Institut Méditerranée Infection, Aix-Marseille University, Marseille, France.
Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLoS Negl Trop Dis. 2018 Nov 13;12(11):e0006951. doi: 10.1371/journal.pntd.0006951. eCollection 2018 Nov.
Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5-20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel.
METHODOLOGY/PRINCIPAL FINDINGS: We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014-July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12-0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0-1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99-11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5-157.2; P = 0.01), were more likely to receive RIG in the country of exposure.
CONCLUSIONS/SIGNIFICANCE: This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.
最近的研究表明，国际旅行者的狂犬病暴露后预防（RPEP）并不理想，只有 5-20%的旅行者在暴露时根据需要在所在国接受狂犬病免疫球蛋白（RIG）。我们假设旅行者可能没有得到适当的 RIG，并且各国的做法可能有所不同。我们旨在描述在旅行期间接受 RIG 和/或 RPEP 的旅行者的特征。
方法/主要发现：我们对接触潜在狂犬病动物的国际旅行者进行了多中心回顾性研究，收集了 RPEP 管理信息。旅行者在 2014 年 9 月至 2017 年 7 月期间在 GeoSentinel 诊所就诊前（A 组）和就诊时（B 组）开始接受 RPEP。我们共纳入 920 名开始接受 RPEP 的旅行者。有 RIG 适应证的 A 组旅行者中约有三分之二未接受 RIG。在印度尼西亚暴露的旅行者在暴露所在国接受 RIG 的可能性较低（相对风险：0.30；95%置信区间：0.12-0.73；P = 0.01）。在泰国（RR 1.38，95%置信区间[95%CI]：1.0-1.8；P = 0.02）、斯里兰卡（RR 3.99，95%CI：3.99-11.9；P = 0.013）和菲律宾（RR 19.95，95%CI：2.5-157.2；P = 0.01）暴露的旅行者更有可能在所在国接受 RIG。
结论/意义：本分析突出了旅行者早期接受 RIG 治疗的差距，并确定了旅行者更有可能或不太可能在所在国接受 RIG 的特定国家。更详细的国家层面信息有助于对国际旅行者进行适当狂犬病预防的风险教育。
