Venom Anim Toxins Incl Trop Dis 2015; 21:34. [PMID: 26336373 PMCID: PMC4557598 DOI: 10.1186/s40409-015-0034-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 08/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Rabies is very common in People’s Republic of China. Henan province, in the central portion of China, is one of the most densely populated provinces in the entire country. With the new rabies epidemic trend noted in northern and western China, it is necessary to investigate the characteristics of human rabies in this area and control the disease. Methods We chose patients in hospital isolation in 18 municipalities in Henan province as the investigation subjects. Data were collected through systematic reporting from these hospitals, whereas a questionnaire was applied to the relatives of patients. Results A total of 1022 rabies cases were reported. The incidence of human rabies in Henan has increased rapidly since 2005, having peaked in 2007, and maintained a high level in the remaining years. The cases were found mainly in rural areas in the south and east of the province. Rabies was often noted in summer and with the highest number in August. Most cases were noted in males and often in farmers. The patients aged between 40 and 60 years accounted for 36.8 % of all the cases. The wound treatment rate (12.2 %) and vaccination rate (2.6 %) of rabies cases after exposure were relatively low, while the rabies immunoglobulin utilization rate was only 2.8 %. Conclusions Rabies epidemic cases at the county level overall were increasing in Henan province during the period of 2005–2013; the epidemic has spread quickly. The data in this study imply that the disease could be better managed by more integrated surveillance across human health and veterinary sectors, improved education and better government policies.
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Jelinek T, Cramer JP, Dieckmann S, Hatz C, Paulke-Korinek M, Alberer M, Reisinger EC, Costantini M, Gniel D, Bosse D, Lattanzi M. Evaluation of rabies immunogenicity and tolerability following a purified chick embryo cell rabies vaccine administered concomitantly with a Japanese encephalitis vaccine. Travel Med Infect Dis 2015; 13:241-50. [PMID: 26005163 DOI: 10.1016/j.tmaid.2015.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/30/2015] [Accepted: 05/03/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND For individuals traveling at short notice to rabies and Japanese encephalitis (JE) endemic countries, concomitant administration of travel vaccines within a short period is often required. METHODS The aim of this study was to determine whether an accelerated (one-week: Days 1-8) pre-exposure rabies (Rabipur(®), Novartis Vaccines) vaccination regimen administered concomitantly with a Japanese encephalitis (JE) vaccination (Ixiaro(®), Valneva) regimen, is non-inferior to the standard (four-week: Days 1, 8, 29) rabies regimen administered alone or concomitantly with the JE vaccine. Healthy adults (18 to ≤ 65 years) were randomized into Rabies + JE-Standard, Rabies + JE-Accelerated, Rabies-Standard and JE-Standard groups. Relative immunogenicity for rabies in each regimen was assessed using the rapid fluorescent focus inhibition test. Safety was evaluated up to and including Day 57. RESULTS Non-inferior immunogenicity for rabies was established between the Rabies + JE-Accelerated group compared to both the Rabies-Standard and Rabies + JE-Standard groups; as well as between the Rabies + JE-Standard regimen and the Rabies-Standard regimen. By Day 57, adequate neutralizing levels were achieved by 97-100% of subjects across all groups. Adverse events (AEs) were comparable for all groups. CONCLUSIONS An accelerated pre-exposure rabies and JE vaccination regimen is non-inferior to the standard four-week rabies regimen and may thus provide a more convenient regimen for individuals traveling to endemic countries at short notice. NCT01662440.
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Affiliation(s)
- Tomas Jelinek
- Berlin Center for Travel and Tropical Medicine, Berlin, Germany
| | - Jakob P Cramer
- Bernhard Nocht Institute for Tropical Medicine, Department of Clinical Research/University Medical Center Hamburg-Eppendorf, Department of Internal Medicine, Section Tropical Medicine, Hamburg, Germany
| | - Sebastian Dieckmann
- Institute of Tropical Medicine and International Health, Charité-Universitaetsmedizin Berlin, Germany
| | - Christoph Hatz
- Institute of Social and Preventive Medicine, University of Zürich, Switzerland
| | - Maria Paulke-Korinek
- Institute of Specific Prophylaxis and Tropical Medicine, Medical University Vienna, Austria
| | - Martin Alberer
- Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany
| | - Emil C Reisinger
- Department of Tropical Medicine and Infectious Diseases, University of Rostock Medical School, Rostock, Germany
| | - Marco Costantini
- Novartis Vaccines and Diagnostics Srl - a GSK company, Siena, Italy
| | - Dieter Gniel
- Novartis Vaccines and Diagnostics Srl - a GSK company, Marburg, Germany
| | - Dietrich Bosse
- Novartis Vaccines and Diagnostics Srl - a GSK company, Marburg, Germany
| | - Maria Lattanzi
- Novartis Vaccines and Diagnostics Srl - a GSK company, Siena, Italy.
