Ross R Stefan, Wolters Bernd, Viazov Sergei O, Roggendorf Michael
Institute of Virology, National Advisory Laboratory for Rabies, University of Duisburg-Essen, D-45122 Essen, Germany.
J Travel Med. 2006 Sep-Oct;13(5):261-7. doi: 10.1111/j.1708-8305.2006.00058.x.
Every year, millions of people travel to countries where rabies is enzootic. However, the quality of rabies-specific information provided by travel health advisors and the extent of their knowledge about pre- and postexposure prophylaxis have not been examined on a large-scale basis up to now.
5,780 German physicians and pharmacists, who identified themselves as active travel health advisors, were chosen from a database. The selected providers were asked to complete an Internet-based questionnaire. The form requested both demographic information and the assessment of different concrete scenarios, each of which featured individuals seeking pre-travel advice on rabies or appropriate postexposure treatment after returning from abroad.
Overall, 496 physicians and pharmacists completed the questionnaire. Almost all respondents indicated that they would mention the risk of rabies and appropriate preventive measures to long-term travelers and tourists planning to visit rural areas. However, only 35% to 60% of the advisors would provide this information to individuals on business trips, package tours, or travelers in urban centers as well. The assessment of the scenarios yielded 51% to 98% of adequate advice. Potentially harmful decisions included, for instance, the failure to recommend further prophylactic measures after exposure of already vaccinated people or the fact that the necessary postexposure prophylaxis was inappropriately withheld in cases where treatment had been initially delayed.
Although the participants of this study were well aware of the travel-associated rabies risks and provided adequate information about this health hazard to most of their clients, evident flaws exist regarding the correct assessment of specific situations in pre- and postexposure rabies prophylaxis. Our findings therefore provide important cues on topics that should be more intensely covered during future postgraduate training in travel medicine and also underline the need for more practically orientated, readily available information on specific prophylactic treatment against rabies.
每年，数以百万计的人前往狂犬病地方流行的国家。然而，迄今为止，旅行健康顾问提供的狂犬病相关信息的质量及其关于暴露前和暴露后预防的知识范围尚未得到大规模研究。
从一个数据库中选取了5780名自称是活跃旅行健康顾问的德国医生和药剂师。要求这些选定的提供者完成一份基于互联网的问卷。该表格既要求提供人口统计学信息，也要求对不同的具体情景进行评估，每个情景都以寻求旅行前狂犬病建议或从国外返回后适当的暴露后治疗的个人为特色。
总体而言，496名医生和药剂师完成了问卷。几乎所有受访者表示，他们会向长期旅行者和计划前往农村地区的游客提及狂犬病风险和适当的预防措施。然而，只有35%至60%的顾问也会向商务旅行者、跟团游游客或城市中心的旅行者提供此信息。对情景的评估得出51%至98%的建议是适当的。潜在有害的决定包括，例如，在已接种疫苗的人暴露后未建议采取进一步的预防措施，或者在治疗最初延迟的情况下不恰当地扣留必要的暴露后预防措施。
尽管本研究的参与者充分意识到与旅行相关的狂犬病风险，并向大多数客户提供了有关这种健康危害的充分信息，但在暴露前和暴露后狂犬病预防的具体情况的正确评估方面存在明显缺陷。因此，我们的研究结果为旅行医学未来研究生培训中应更深入涵盖的主题提供了重要线索，也强调了需要有更多针对狂犬病具体预防治疗的、更具实践导向且易于获取的信息。
