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Warmerdam AMT, Luppino FS, Visser LG. The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury. Trop Dis Travel Med Vaccines 2023; 9:11. [PMID: 37580813 PMCID: PMC10426805 DOI: 10.1186/s40794-023-00193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Prompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors. METHODS A retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses. RESULTS We showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24-48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels. CONCLUSIONS This study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.
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Affiliation(s)
| | | | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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2
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Alberer M. [International travels with children]. Monatsschr Kinderheilkd 2023; 171:271-281. [PMID: 36816715 PMCID: PMC9926454 DOI: 10.1007/s00112-023-01699-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 02/16/2023]
Abstract
International travels with children need special planning and preparation. Besides considering general aspects, such as the age of the child, physical fitness, pre-existing illnesses, type and extent of the journey, climatic conditions at the destination and previous travel experiences, it is important to discuss relevant travel-associated risks in the context of travel consulting. This includes extensive advice concerning mosquito protection and malaria prophylaxis and counselling and implementation of travel vaccinations. Depending on the situation of the family, an individualized travel concept can be prepared, creating the foundation for a possible problem-free international travel.
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Affiliation(s)
- Martin Alberer
- Praxis Dr. Frühwein & Partner, Briennerstr. 11, 80333 München, Deutschland
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Graumans W, Stone WJR, Bousema T. No time to die: An in-depth analysis of James Bond's exposure to infectious agents. Travel Med Infect Dis 2021; 44:102175. [PMID: 34662727 DOI: 10.1016/j.tmaid.2021.102175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
Global travelers, whether tourists or secret agents, are exposed to a smörgåsbord of infectious agents. We hypothesized that agents pre-occupied with espionage and counterterrorism may, at their peril, fail to correctly prioritize travel medicine. To examine our hypothesis, we examined adherence to international travel advice during the 86 international journeys that James Bond was observed to undertake in feature films spanning 1962-2021. Scrutinizing these missions involved ∼3113 min of evening hours per author that could easily have been spent on more pressing societal issues. We uncovered above-average sexual activity, often without sufficient time for an exchange of sexual history, with a remarkably high mortality among Bond's sexual partners (27.1; 95% confidence interval 16.4-40.3). Given how inopportune a bout of diarrhea would be in the midst of world-saving action, it is striking that Bond is seen washing his hands on only two occasions, despite numerous exposures to foodborne pathogens. We hypothesize that his foolhardy courage, sometimes purposefully eliciting life-threatening situations, might even be a consequence of Toxoplasmosis. Bond's approach to vector-borne diseases and neglected tropical diseases is erratic, sometimes following travel advice to the letter, but more often dwelling on the side of complete ignorance. Given the limited time Bond receives to prepare for missions, we urgently ask his employer MI6 to take its responsibility seriously. We only live once.
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Affiliation(s)
- Wouter Graumans
- Department of Medical Microbiology & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - William J R Stone
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Teun Bousema
- Department of Medical Microbiology & Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
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Riccardi N, Giacomelli A, Antonello RM, Gobbi F, Angheben A. Rabies in Europe: An epidemiological and clinical update. Eur J Intern Med 2021; 88:15-20. [PMID: 33934971 DOI: 10.1016/j.ejim.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Rabies is a vaccine preventable zoonotic disease with a significant mortality burden worldwide. Several years of vaccination campaigns in wildlife animals have now achieved the control of rabies in Western Europe through a vaccination belt in front of endemic Eastern European countries. Nevertheless, rabies could be imported both by travellers from areas without an active public control of the disease or by animals coming from areas where the virus circulates in wildlife fauna. The knowledge of the current world epidemiology combined with a high index of clinical suspicion are needed to reach a diagnosis of rabies, especially in case of atypical presentation or without a history of animal exposure. The pre-travel counselling to people visiting highly endemic areas is essential to give information on how to reduce exposure to potential sources of infection and to select those subjects who could benefit from pre-travel vaccination. Rabies is almost invariably fatal, but the prompt administration of a vaccine course combined with anti-rabies immunoglobulins significantly reduces the probability to develop life-threatening consequences. In this review, we give a brief epidemiological and clinical update about rabies in Europe.