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Gundamaraju R, Vemuri RC, Sau Kuen L, Manikam R, Singla RK, Sekaran SD, Chakrapani R. The science of rabies in tropical regions: From epidemiological pandemonium to prevention. FRONTIERS IN LIFE SCIENCE 2015. [DOI: 10.1080/21553769.2015.1041186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Shaw MTM, Visser J, Edwards C. Rabies postexposure consultations in New Zealand from 1998 to 2012. J Travel Med 2015; 22:31-8. [PMID: 25315202 DOI: 10.1111/jtm.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/21/2014] [Accepted: 07/15/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Rabies is an invariably fatal zoonotic viral disease. New Zealanders going abroad are largely unaware of the risk of contracting the disease. Prevention is the key to controlling the spread of this disease. METHODS Data from 363 individuals presenting to New Zealand travel health clinics between 1998 and 2012 for post-travel consultations on potential rabies exposure were collated retrospectively. The data focused on traveler demographics, the country and nature of exposure, the purpose of travel, and pre-travel rabies awareness. RESULTS The female-to-male ratio of subject travelers presenting was almost equal (1.1 : 1 ratio, respectively); the subjects were typically between 16 and 30 years (44.6%), tourists (64.5%), traveling less than 1 month (55.3%), and likely to have been exposed to animal contact in either Thailand (31.1%), China (13.2%), or Indonesia (12.3%). The animals to which they were exposed were usually dogs (59.5%) or monkeys (28.7%). Most potential exposures were penetrating (69.9%). Injury caused by the animal was more common in the lower limbs (50%) than in the upper limbs (43.4%); 89.4% of exposures were of World Health Organization (WHO) category III. Travelers were more likely to have received pre-travel rabies advice if they had been seen by a travel medicine specialist (96.1%) compared to a general practitioner (GP) (53.3%). Sixteen percent of travelers received rabies preexposure prophylaxis. Of the subjects who were managed following exposure, 79.7% did not receive immunoglobulin when indicated, and 21.5% did not receive any vaccine. Of the travelers that did receive a vaccine, 62.5% did so on the day of exposure. Of the travelers assessed, 16.7% had traveled without insurance. CONCLUSIONS New Zealanders require better guidance in understanding the need for travel-related rabies vaccination, as they are not managed abroad according to WHO guidelines. Few travelers had had pre-travel immunization, and only 20.3% of them had received WHO-advised postexposure management. Thus, 79.7% of the cohort theoretically remained at risk for contracting rabies because of inappropriate management following possible exposure to the disease.
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Affiliation(s)
- Marc T M Shaw
- Worldwise Travellers Health Centres of New Zealand, Auckland, New Zealand; School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia
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Edenborough K, Marsh GA. Reverse genetics: Unlocking the secrets of negative sense RNA viral pathogens. World J Clin Infect Dis 2014; 4:16-26. [DOI: 10.5495/wjcid.v4.i4.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/29/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
Negative-sense RNA viruses comprise several zoonotic pathogens that mutate rapidly and frequently emerge in people including Influenza, Ebola, Rabies, Hendra and Nipah viruses. Acute respiratory distress syndrome, encephalitis and vasculitis are common disease outcomes in people as a result of pathogenic viral infection, and are also associated with high case fatality rates. Viral spread from exposure sites to systemic tissues and organs is mediated by virulence factors, including viral attachment glycoproteins and accessory proteins, and their contribution to infection and disease have been delineated by reverse genetics; a molecular approach that enables researchers to experimentally produce recombinant and reassortant viruses from cloned cDNA. Through reverse genetics we have developed a deeper understanding of virulence factors key to disease causation thereby enabling development of targeted antiviral therapies and well-defined live attenuated vaccines. Despite the value of reverse genetics for virulence factor discovery, classical reverse genetic approaches may not provide sufficient resolution for characterization of heterogeneous viral populations, because current techniques recover clonal virus, representing a consensus sequence. In this review the contribution of reverse genetics to virulence factor characterization is outlined, while the limitation of the technique is discussed with reference to new technologies that may be utilized to improve reverse genetic approaches.
