Lecturer Nursing Education at The Hague University of Applied Sciences, The Hague, The Netherlands.
Eurocross Assistance, Leiden, The Netherlands.
J Travel Med. 2021 Apr 14;28(3). doi: 10.1093/jtm/taaa240.
After an animal-associated injury (AAI) in rabies-endemic regions, post-exposure prophylaxis (PEP) is needed to prevent infection.1,2 PEP consists of rabies vaccinations (RV) and in some cases also additional rabies immune globulins (RIG). Not always PEP medication, and RIG in particular, is accessible. Along with an increased number of exposure notifications among Dutch travellers, this might lead to treatment delay and thus to increased health risks. Until now, research mainly focused on factors associated with exposition, but none on which factors are associated with PEP delay. This study aimed to identify which general sample characteristics are associated with PEP delay while being abroad.
A quantitative retrospective observational study was conducted. The study population consisted of insured Dutch international travellers who actively contacted their medical assistance company (2015-2019) because of an animal-associated injury (AAI) (N = 691). The association between general sample characteristics and delay of different PEP treatments was studied using survival analysis.
Travellers without pre-exposure prophylaxis (PrEP) had an increased hazard, and therefore a shorter delay, for receiving their first RV as compared to travellers with PrEP (HR:1.11, 95%CI:1.01-1.22). The travellers needing both RV and RIG had a decreased hazard, and therefore a longer delay, as compared to travellers only needing RV (HR:0.81, 95%CI:0.67-0.96). General sample characteristic associated with RIG administration delay was travel destination. Travellers to Central and South America, East Mediterranean and Europe had a decreased hazard, and therefore a longer delay, for receiving RIG treatments relative to travellers to South East Asia (HR:0.31, 95%CI:0.13-0.70; HR:0.34, 95%CI:0.19-0.61; HR:0.46, 95%CI:0.24-0.89; HR:0.48, 95%CI:0.12-0.81, respectively).
Our results suggest that the advice for PrEP should be given based on travel destination, as this was found to be the main factor for PEP delay, among travellers going to rabies-endemic countries.
在狂犬病流行地区发生动物接触伤（AAI）后，需要进行暴露后预防（PEP）以预防感染。1,2 PEP 包括狂犬病疫苗（RV）接种，在某些情况下还包括狂犬病免疫球蛋白（RIG）。并非总是可以获得 PEP 药物，特别是 RIG。随着荷兰旅行者中暴露通知数量的增加，这可能导致治疗延迟，从而增加健康风险。到目前为止，研究主要集中在与暴露相关的因素上，但没有研究哪些因素与 PEP 延迟有关。本研究旨在确定在国外时，哪些一般样本特征与 PEP 延迟有关。
进行了一项定量回顾性观察研究。研究人群包括因动物接触伤（AAI）而主动联系其医疗援助公司的有保险的荷兰国际旅行者（2015-2019 年）（N=691）。使用生存分析研究了一般样本特征与不同 PEP 治疗延迟之间的关联。
与接受过暴露前预防（PrEP）的旅行者相比，未接受 PrEP 的旅行者接种第一剂 RV 的风险增加，因此延迟时间更短（HR：1.11，95%CI：1.01-1.22）。需要同时接种 RV 和 RIG 的旅行者接种 RV 的风险降低，因此延迟时间更长（HR：0.81，95%CI：0.67-0.96）。与仅需要 RV 接种的旅行者相比，需要 RIG 治疗的旅行者的一般样本特征与 RIG 给药延迟相关，与前往东南亚的旅行者相比，前往中美洲和南美洲、东地中海和欧洲的旅行者接受 RIG 治疗的风险降低，因此延迟时间更长（HR：0.31，95%CI：0.13-0.70；HR：0.34，95%CI：0.19-0.61；HR：0.46，95%CI：0.24-0.89；HR：0.48，95%CI：0.12-0.81）。
我们的研究结果表明，应根据旅行目的地来提供 PrEP 建议，因为这是前往狂犬病流行国家的旅行者中 PEP 延迟的主要因素。
