Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20359 Hamburg, Germany.
J Travel Med. 2020 Nov 9;27(7). doi: 10.1093/jtm/taaa058.
Rabies causes thousands of deaths worldwide and trips to rabies endemic countries are popular. Travellers are often uncertain whether pre-exposure prophylaxis (PrEP) is advisable since they find it difficult to estimate the exposure risk during travel and the availability of post-exposure prophylaxis in endemic regions. The aim of this study was to determine the potential rabies exposures in travellers and to assess their knowledge on rabies. Secondly, we explored the access to appropriate post-exposure medical care in respective countries.
We conducted a cross-sectional study at Frankfurt Airport. Returning adult travellers arriving from Asia, the Middle East, Africa, South and Central America were invited to participate in this questionnaire-based study while waiting in the baggage claim area.
Over a one-month recruitment phase in March 2019, we enrolled 3066 travellers; 2929 were included in the analysis. The gender ratio was balanced; the median age was 42 years (range 18-83 years). Participants arrived from Asia (46%), Africa (29%), Central/South America (13%), the Middle East (8%) and the Caribbean (8%). Forty-five per cent sought pretravel advice and 22% received ≥2 injections of rabies PrEP. Travellers with pretravel advice from tropical medicine specialists reached significantly higher knowledge scores than others. We found that potential rabies exposure occurred in 2.0% (57/2915) of travellers with 31% (13/42) of the contacts being unprovoked; 19% (8/42) of the exposed sought medical care and 3/8 were adequately treated before returning to Germany. Risk factors for animal exposure were: male sex, young age, trips to Asia and a long stay abroad (>4 weeks).
A total of 2% of returning travellers (n = 2915) experienced a potential rabies exposure during their journey. A majority of the exposed individuals did not seek medical care; those seeking medical care were often treated inadequately. Rabies information must be emphasised during pretravel counselling and PrEP should be offered generously, especially to travellers with high exposure risks.
狂犬病在全球范围内导致数千人死亡，前往狂犬病流行地区的旅行很受欢迎。旅行者往往不确定是否需要进行暴露前预防（PrEP），因为他们难以估计旅行期间的暴露风险，以及在流行地区获得暴露后预防的情况。本研究的目的是确定旅行者的潜在狂犬病暴露情况，并评估他们对狂犬病的认识。其次，我们探讨了在各自国家获得适当的暴露后医疗护理的途径。
我们在法兰克福机场进行了一项横断面研究。邀请从亚洲、中东、非洲、南美和中美洲返回的成年旅行者在行李提取区等候时参与这项基于问卷的研究。
在 2019 年 3 月的一个月招募期内，我们招募了 3066 名旅行者；其中 2929 名纳入分析。性别比例平衡；中位年龄为 42 岁（范围 18-83 岁）。参与者来自亚洲（46%）、非洲（29%）、中/南美（13%）、中东（8%）和加勒比地区（8%）。45%的人寻求旅行前咨询，22%的人接受了≥2 剂狂犬病 PrEP。从热带医学专家那里获得旅行前咨询的旅行者的知识得分显著更高。我们发现，2.0%（57/2915）的旅行者存在潜在的狂犬病暴露风险，其中 31%（13/42）的接触是无端的；19%（8/42）的暴露者寻求医疗护理，其中 8/8 在返回德国之前得到了适当的治疗。动物暴露的危险因素是：男性、年轻、前往亚洲和在国外逗留时间长（>4 周）。
共有 2%（n=2915）的返回旅行者在旅行期间经历了潜在的狂犬病暴露。大多数暴露者没有寻求医疗护理；那些寻求医疗护理的人往往治疗不充分。在旅行前咨询时必须强调狂犬病信息，应慷慨地提供 PrEP，特别是对高暴露风险的旅行者。