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Tantawichien T, Sibunruang S, Tantawichien T, Angsanakul J, Benjavongkulchai M, Limsuwan K, Udomchaisakul P, Khomvilai S, Sitprija V. Safety and immunogenicity of chromatographically purified Vero cell rabies vaccine for intradermal pre- and post-exposure rabies prophylaxis. Expert Rev Vaccines 2014; 13:1593-601. [DOI: 10.1586/14760584.2014.971764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kashino W, Piyaphanee W, Kittitrakul C, Tangpukdee N, Sibunruang S, Lawpoolsri S, Yamashita H, Muangnoicharoen S, Silachamroon U, Tantawichien T. Incidence of potential rabies exposure among Japanese expatriates and travelers in Thailand. J Travel Med 2014; 21:240-7. [PMID: 24845015 DOI: 10.1111/jtm.12124] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 11/01/2013] [Accepted: 11/12/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rabies has become a forgotten and neglected disease in Japan. In 2006, there was a slight increase in social awareness of rabies when Japan had two reported cases of human rabies, originating in the Philippines. Although the number of Japanese either traveling or living in other Asian countries has been increasing, the exact risk of this population contracting rabies is unknown. Thus, this study utilized a questionnaire to investigate the incidence of rabies exposure, as well as the knowledge, attitude, and practice toward rabies prevention among Japanese expatriates and travelers in Thailand. METHODS Japanese travelers and expatriates were asked questions related to knowledge, attitude, practice toward rabies risk, and experiences of potential rabies exposure such as animal bites, licks, and scratches. Questionnaires were either completed at the Bangkok Suvarnabhumi International Airport and other tourist areas or distributed within Japanese associations in Thailand. RESULTS A total of 1,208 questionnaires from Japanese expatriates and 590 from Japanese travelers were collected and analyzed. We found high incidence rates of potential exposure events among these populations. In particular, Japanese travelers had the highest incidence rate compared to previous studies of international travelers in Thailand. While expatriates' incidence rates of animal bites, licks, and scratches were 1.7, 6.9, and 1.8/1,000 person-months, travelers have much higher incidence rates of 43.1, 136.1, and 33.0/1,000 person-months. Generally, travelers, compared to expatriates, tended to have less accurate knowledge and less often had the pre-exposure prophylaxis vaccination. Moreover, survey answers indicated that 55.0% of expatriates and 88.9% of travelers who were bitten would not seek proper treatment. CONCLUSIONS Since rabies is a preventable disease as long as one has the appropriate knowledge, attitude, and practice, it is essential to promote prevention activities for the Japanese population in Thailand to avert serious consequences of this disease.
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Affiliation(s)
- Wataru Kashino
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
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Piyaphanee W, Kittitrakul C, Lawpoolsri S, Tangkanakul W, Sa-Ngiamsak N, Nasok P, Wongchai S, Ponam T, Wichianprasat P, Phumratanaprapin W. Incidence and spectrum of health problems among travelers to Laos. J Travel Med 2014; 21:163-8. [PMID: 24612354 DOI: 10.1111/jtm.12107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/18/2013] [Accepted: 10/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The number of travelers visiting Laos has more than doubled in the last 5 years. Little is known about their pre-travel preparations and the incidence of health problems during their trips. METHODS At three border posts between Laos and Thailand, travelers were invited to complete a study questionnaire. They were asked about their demographic profile, travel characteristics, pre-travel health preparations, and health problems during their stay in Laos. RESULTS From September 2011 to April 2012, 1,205 questionnaires from Thais and 1,191 from foreigners were collected. Approximately 60% of the travelers were male; the overall median age among the Thais was 43 years, and among the foreigners was 32 years. Most foreign visitors were from Europe (66.8%), followed by other Asian countries (19.0%) and North America (7.1%). Almost half of the foreigners (47.8%) traveled as individual backpackers, whereas the majority of Thais traveled as package tourists. Foreigners were more likely to trek, cycle, and swim during their trips. There were also significant differences in the average length of stay between foreigners (16.1 days) and Thais (3.8 days, p < 0.001). Health problems were reported in 24.9% of foreigners, the most common being diarrhea, cough, animal exposure, and fever. Only 6.1% of Thais reported health problems, the most common being cough and diarrhea. The relative risk adjusted for duration of stay was 1.63 (95% confidence interval: 1.01-2.64). Occurrence of health problems was associated with younger age group, non-Asian nationality, length of stay, and participation in adventurous activities. CONCLUSIONS Health problems are rather frequent among non-Thai travelers in contrast to Thais during their trips to Lao People's Democratic Republic. There were significant differences in terms of risk profile and prevalence of health problems between these two groups.
