Animal bites and rabies exposure in Australian travelers

Objectives: To examine the circumstances of animal exposure in a case series of Australian travellers who required rabies post exposure prophylaxis, and to assess the appropriateness of current guidelines for rabies pre-exposure vaccination. Design, participants and setting: Prospective case series of 65 returned travellers who presented to four Australian travel medicine clinics between 1 April 2009 and 31 July 2010 for rabies post-exposure prophylaxis. Main outcome measures: Demographic characteristics associated with risk of injury; countries where injuries occurred; circumstances of the injuries; and travellers' experiences of obtaining post exposure prophylaxis overseas. Results: Animal bites and scratches occurred most commonly among travelers aged 20-29 years. Most injuries occurred in Bali, Indonesia (30 [46%]) and Thailand (21 [32%]), and the most common animals responsible for the injuries to the 65 travellers were monkeys (29 travellers [45%]) and dogs (27 [42%]). Thirty-nine of the travellers (60%) initiated contact with the animal. Forty travellers (62%) were able to commence rabies vaccination overseas, but only nine (14%) were able to obtain rabies immunoglobulin overseas. Conclusions: Most travellers had difficulty obtaining rabies post exposure prophylaxis overseas, resulting in significant delays in appropriate treatment. We recommend that current National Health and Medical Research Council guidelines for at-risk persons be broadened, and that the risk of rabies and the option of pre-exposure vaccination be discussed with all travellers to rabies-endemic areas.