Menachem Meital, Grupper Moti, Paz Alona, Potasman Israel
Infectious Diseases Unit, Bnai Zion Medical Center, P.O. Box 4940, Haifa 31048, Israel.
Travel Med Infect Dis. 2008 Jan-Mar;6(1-2):12-6. doi: 10.1016/j.tmaid.2007.09.041. Epub 2007 Oct 25.
The decision whether or not to administer rabies pre-exposure prophylaxis (PEP) to travelers visiting endemic areas is a complex one. Paramount for making that decision is knowledge of the risk of animal bites during travel. This study attempts to estimate the risk of bites in travelers, and study the action they took before and after the incident.
Travelers presenting for pre-travel immunizations during the period of August through December 2004, who planned a travel of >or= 1 month's duration were retrospectively identified, contacted and interviewed by a structured questionnaire. These travelers did not receive specific advice concerning rabies.
The study cohort comprised of 815 travelers (median age=25), of who 13 (1.6%) were injured by a potentially rabid animal (mainly, dog=6; monkey=4). The incidence of potential rabies exposure was found to be of 2.66 per 1000 travelers per month. Those injured had significantly longer trips than the non-injured (6.9+/-3.8 vs. 4+/-5.0 months, p=0.037); notably, the injuries occurred after a median of 5 weeks from departure. Although seven travelers noted blood at the site of injury, only four (31%) of the injured sought medical attention following the exposure, and all four received post-exposure prophylaxis.
An injury by potentially rabid animals is not rare among long-term travelers. As the injury may occur early in the itinerary, rabies PEP should be considered for this population. Educational efforts are required in light of the lack of understanding of the dismal consequences of rabies among travelers.
对于前往狂犬病流行地区的旅行者，决定是否进行暴露前预防（PEP）是一个复杂的问题。做出该决定的关键在于了解旅行期间动物咬伤的风险。本研究旨在估计旅行者被咬伤的风险，并研究他们在事件前后采取的行动。
回顾性确定2004年8月至12月期间前来进行旅行前免疫接种、计划旅行时长≥1个月的旅行者，并通过结构化问卷对其进行联系和访谈。这些旅行者未接受关于狂犬病的具体建议。
研究队列包括815名旅行者（中位年龄=25岁），其中13人（1.6%）被可能感染狂犬病的动物咬伤（主要是狗咬伤6人；猴子咬伤4人）。发现潜在狂犬病暴露的发生率为每1000名旅行者每月2.66例。受伤者的旅行时间明显长于未受伤者（6.9±3.8个月对4±5.0个月，p=0.037）；值得注意的是，受伤事件发生在出发后的中位时间为5周。尽管有7名旅行者注意到受伤部位有血迹，但受伤者中只有4人（31%）在暴露后寻求了医疗救助，且这4人都接受了暴露后预防治疗。
在长期旅行者中，被可能感染狂犬病的动物咬伤并不罕见。由于受伤可能发生在行程早期，因此应考虑对这一人群进行狂犬病暴露前预防。鉴于旅行者对狂犬病严重后果缺乏了解，需要开展教育工作。