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Young MK, El Saadi D, McCall BJ. Preventing Australian Bat Lyssavirus: Community Knowledge and Risk Perception of Bats in South East Queensland. Vector Borne Zoonotic Dis 2014; 14:284-90. [DOI: 10.1089/vbz.2013.1414] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan K. Young
- School of Medicine and GHI, Logan Campus, Griffith University, Meadowbrook Queensland, Australia
- Metro North Public Health Unit, Metro North HHS, Meadowbrook, Queensland, Australia
| | - Debra El Saadi
- Communicable Diseases Unit, Queensland Health, Brisbane, Queensland, Australia
| | - Bradley J. McCall
- Metro South Public Health Unit, Metro South HHS, Brisbane, Queensland, Australia
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Stoney RJ, Jentes ES, Sotir MJ, Kozarsky P, Rao SR, LaRocque RC, Ryan ET, the Global TravEpiNet Consortium. Pre-travel preparation of US travelers going abroad to provide humanitarian service, Global TravEpiNet 2009-2011. Am J Trop Med Hyg 2014; 90:553-559. [PMID: 24445203 PMCID: PMC3945703 DOI: 10.4269/ajtmh.13-0479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/23/2013] [Indexed: 11/07/2022] Open
Abstract
We analyzed characteristics of humanitarian service workers (HSWs) seen pre-travel at Global TravEpiNet (GTEN) practices during 2009-2011. Of 23,264 travelers, 3,663 (16%) travelers were classified as HSWs. Among HSWs, 1,269 (35%) travelers were medical workers, 1,298 (35%) travelers were non-medical service workers, and 990 (27%) travelers were missionaries. Median age was 29 years, and 63% of travelers were female. Almost one-half (49%) traveled to 1 of 10 countries; the most frequent destinations were Haiti (14%), Honduras (8%), and Kenya (6%). Over 90% of travelers were vaccinated for or considered immune to hepatitis A, typhoid, and yellow fever. However, for hepatitis B, 292 (29%) of 990 missionaries, 228 (18%) of 1,298 non-medical service workers, and 76 (6%) of 1,269 medical workers were not vaccinated or considered immune. Of HSWs traveling to Haiti during 2010, 5% of travelers did not receive malaria chemoprophylaxis. Coordinated efforts from HSWs, HSW agencies, and clinicians could reduce vaccine coverage gaps and improve use of malaria chemoprophylaxis.
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Affiliation(s)
- Rhett J. Stoney
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford Veteran Affairs Medical Center, Bedford, Massachusetts; Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Dolan SB, Jentes ES, Sotir MJ, Han P, Blanton JD, Rao SR, LaRocque RC, Ryan ET. Pre-exposure rabies vaccination among US international travelers: findings from the global TravEpiNet consortium. Vector Borne Zoonotic Dis 2014; 14:160-7. [PMID: 24359420 PMCID: PMC3928762 DOI: 10.1089/vbz.2013.1381] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND People who travel to areas with high rabies endemicity and have animal contact are at increased risk for rabies exposure. We examined characteristics of international travelers queried regarding rabies vaccination during pretravel consultations at Global TravEpiNet (GTEN) practices during 2009-2010. MATERIAL AND METHODS We performed bivariate and multivariable analyses of data collected from 18 GTEN clinics. Travel destinations were classified by strength level of rabies vaccination recommendation. RESULTS Of 13,235 travelers, 226 (2%) reported previous rabies vaccination, and 406 (3%) received rabies vaccine at the consultation. Common travel purposes for these 406 travelers were leisure (26%), research/education (17%), and nonmedical service work (14%). Excluding the 226 who were previously vaccinated, 8070 (62%) of 13,009 travelers intended to visit one or more countries with a strong recommendation for rabies vaccination; 1675 (21%) of these 8070 intended to travel for 1 month or more. Among these 1675 travelers, 145 (9%) were vaccinated, 498 (30%) declined vaccination, 832 (50%) had itineraries that clinicians determined did not indicate vaccination, and 200 (12%) remained unvaccinated for other reasons. In both bivariate and multivariate analyses, travelers with trip durations >6 months versus 1-3 months (adjusted odds ratio [OR]=4.9 [95% confidence interval [CI] 2.1, 11.4]) and those traveling for "research/education" or to "provide medical care" (adjusted OR=5.1 [95% CI 1.9, 13.7] and 9.5 [95% CI 2.2, 40.8], respectively), compared with leisure travelers, were more likely to receive rabies vaccination. CONCLUSIONS Few travelers at GTEN clinics received rabies vaccine, although many planned trips 1 month long or more to a strong-recommendation country. Clinicians often determined that vaccine was not indicated, and travelers often declined vaccine when it was offered. The decision to vaccinate should take into account the strength of the vaccine recommendation at the destination country, duration of stay, availability of postexposure prophylaxis, potential for exposure to animals, and likelihood of recurrent travel to high-risk destinations.