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Affiliation(s)
- Niccolò Riccardi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Giacomelli
- III Infectious Diseases Unit, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Roberta Maria Antonello
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University Hospital, Trieste, Italy.
| | - Federico Gobbi
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Andrea Angheben
- Department of Infectious, Tropical Diseases & Microbiology (DITM), IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
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5
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Verdoes L, Luppino FS, Wallinga PJ, Visser PLG. Delayed rabies post-exposure prophylaxis treatment among Dutch travellers during their stay abroad: a comprehensive analysis. J Travel Med 2021; 28:6064331. [PMID: 33403393 DOI: 10.1093/jtm/taaa240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Loes Verdoes
- Lecturer Nursing Education at The Hague University of Applied Sciences, The Hague, The Netherlands
| | | | - Prof Jacco Wallinga
- Department of Biomedical Data Sciences, Leiden University Medical Centre, The Netherlands
| | - Prof Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands
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New Rabies Vaccines for Use in Humans. Vaccines (Basel) 2019; 7:vaccines7020054. [PMID: 31226750 PMCID: PMC6631309 DOI: 10.3390/vaccines7020054] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022] Open
Abstract
Although vaccines are available, rabies still claims more than 55,000 human lives each year. In most cases, rabies vaccines are given to humans after their exposure to a rabid animal; pre-exposure vaccination is largely reserved for humans at high risk for contacts with the virus. Most cases of human rabies are transmitted by dogs. Dog rabies control by mass canine vaccination campaigns combined with intensive surveillance programs has led to a decline of human rabies in many countries but has been unsuccessful in others. Animal vaccination programs are also not suited to control human rabies caused by bat transmission, which is common in some Central American countries. Alternatively, or in addition, more widespread pre-exposure vaccination, especially in highly endemic remote areas, could be implemented. With the multiple dose regimens of current vaccines, pre-exposure vaccination is not cost effective for most countries and this warrants the development of new rabies vaccines, which are as safe as current vaccines, but achieve protective immunity after a single dose, and most importantly, are less costly. This chapter discusses novel rabies vaccines that are in late stage pre-clinical testing or have undergone clinical testing and their potential for replacing current vaccines.
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Marano C, Moodley M, Melander E, De Moerlooze L, Nothdurft HD. Perceptions of rabies risk: a survey of travellers and travel clinics from Canada, Germany, Sweden and the UK. J Travel Med 2019; 26:S3-S9. [PMID: 30476212 PMCID: PMC6377182 DOI: 10.1093/jtm/tay062] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Extensive global experience shows that rabies pre-exposure prophylaxis (PrEP) through vaccination is effective and well tolerated, yet many travellers opt not to be vaccinated when travelling to rabies-endemic countries. Previous research has identified several factors influencing the choices travellers make to reduce the risk of rabies, including cost, time constraint and perspective on the importance of vaccination. The objectives of this study were to assess travellers' awareness of rabies and advice-seeking attitudes and to evaluate travel clinics practices regarding rabies pre-travel advice. METHODS We surveyed individuals aged 18-65 years residing in the UK, Germany, Canada and Sweden who had travelled to rabies-endemic countries between 2013 and 2016 and defined this as the rabies visit-risk sample. The first 850 respondents from the visit-risk sample who had undertaken pre-defined at-risk activities (e.g. contact with animals during the trip) completed an additional 15-min online questionnaire and were included in the activity-risk subsample. We also interviewed travel clinic personnel using a 25-min online or phone questionnaire. RESULTS The visit-risk sample included 4678 individuals. Many sought pre-travel health information online (33%) or talked to a family doctor (24%). Within the activity-risk subsample, 83% of travellers were aware of at least a few basic facts about rabies, and 84% could identify at least one correct rabies prevention measure; 49% were aware of a rabies vaccine, however, only 8% reported receiving PrEP vaccination within the past 3 years. Among 180 travel clinic respondents, 21% reported recommending PrEP against rabies to all travellers to rabies-endemic countries. Travel clinics estimated that 81% of travellers complete their travel vaccination schedules and reported sending reminders by e-mails (38%), text (38%), phone calls (37%) or by using vaccination cards (37%). CONCLUSIONS These findings suggest that although travellers had frequently heard of rabies, awareness of the risks of this serious infectious disease was relatively low. 5975671594001tay062media15975671594001.
