Travelers to At-Risk Areas Often Fail to Get Rabies Shot

Emma Hitt, PhD

March 19, 2012

March 19, 2012 (Atlanta, Georgia) — Travelers visiting friends and relatives in areas with a strong indication for rabies vaccine were much more likely to decline a rabies vaccination than those traveling for other reasons, according to data from the US Centers for Disease Control and Prevention (CDC).

Samantha Dolan, from the CDC National Center for Emerging and Zoonotic Infectious Diseases, reported the findings in a poster presentation here at the International Conference on Emerging Infectious Diseases 2012.

Dolan and colleagues sought to characterize rabies vaccinations among travelers visiting rabies-endemic areas for at least 28 days.

Data were derived from 18 clinics participating in the Global TravEpiNet Consortium, a network of travel clinics based in the United States that collects data on pretravel consultations. For the current analysis, data on 13,235 travelers were collected from January 2009 to January 2011.

Of the participants, 406 (3%) received a vaccination at their pretravel consultation, 226 (2%) reported having been previously immunized against rabies, and 12,603 (95%) who were not previously immunized were not vaccinated during the visit.

A total of 1675 travelers who were not previously immunized traveled to a country with a strong recommendation for rabies vaccine and stayed in that country for at least 28 days.

Of those, 832 had itineraries that clinicians determined did not indicate vaccination; of those with itineraries indicating vaccination, 498 declined the vaccination, 145 received it at the visit, and 200 did not receive it for other reasons.

For those who declined vaccination, the most common reason for travel was visiting relatives (18%), and 63% of those were visiting rural areas, where rabies is more likely.

"It did not surprise us to find that around one third of travelers going on trips for longer than 1 month to a country with a strong recommendation declined a rabies vaccination," Dolan told Medscape Medical News. "There are many barriers to the vaccine's administration, including its cost, the time to complete the vaccine series, and a traveler's perception of rabies risk," she said.

"However, it was surprising to find that travelers visiting friends and relatives were approximately 6 times more likely to decline a rabies vaccination, compared with travelers considered to have low potential exposure to rabies."

According to Dolan, clinicians providing pretravel care should ensure that patients receive customized recommendations regarding rabies vaccination based on the traveler's planned activities and trip duration.

"Clinicians should warn travelers about the risk of acquiring rabies abroad, provide information on animal-bite-prevention strategies, educate the patient on what to do if a bite occurs, and discuss purchasing medical evacuation insurance," she said.

Independent commentator Mary J. Warrell, MB BS, from the Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, United Kingdom, noted that these data from American travel clinics confirm reports of rabies preexposure immunization from travelers in Asia and in clinics in Europe.

According to Dr. Warrell, the fact that visitors to friends and relatives are the group least likely to accept pretravel immunization for other diseases explains their low uptake of rabies vaccine. "Travelers, particularly visitors to friends and relatives, children, and anyone who might travel again in future, should be encouraged to have a rabies vaccine," she told Medscape Medical News.

"Although some studies have shown that the risk of exposure increases with duration of travel, other studies indicate early risk," she pointed out. "Hence, the duration of travel is not important when deciding on the need for rabies vaccination."

In addition to the recommendations in the poster presentation, Dr. Warrell said that rabies vaccination should be strongly encouraged if the vaccine or rabies immune globulin might not be available at the destination or if the person might be traveling to a high-risk country in the future.

The study was not commercially funded. The researchers and Dr. Warrell have disclosed no relevant financial relationships.

International Conference on Emerging Infectious Diseases (ICEID) 2012: Board 218. Presented March 13, 2012.

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