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Affiliation(s)
- Samantha B. Dolan
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily S. Jentes
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark J. Sotir
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pauline Han
- Travelers' Health Branch, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jesse D. Blanton
- Poxvirus and Rabies Branch, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sowmya R. Rao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
- Center for Health Quality, Outcomes and Economic Research, Bedford VA Medical Center, Bedford, Massachusetts
| | - Regina C. LaRocque
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Edward T. Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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Tack DM, Blanton JD, Holman RC, Longenberger AH, Petersen BW, Rupprecht CE. Evaluation of knowledge, attitudes, and practices of deer owners following identification of a cluster of captive deer with rabies in Pennsylvania in July 2010. J Am Vet Med Assoc 2013; 242:1279-85. [PMID: 23600787 DOI: 10.2460/javma.242.9.1279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate knowledge, attitudes, and practices of deer owners following identification of a cluster of captive deer with rabies as an aid for the development of rabies prevention educational materials. DESIGN Cross-sectional study. POPULATION Captive-deer owners who were members of the pennsylvania deer farmers association. PROCEDURES Information was obtained via a mailed, self-administered questionnaire. RESULTS The questionnaire response rate was 59% (249/425). One hundred three of 206 (50%) respondents had incomplete knowledge of rabies virus vectors, transmission, severity, and prevention measures. Birds or snakes were incorrectly identified as rabies vectors by 96 of 213 (45%) respondents, and most (≥ 94%) respondents identified rabies virus reservoirs as vectors. Ninety of 231 (39%) respondents identified death as an outcome of rabies, and 184 of 235 (78%) respondents would seek emergency treatment if they suspected exposure. Only 62 of 235 (26%) respondents would wash a wound immediately. The majority of respondents (173/239 [72%]) did not know the clinical signs of rabies in deer. Nine respondents indicated that they vaccinated their deer against rabies, and the majority of respondents (158/214 [74%]) would be willing to vaccinate. CONCLUSIONS AND CLINICAL RELEVANCE Findings suggested that deer owners in Pennsylvania have a basic knowledge of rabies; however, knowledge, attitudes, and practices regarding prevention of rabies transmission could be improved considerably. Rabies educational materials for deer owners should focus on postexposure procedures, disease severity, recognition of rabies in deer, and changes in management practices such as vaccination to prevent rabies.
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Affiliation(s)
- Danielle M Tack
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA 30333, USA.
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Dhand NK, Rai BD, Tenzin S, Tsheten K, Ugyen P, Singye K, Ward MP. Community-based study on knowledge, attitudes and perception of rabies in Gelephu, south-central Bhutan. Int Health 2013; 4:210-9. [PMID: 24029402 DOI: 10.1016/j.inhe.2012.03.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Community knowledge, attitudes and practices are important both for prevention of human deaths due to rabies and for control of the disease in animals. This study was a cross-sectional survey investigating the level of community knowledge as well as attitudes and perceptions about rabies in Gelephu, south-central Bhutan, a region endemic for rabies. A total of 615 household respondents were interviewed, of which 224 (36%) were male and 391 (64%) were female. The majority of respondents had a high level of knowledge, attitudes and perception of rabies and had a positive attitude towards the prevention and control of rabies. Multivariate logistic regression modelling showed that better knowledge of rabies was predicted by gender, educational level and dog ownership status of respondents, whilst health-seeking behaviour of animal bite injuries was predicted by dog ownership status, presence of children in the household and occupation of the respondents. The majority of respondents believed that stray dogs are a problem in the community and felt that it was important to control the dog population in Gelephu. These findings also indicate that there exists a knowledge gap about rabies in the community that could be improved by creating an awareness education programme.
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Lankau EW, Cohen NJ, Jentes ES, Adams LE, Bell TR, Blanton JD, Buttke D, Galland GG, Maxted AM, Tack DM, Waterman SH, Rupprecht CE, Marano N. Prevention and control of rabies in an age of global travel: a review of travel- and trade-associated rabies events--United States, 1986-2012. Zoonoses Public Health 2013; 61:305-16. [PMID: 23870674 DOI: 10.1111/zph.12071] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Indexed: 11/28/2022]
Abstract
Rabies prevention and control efforts have been successful in reducing or eliminating virus circulation regionally through vaccination of specific reservoir populations. A notable example of this success is the elimination of canine rabies virus variant from the United States and many other countries. However, increased international travel and trade can pose risks for rapid, long-distance movements of ill or infected persons or animals. Such travel and trade can result in human exposures to rabies virus during travel or transit and could contribute to the re-introduction of canine rabies variant or transmission of other viral variants among animal host populations. We present a review of travel- and trade-associated rabies events that highlight international public health obligations and collaborative opportunities for rabies prevention and control in an age of global travel. Rabies is a fatal disease that warrants proactive coordination among international public health and travel industry partners (such as travel agents, tour companies and airlines) to protect human lives and to prevent the movement of viral variants among host populations.
