Rabies postexposure prophylaxis in international travellers: Results from a Spanish travellers referral unit

Abstract

BackgroundRabies represents a major public health issue for travellers because pretravel preexposure (PrEP) rabies vaccination is not routinely indicated. For those unvaccinated, adequate postexposure prophylaxis (PEP), including rabies immunoglobulin (RIG) if needed, is the only effective method to prevent this fatal disease. MethodsDescriptive retrospective study at a National Referral Unit for Tropical and Travel Medicine in Madrid, Spain, among travellers treated with PEP for rabies (January 2012–December 2017). Demographic, clinical and management data were reviewed. Results168 patients were treated for possible rabies exposure (53% females, median age 35 years; IQR: 31–42). Southeast Asia accounted for more than half of the cases (N=86, 57.3%; CI 95% 49–65%). Dogs were the primary animal involved (n=67, 44.9%; CI 37–53%). After the bite, in half of the cases (n=88, 52.4%; CI 44–60%) PEP rabies vaccine was started abroad, and the vaccine plus RIG in about 10% (n=22, 13.1%; CI: 8–19%). Most of patients classified as category III did not received RIG at all (n=88, 69.3% CI: 60–77%). ConclusionsAlthough indicated, most travellers did not receive RIG abroad, nor appropriate first doses of PEP. Clinicians should be aware of the importance of appropriate PrEP in selected individuals.