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Affiliation(s)
| | | | | | | | - Hans D Nothdurft
- Department of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany
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8
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Gautret P, Angelo KM, Asgeirsson H, Lalloo DG, Shaw M, Schwartz E, Libman M, Kain KC, Piyaphanee W, Murphy H, Leder K, Vincelette J, Jensenius M, Waggoner J, Leung D, Borwein S, Blumberg L, Schlagenhauf P, Barnett ED, Hamer DH. Rabies post-exposure prophylaxis started during or after travel: A GeoSentinel analysis. PLoS Negl Trop Dis 2018; 12:e0006951. [PMID: 30422981 PMCID: PMC6258561 DOI: 10.1371/journal.pntd.0006951] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/27/2018] [Accepted: 10/26/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Recent studies demonstrate that rabies post-exposure prophylaxis (RPEP) in international travelers is suboptimal, with only 5-20% of travelers receiving rabies immune globulin (RIG) in the country of exposure when indicated. We hypothesized that travelers may not be receiving RIG appropriately, and practices may vary between countries. We aim to describe the characteristics of travelers who received RIG and/or RPEP during travel. METHODOLOGY/PRINCIPAL FINDINGS We conducted a multi-center review of international travelers exposed to potentially rabid animals, collecting information on RPEP administration. Travelers who started RPEP before (Group A) and at (Group B) presentation to a GeoSentinel clinic during September 2014-July 2017 were included. We included 920 travelers who started RPEP. About two-thirds of Group A travelers with an indication for rabies immunoglobulin (RIG) did not receive it. Travelers exposed in Indonesia were less likely to receive RIG in the country of exposure (relative risk: 0.30; 95% confidence interval: 0.12-0.73; P = 0.01). Travelers exposed in Thailand [Relative risk (RR) 1.38, 95% Confidence Interval (95% CI): 1.0-1.8; P = 0.02], Sri Lanka (RR 3.99, 95% CI: 3.99-11.9; P = 0.013), and the Philippines (RR 19.95, 95% CI: 2.5-157.2; P = 0.01), were more likely to receive RIG in the country of exposure. CONCLUSIONS/SIGNIFICANCE This analysis highlights gaps in early delivery of RIG to travelers and identifies specific countries where travelers may be more or less likely to receive RIG. More detailed country-level information helps inform risk education of international travelers regarding appropriate rabies prevention.
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Affiliation(s)
- Philippe Gautret
- Institut Méditerranée Infection, Aix-Marseille University, Marseille, France
| | - Kristina M. Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, and Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - David G. Lalloo
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Marc Shaw
- Public Health and Tropical Medicine Department, James Cook University, Townsville, Australia, and WORLDWISE Travellers Health Centres of New Zealand
| | - Eli Schwartz
- The Center of Geographical Medicine, Sheba Medical Center, Tel HaShomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Canada
| | - Kevin C. Kain
- Tropical Disease Unit, UHN-Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Watcharapong Piyaphanee
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Holly Murphy
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Karin Leder
- School of Epidemiology and Preventive Medicine, Monash University, and Victorian Infectious Disease Service, Royal Melbourne Hospital at the Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jean Vincelette
- Clinique Santé-voyage, Fondation du CHUM, Université de Montréal, Montreal, Canada
| | - Mogens Jensenius
- Department of Infectious Diseases - Oslo University Hospital, Oslo, Norway
| | - Jesse Waggoner
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Daniel Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Sarah Borwein
- TravelSafe Medical Centre - Central Health Medical Practice, Hong Kong, China
| | | | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland
| | - Elizabeth D. Barnett
- Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center, and Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
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9
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Rabies Preexposure Prophylaxis: Application of Updated World Health Organization Position to Travelers. Clin Infect Dis 2018; 67:1948-1950. [DOI: 10.1093/cid/ciy422] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/10/2018] [Indexed: 11/14/2022] Open
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Kong LY, Vincelette J, Laplante G, Duchesne JA, Libman M, Barkati S. Intradermal pre-exposure rabies vaccination in a Canadian travel clinic: 6-year retrospective observational study. CMAJ Open 2018; 6:E168-E175. [PMID: 29636332 PMCID: PMC7869659 DOI: 10.9778/cmajo.20170147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The intradermal route of vaccine administration for pre-exposure rabies prophylaxis, endorsed by the Canadian National Advisory Committee on Immunization, was implemented at a large travel clinic in Montréal in 2008. We evaluated the effect of intradermal vaccination availability on uptake of pre-exposure rabies prophylaxis and rates of seroconversion with intradermal vaccination. METHODS We conducted a retrospective cross-sectional study using data from December 2008 to December 2014. The number of travellers who received pre-exposure rabies prophylaxis before and after the introduction of intradermal vaccination was compared. Postvaccination antibody titres were measured in intradermal vaccination recipients. We compared demographic and travel characteristics between vaccinated and unvaccinated travellers and between travellers in the intradermal and intramuscular groups using univariate and multivariate analyses. RESULTS The proportion of travellers who received pre-exposure prophylaxis increased after the introduction of intradermal vaccination (annual average of 300 travellers from December 2009 to December 2014 v. 183 travellers from December 2006 to December 2007). Seroconversion occurred in 99.9% of those in the intradermal group. Travellers who received pre-exposure prophylaxis were older (mean age 35.8 yr v. 32.1 yr) and had longer travel duration than those who did not receive pre-exposure prophylaxis. Travellers to Asia were more likely to receive pre-exposure prophylaxis, and travellers visiting friends and relatives were less likely to receive it. Travellers in the intradermal group were younger than those in the intramuscular group and were more likely to be travelling for tourism. INTERPRETATION The introduction of intradermal vaccination for pre-exposure rabies prophylaxis was associated with an increase in vaccination uptake. Reduced cost may be responsible for the increased coverage among younger travellers and those travelling for tourism. The high seroconversion rate after intradermal vaccination supports the effectiveness of this route of administration for pre-exposure rabies prophylaxis in immunocompetent people.