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Affiliation(s)
- E W Lankau
- Epidemic Intelligence Service, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA; Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), CDC, Atlanta, GA, USA
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Jentes ES, Blanton JD, Johnson KJ, Petersen BW, Lamias MJ, Robertson K, Franka R, Briggs D, Costa P, Lai I, Quarry D, Rupprecht CE, Marano N, Brunette GW. The global availability of rabies immune globulin and rabies vaccine in clinics providing direct care to travelers. J Travel Med 2013; 20:148-58. [PMID: 23577860 DOI: 10.1111/jtm.12024] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/09/2013] [Accepted: 01/11/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rabies, which is globally endemic, poses a risk to international travelers. To improve recommendations for travelers, we assessed the global availability of rabies vaccine (RV) and rabies immune globulin (RIG). METHODS We conducted a 20-question online survey, in English, Spanish, and French, distributed via e-mail to travel medicine providers and other clinicians worldwide from February 1 to March 30, 2011. Results were compiled according to the region. RESULTS Among total respondents, only 190 indicated that they provided traveler postexposure care. Most responses came from North America (38%), Western Europe (19%), Australia and South and West Pacific Islands (11%), East and Southeast Asia (8%), and Southern Africa (6%). Approximately one third of 187 respondents stated that patients presented with wounds from an animal exposure that were seldom or never adequately cleansed. RIG was often or always accessible for 100% (n = 5) of respondents in the Middle East and North Africa; 94% (n = 17) in Australia and South and West Pacific Islands; 20% (n = 1) in Tropical South America; and 56% (n = 5) in Eastern Europe and Northern Asia. Ninety-one percent (n = 158) of all respondents reported that RV was often or always accessible. For all regions, 35% (n = 58) and 26% (n = 43) of respondents felt that the cost was too high for RIG and RV, respectively. CONCLUSION The availability of RV and RIG varied by geographic region. All travelers should be informed that RIG and RV might not be readily available at their destination and that travel health and medical evacuation insurance should be considered prior to departure. Travelers should be educated to avoid animal exposures; to clean all animal bites, licks, and scratches thoroughly with soap and water; and to seek medical care immediately, even if overseas.
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Affiliation(s)
- Emily S Jentes
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
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Sibunruang S, Tepsumethanon S, Raksakhet N, Tantawichien T. Rabies immunization of travelers in a canine rabies endemic area. J Travel Med 2013; 20:159-64. [PMID: 23577861 DOI: 10.1111/jtm.12023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 11/25/2012] [Accepted: 12/20/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Travelers to countries where rabies is endemic may be at risk of rabies exposure. We assessed rabies immunization of travelers attending a travel clinic in Thailand. METHODS The medical charts of international travelers who came for preexposure (PrEP) or postexposure (PEP) rabies prophylaxis at the Queen Saovabha Memorial Institute (QSMI), Bangkok, Thailand between 2001 and 2011 were retrospectively reviewed. RESULTS A total of 782 travelers, including 188 patients who presented with mammal-associated injuries and possible rabies exposures and 594 persons who came requesting PrEP, were studied. Of the travelers who received PEP, only 27 (14.3%) had been previously immunized against rabies and 141 (75.0%) cases experienced high-risk WHO category III exposure. Most of the incidents were unprovoked. Although promptly seeking medical services after the injuries, 114 (60.7%) travelers did not undertake any first-aid care for their wounds. Of these travelers, 19 (10.3%) received intradermal rabies vaccination as they could complete the series here. Rabies immunoglobulin was given to 118 of 121 (97.5%) patients. About one fourth of recipients could accomplish the full schedule at QSMI. Among visitors who requested PrEP, 454 (76.4%) persons had just started their first dose. Among all visitors, 263 (44.3%) were Japanese. The number of Japanese asking for PrEP was higher in 2006, the year when cases of imported human rabies to Japan were reported. This trend has sustained since then. Two (0.3%) travelers were bitten by suspected rabid dogs before they completed their PrEP program. CONCLUSION Rabies prophylaxis is an important decision for each traveler. It should be made before visiting endemic areas.
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Affiliation(s)
- Suda Sibunruang
- Queen Saovabha Memorial Institute (WHO Collaborating Centre for Research on Rabies Pathogenesis and Prevention), The Thai Red Cross Society, Bangkok, Thailand.
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Zimmermann R, Hattendorf J, Blum J, Nüesch R, Hatz C. Risk perception of travelers to tropical and subtropical countries visiting a swiss travel health center. J Travel Med 2013; 20:3-10. [PMID: 23279224 DOI: 10.1111/j.1708-8305.2012.00671.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 07/15/2012] [Accepted: 07/16/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study assessed the risk perception ratings of travelers pre- and post-travel and in comparison to the ratings by travel health experts. While most surveys on travel health knowledge, attitudes, and practices focus on malaria and vaccine-preventable diseases, noninfectious travel risks were included in this study. METHODS Pre- and post-travel perception of nine travel-associated health risks was recorded among 314 travelers to tropical and subtropical destinations. All travelers sought pre-travel health advice at the Travel Clinic of the Swiss Tropical and Public Health Institute in 2008 and 2009. In addition, 18 Swiss travel health experts provided an assessment of the respective risks. A validated visual psychometric measuring instrument was used [pictorial representation of illness and self measure (PRISM)]. RESULTS Travelers and experts rated most risks similarly, except for accidents and sexually transmitted infections (STIs) which experts rated higher. Compared to other risks, accidents ranked highly in both groups and were the only risk perceived higher after travel. Pre- and post-travel perceptions of all other risks were similar with a tendency to be lower after travel. Travelers perceived mosquitoes to be the highest risk before travel and accidents after travel. CONCLUSION Travelers' risk perception appears to be accurate for most risks stated in this study. However, travel health professionals should be aware that some perception patterns among travelers regarding travel-related health risks may be different from professional risk assessment. Important but insufficiently perceived health risks, such as sexual behavior/STIs and accidents, should be considered to be part of any pre-travel health advice package.
