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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 Apr; 23(4)JT

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.

Authors+Show Affiliations

Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark ahc@ssi.dk.Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark.Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark.Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institute, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27147729

Citation

Christiansen, Annette H., et al. "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." Journal of Travel Medicine, vol. 23, no. 4, 2016.
Christiansen AH, Rodriguez AB, Nielsen J, et al. 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(4).
Christiansen, A. H., Rodriguez, A. B., Nielsen, J., & Cowan, S. A. (2016). 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. Journal of Travel Medicine, 23(4). https://doi.org/10.1093/jtm/taw022
Christiansen AH, et al. 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(4) PubMed PMID: 27147729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Christiansen,Annette H, AU - Rodriguez,Anna B, AU - Nielsen,Jens, AU - Cowan,Susan A, Y1 - 2016/05/04/ PY - 2016/03/29/accepted PY - 2016/5/6/entrez PY - 2016/5/6/pubmed PY - 2017/1/11/medline KW - Postexposure prophylaxis KW - Rabies KW - Rabies exposure JF - Journal of travel medicine JO - J Travel Med VL - 23 IS - 4 N2 - 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. SN - 1708-8305 UR - https://www.unboundmedicine.com/medline/citation/27147729/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_ L2 - https://academic.oup.com/jtm/article-lookup/doi/10.1093/jtm/taw022 DB - PRIME DP - Unbound Medicine ER -