Infect Chemother.  2014 Mar;46(1):13-20. 10.3947/ic.2014.46.1.13.

Rabies Post-Exposure Prophylaxis of Overseas Travelers in the International Travel Clinic of the National Medical Center from 2006 to 2012, Korea

• Park JH
• Lee CH
• Won YK
• Chin BS
• Shin HS
• Kim JY

• KMID: 2170455
• DOI: http://doi.org/10.3947/ic.2014.46.1.13

Abstract

BACKGROUND
Rabies is an acute fatal viral disease generally transmitted from infected animals to humans through bites. It is distributed worldwide. The number of Korean people traveling to rabies-endemic countries and being bitten by infected animals has been increasing recently. Therefore, we investigated international travelers who received rabies post-exposure prophylaxis (PEP) at the National Medical 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 NMC and 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) administration according 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 and 96 older than 15 years. The mean age of the patients who received PEP was 33.4 years. Of the patients, 53 were male and another 53 were female. Most of the exposures occurred in Southeast Asia, predominantly from dog bites (71, 66.9%). The lower extremities were 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 them received RIG while overseas; the remaining 32 (30.2%) initiated rabies vaccination after returning to Korea. Within 7 days, all the children and 74 adults received their first rabies vaccination. Six adults initiated first rabies vaccination after 1 week. Eleven of the 106 patients stopped PEP before 5 doses, among whom 4 (1 child and 3 adults) discontinued vaccination after confirming that the biting animal 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 appropriate rabies PEP. However, the interval between exposure and first rabies vaccination was often delayed. Tourists who plan to travel in rabies enzootic regions need to be aware that prompt initiation of PEP is important to reduce the risk for developing human rabies.

Keyword

Rabies; Post-exposure prophylaxis; Vaccination

MeSH Terms

Adult
Animals
Asia, Southeastern
Child
Dogs
Female
Humans
Immunoglobulins
Korea*
Lower Extremity
Male
Post-Exposure Prophylaxis*
Rabies*
Retrospective Studies
Vaccination
Virus Diseases
World Health Organization
Immunoglobulins

Figure

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  Figure 1 Age and sex distribution of the travelers with rabies post-exposure prophylaxis.

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  Figure 2 Number of exposed travelers according to the animal species causing the bite.

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  Figure 3 Number of exposed travelers according to the body site of the animal bite. aExposure occurred at 2 or more body sites. bOlder than 15 years. cAged 15 years or younger.

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