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Affiliation(s)
- Rosalie Zimmermann
- Departments of Medicine and Diagnostics, Swiss Tropical and Public Health Institute, Basel, Switzerland.
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Piyaphanee W, Steffen R, Shlim DR, Gherardin T, Chatterjee S. Travel medicine for Asian travelers--do we need new approaches? J Travel Med 2012; 19:335-7. [PMID: 23379702 DOI: 10.1111/j.1708-8305.2012.00661.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Piyaphanee W, Kittitrakul C, Lawpoolsri S, Gautret P, Kashino W, Tangkanakul W, Charoenpong P, Ponam T, Sibunruang S, Phumratanaprapin W, Tantawichien T. Risk of potentially rabid animal exposure among foreign travelers in Southeast Asia. PLoS Negl Trop Dis 2012; 6:e1852. [PMID: 23029598 PMCID: PMC3459869 DOI: 10.1371/journal.pntd.0001852] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022] Open
Abstract
Background Each year millions of travelers visit Southeast Asia where rabies is still prevalent. This study aimed to assess the risk of rabies exposure, i.e., by being bitten or licked by an animal, among travelers in Southeast Asia. The secondary objective was to assess their attitudes and practices related to rabies. Methodology/Principal Findings Foreign travelers departing to the destination outside Southeast Asia were invited to fill out the study questionnaire in the departure hall of Bangkok International Airport. They were asked about their demographic profile, travel characteristics, pre-travel health preparations, their possible exposure and their practices related to rabies during this trip. From June 2010 to February 2011, 7,681 completed questionnaires were collected. Sixty-two percent of the travelers were male, and the median age was 32 years. 34.0% of the participants were from Western/Central Europe, while 32.1% were from East Asia. Up to 59.3% had sought health information before this trip. Travel clinics were the source of information for 23.6% of travelers. Overall, only 11.6% of the participants had completed their rabies pre-exposure prophylaxis, and 15.3% had received only 1–2 shots, while 73.1% had not been vaccinated at all. In this study, the risk of being bitten was 1.11 per 100 travelers per month and the risk of being licked was 3.12 per 100 travelers per month. Among those who were bitten, only 37.1% went to the hospital to get post exposure treatment. Travelers with East Asian nationalities and longer duration of stay were significantly related to higher risk of animal exposure. Reason for travel was not related to the risk of animal exposure. Conclusions Travelers were at risk of being exposed to potentially rabid animals while traveling in Southeast Asia. Many were inadequately informed and unprepared for this life-threatening risk. Rabies prevention advice should be included in every pre-travel visit. Rabies is a fatal disease most commonly transmitted through a bite or a lick of a rabid animal on the broken skin. Most deaths from rabies are reported in Asia and Africa where animal rabies is poorly controlled. Not only local people, but travelers in these areas are inevitably at risk also. In this study we surveyed foreign travelers just before they departed Southeast Asia at Bangkok International Airport. We aimed to determine the risk of possible rabies exposure and their attitudes and practices related to rabies. The risk of being bitten among 7,681 participants studied was 1.11 per 100 travelers per month and the risk of being licked was 3.12 per 100 travelers per month. Among those who were bitten, only 37.1% went to the hospital to get rabies post exposure treatment. Travelers with East Asian nationalities and who stay longer were more likely to be exposed to animals. The risk of animal exposure was not related with the reason for travel. These findings confirm that travelers in Southeast Asia were at real risk of possible exposure to rabies. However, most of them were inadequately informed and unprepared for this life-threatening disease. Rabies prevention advice should be given to all travelers in rabies endemic area.