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Affiliation(s)
- Ling Yuan Kong
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jean Vincelette
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Gaétan Laplante
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Jo-Anne Duchesne
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Michael Libman
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
| | - Sapha Barkati
- Affiliations: J.D. MacLean Centre for Tropical Diseases (Kong, Libman, Barkati), McGill University Health Centre; Clinique Santé-voyage de la Fondation du Centre hospitalier de l'Université de Montréal (Vincelette, Laplante, Duchesne, Barkati); Centre hospitalier de l'Université de Montréal (Vincelette, Barkati), Montréal, Que
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Torresi J, Steffen R. Redefining priorities towards graded travel-related infectious disease research. J Travel Med 2017; 24:4359791. [PMID: 29088486 DOI: 10.1093/jtm/tax064] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 01/01/2023]
Abstract
Our knowledge of the health problems and infections encountered by international travellers has evolved considerably in the past decades. The growth of global networks such as the GeoSentinel Surveillance network, TropNet Europe, EuroTravNet and networks based in North America have provided valuable information on the frequency of a wide array of travel-related diseases and accidents, including details on the destination of travel and trends over time. The information gained from these network studies has provided important data for the practice of travel medicine and in some instances for the development of practice guidelines. However, network data due to a lack of denominators usually cannot serve as a basis for a GRADE approach to guideline development. Although epidemiological network studies will continue to serve an important role in travel medicine we encourage an additional strong focus towards translational scientific research questions and towards the broader use of novel techniques to obtain more accurate epidemiological analyses to address the many unanswered questions in our field.
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Affiliation(s)
- Joseph Torresi
- Department of Microbiology and Immunology, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, Division of Communicable Diseases, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland.,Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
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12
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Antwi S, Parola P, Sow D, Sornin V, Henrion M, Gautret P. Familial cluster of exposure to a confirmed rabid dog in travelers to Algeria. Travel Med Infect Dis 2017; 16:46-48. [PMID: 28089844 DOI: 10.1016/j.tmaid.2017.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 11/26/2022]
Abstract
A 10 person-family originating from Algeria traveled in rural Algeria for the purpose of visiting friends and relatives without seeking pre-travel advice, did not received pre-travel rabies immunization, and were exposed to a confirmed rabid dog including 8 within less than 4 days of arrival. Three received suckling mouse brain rabies vaccine although WHO strongly recommends that its production and administration be discontinued and seven received insufficient doses of equine rabies immune globulin abroad. Rabies treatment was completed on returning to France. This reports underline the fact that travelers visiting friends and relatives in dog rabies endemic country are at high risk of rabies exposure and unaware of such a risk in most instances. Rabies risk warning should be reinforced and rabies pre-exposure vaccination should be considered in all individuals traveling to North Africa (and to sub-Saharan Africa) whatever the duration of stay.
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Affiliation(s)
- Sylvie Antwi
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Philippe Parola
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Doudou Sow
- Service de Parasitologie-Mycologie, Faculté de médecine, UCAD, Dakar-Fann, Senegal
| | - Victoria Sornin
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France
| | - Maxime Henrion
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France
| | - Philippe Gautret
- Institut Hospitalo-Universitaire Méditerranée Infection, 13005, Marseille, France; Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, INSERM 1095, Marseille, France.
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14
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Abstract
The diagnosis of rabies encephalitis relies on awareness of the varied clinical features and eliciting a history of unusual contact with a mammal throughout the endemic area. The diagnosis is easily missed. Laboratory tests are not routine and only confirm clinical suspicion. Rabies infection carries a case fatality exceeding 99.9%. Palliation is appropriate, except for previously-vaccinated patients or those infected by American bats, for whom intensive care is probably indicated. However, as rabies vaccines are outstandingly effective, no one should die of dog-transmitted infection. Vaccines and rabies immunoglobulin are expensive and usually scarce in Asia and Africa. All travellers to dog rabies enzootic areas should be strongly encouraged to have pre-exposure immunisation before departure. There is no contraindication to vaccination but the cost can be prohibitive. Intradermal immunisation, using 0.1 ml and sharing vials of vaccine, is cheaper and is now permitted by UK regulations. Returning travellers may need post-exposure prophylaxis. Economical intradermal post-exposure vaccination is practicable and should be introduced into rural areas of Africa and Asia immediately. Eliminating rabies in dogs is now feasible and would dramatically reduce human mortality, if funds were made available. The high current economic burden of human prophylaxis would then be largely relieved.
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Affiliation(s)
| | - David A Warrell
- Royal College of Physicians, London, UK, and emeritus professor of tropical medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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