With the surge of global tourism comes the possibility of exposure to rabies. A new review of the current rabies considerations for travelers is published in the latest issue of Wilderness Medicine.
In 2004, tourism growth was particularly strong in Asia and the Pacific, where it increased 28 percent. In 2005, growth was strongest in Sub-Saharan Africa, 13 percent, and Kenya had an increase of 26 percent. Well over 90 percent of human rabies deaths occur in these two areas.
Despite the growing risk of rabies with increased tourism, ignorance about rabies abounds. This is seen in a written survey completed at the 1998 Los Angeles Times Travel Meeting, which was attended by 23,500 people. Though the respondents described themselves as ?seasoned travelers taking frequent international trips,? only 33 percent knew that rabies was 100 percent fatal in humans, and that the disease can be contracted without a person?s knowledge. In addition, a high majority of the rabies cases in the United States and the United Kingdom were acquired in other countries, which makes the case for travelers to study the risk of rabies.
Recommendations for a pre-exposure vaccine vary somewhat from group to group. The Advisory Committee for Immunization Practices (ACIP) of the Centers for Disease Control and Prevention recommends that travelers obtain the vaccine when going to areas where there is rabies for a stay of 30 days or more.
In 1991, a group of investigators at the Canadian International Water and Energy Consultants (CIWEC) clinic in Kathmandu challenged the recommendation for travelers because the cost of vaccination is high, and they determined the probability for exposure to be low. However, investigators from the Queen Saovabha Memorial Institute in Bangkok subsequently surveyed 1,882 departing English-speaking travelers from the Bangkok air terminal and determined that 1.2 percent had been bitten by a dog and 8.7 percent had been licked by a dog during their stay. These investigators recommended that all travelers be routinely vaccinated for rabies by the intramuscular route.
Another consideration for the preexposure vaccine is postexposure therapy. If travelers are unable to receive timely postexposure therapy, the vaccine is recommended, according to a New England Journal of Medicine study. This is echoed by the CIWEC clinic that recommends preexposure vaccination for travelers visiting locations more than 24 hours from a reliable source of postexposure rabies vaccine.