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Affiliation(s)
- Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Hatz CFR, Kuenzli E, Funk M. Rabies: relevance, prevention, and management in travel medicine. Infect Dis Clin North Am 2012; 26:739-53. [PMID: 22963781 DOI: 10.1016/j.idc.2012.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rabies is a zoonotic viral disease, transmitted only in mammals. Terrestrial rabies, predominantly transmitted by dogs, is the most important rabies cycle threatening humans. The causative neurotropic virus is a negative-stranded RNA virus of the family Rhabdoviridae, genus Lyssavirus. This genus contains several rabies-related viruses. All variants are known or suspected to cause rabieslike diseases. Transmission occurs by the virus entering through the skin or the mucosa after bites, scratches, or preexisting injuries contaminated by the saliva of an infected mammal. Only 51 human rabies cases that have not been transmitted by animal bites are described.
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Leder K, Chen L, Wilson M. Aggregate travel vs. single trip assessment: Arguments for cumulative risk analysis. Vaccine 2012; 30:2600-4. [DOI: 10.1016/j.vaccine.2011.12.133] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/27/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Warrell M. Current rabies vaccines and prophylaxis schedules: Preventing rabies before and after exposure. Travel Med Infect Dis 2012; 10:1-15. [DOI: 10.1016/j.tmaid.2011.12.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
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Gautret P, Parola P. Rabies vaccination for international travelers. Vaccine 2011; 30:126-33. [PMID: 22085557 DOI: 10.1016/j.vaccine.2011.11.007] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/21/2011] [Accepted: 11/01/2011] [Indexed: 12/15/2022]
Abstract
Rabies prevention in travelers is a controversial issue. According to experts, the decision to vaccinate results from an individual risk assessment based on the duration of stay, the likelihood of engagement in at-risk activities, the age of the traveler, the rabies endemicity and access to appropriate medical care in the country of destination. However, no detailed information is available regarding the last two determinants in many regions. Twenty-two cases of rabies were reported in tourists, expatriates and migrant travelers over the last decade, including three cases following short-term travel of no more than two weeks. Studies on rabies post-exposure prophylaxis (PEP) in travelers show that overall, 0.4% (range 0.01-2.3%) of travelers have experienced an at-risk bite per month of stay in a rabies-endemic country, while 31% of expatriates and 12% of tourists were vaccinated against rabies before traveling. The main reason cited by travelers for not being vaccinated is the cost of the vaccine. The majority of patients who sustained a high risk injury was not vaccinated against rabies before traveling and were not properly treated abroad. From available studies, the following risk factors for injuries sustained from potentially rabid animals may be identified: traveling to South-East Asia, India or North Africa, young age, and traveling for tourism. The duration of travel does not appear to be a risk factor. It should be noted that "at-risk activities" have not been addressed in these studies. Detailed rabies distribution maps and information on the availability of rabies biologics are urgently needed in order to identify those travelers who need pre-travel vaccination. Meanwhile, cost-minimization of rabies pre-exposure vaccination may be achieved in several ways, notably by using the intra-dermal method of vaccination.
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Affiliation(s)
- Philippe Gautret
- Institut Hospitalo-Universitaire en Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Marseille, France.
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Malerczyk C, Detora L, Gniel D. Imported human rabies cases in europe, the United States, and Japan, 1990 to 2010. J Travel Med 2011; 18:402-7. [PMID: 22017716 DOI: 10.1111/j.1708-8305.2011.00557.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Burgos-Cáceres S. Canine Rabies: A Looming Threat to Public Health. Animals (Basel) 2011; 1:326-42. [PMID: 26486619 PMCID: PMC4513477 DOI: 10.3390/ani1040326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/13/2011] [Accepted: 09/22/2011] [Indexed: 12/14/2022] Open
Abstract
Rabies is an acute, fatal viral disease that infects domestic and wild animals and is transmissible to humans. Worldwide, rabies kills over 55,000 people every year. The domestic dog plays a pivotal role in rabies transmission. Domestic dogs are not only part of our daily lives but also of our immediate surroundings, and this is reflected in the rise in pet dog ownership in developed and developing countries. This is important given that more frequent exposures and interactions at the animal-human interface increases the likelihood of contracting zoonotic diseases of companion animals. Despite existing vaccines and post-exposure prophylactic treatment, rabies remains a neglected disease that is poorly controlled throughout much of the developing world, particularly Africa and Asia, where most human rabies deaths occur. It is believed that with sustained international commitments, global elimination of rabies from domestic dog populations, the most dangerous vector to humans, is a realistic goal.
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Affiliation(s)
- Sigfrido Burgos-Cáceres
- Food and Agriculture Organization of the United Nations, Viale delle Terme di Caracalla, Building C, Room 506, Rome, 00100, Italy.
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Affiliation(s)
- Bruno B Chomel
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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Gautret P, Tantawichien T, Hai VV, Piyaphanee W. Determinants of pre-exposure rabies vaccination among foreign backpackers in Bangkok, Thailand. Vaccine 2011; 29:3931-4. [DOI: 10.1016/j.vaccine.2011.03.096] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/23/2011] [Accepted: 03/28/2011] [Indexed: 10/18/2022]
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