Rabies Post-Exposure Prophylaxis of Overseas Travelers in the International Travel Clinic of the National Medical Center from 2006 to 2012, Korea
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Background: Rabies is an acute fatal viral disease generally transmitted from infected animals to humans through bites. It is distributedworldwide. The number of Korean people traveling to rabies-endemic countries and being bitten by infected animals has beenincreasing recently. Therefore, we investigated international travelers who received rabies post-exposure prophylaxis (PEP) at the NationalMedical Center (NMC) and compared the data with those of other clinics. Materials and Methods: This study was a retrospective review of 106 patients who visited the International Travel Clinic of the NMCand received rabies PEP between July 2006 and December 2012. During that period, we used the Essen intramuscular regimen protocol. Complete rabies PEP was defined as 5 doses of rabies vaccination with or without rabies immunoglobulin (RIG) administrationaccording to the World Health Organization guidelines. Results: A total 106 cases documented within the period of 6 years were selected, including 10 children younger than 15 years and96 older than 15 years. The mean age of the patients who received PEP was 33.4 years. Of the patients, 53 were male and another53 were female. Most of the exposures occurred in Southeast Asia, predominantly from dog bites (71, 66.9%). The lower extremitieswere the most frequent site of exposure (37, 34.9%). All the patients began receiving rabies vaccination for prophylaxis after exposure,and 51 received rabies vaccination with RIG. Meanwhile, 74 cases (69.8%) initiated rabies vaccination overseas, but only 10 of themreceived RIG while overseas; the remaining 32 (30.2%) initiated rabies vaccination after returning to Korea. Within 7 days, all thechildren and 74 adults received their first rabies vaccination. Six adults initiated first rabies vaccination after 1 week. Eleven of the 106patients stopped PEP before 5 doses, among whom 4 (1 child and 3 adults) discontinued vaccination after confirming that the bitinganimal remained healthy throughout 10 days of observation. None of the patients had been previously vaccinated against rabies. Conclusions: Most of the overseas travelers who visited our clinic after being bitten by suspected rabid animals received appropriaterabies PEP. However, the interval between exposure and first rabies vaccination was often delayed. Tourists who planto travel in rabies enzootic regions need to be aware that prompt initiation of PEP is important to reduce the risk for developinghuman rabies.
Abstract
Background: Rabies is an acute fatal viral disease generally transmitted from infected animals to humans through bites. It is distributedworldwide. The number of Korean people traveling to rabies-endemic countries and being bitten by infected animals has beenincreasing recently. Therefore, we investigated international travelers who received rabies post-exposure prophylaxis (PEP) at the NationalMedical Center (NMC) and compared the data with those of other clinics. Materials and Methods: This study was a retrospective review of 106 patients who visited the International Travel Clinic of the NMCand received rabies PEP between July 2006 and December 2012. During that period, we used the Essen intramuscular regimen protocol. Complete rabies PEP was defined as 5 doses of rabies vaccination with or without rabies immunoglobulin (RIG) administrationaccording to the World Health Organization guidelines. Results: A total 106 cases documented within the period of 6 years were selected, including 10 children younger than 15 years and96 older than 15 years. The mean age of the patients who received PEP was 33.4 years. Of the patients, 53 were male and another53 were female. Most of the exposures occurred in Southeast Asia, predominantly from dog bites (71, 66.9%). The lower extremitieswere the most frequent site of exposure (37, 34.9%). All the patients began receiving rabies vaccination for prophylaxis after exposure,and 51 received rabies vaccination with RIG. Meanwhile, 74 cases (69.8%) initiated rabies vaccination overseas, but only 10 of themreceived RIG while overseas; the remaining 32 (30.2%) initiated rabies vaccination after returning to Korea. Within 7 days, all thechildren and 74 adults received their first rabies vaccination. Six adults initiated first rabies vaccination after 1 week. Eleven of the 106patients stopped PEP before 5 doses, among whom 4 (1 child and 3 adults) discontinued vaccination after confirming that the bitinganimal remained healthy throughout 10 days of observation. None of the patients had been previously vaccinated against rabies. Conclusions: Most of the overseas travelers who visited our clinic after being bitten by suspected rabid animals received appropriaterabies PEP. However, the interval between exposure and first rabies vaccination was often delayed. Tourists who planto travel in rabies enzootic regions need to be aware that prompt initiation of PEP is important to reduce the risk for developinghuman rabies.
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