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The clinical problem discussed in this case report involves the management of an adolescent traveler bitten by a non-captive monkey in Southeast Asia. Treatment decisions and the state of evidence for or against are discussed. To assure successful clinical management of travelers who suffer injuries inflicted by nonhuman primates, clinicians should acquaint themselves with the potential threats and discuss current published recommendations with their patients prior to arriving at a treatment plan.Your patient is a 14-year-old high school student who just returned from a school-sponsored trip to Ko Phi-Phi, in Thailand. She is in your clinic because of a bite to her right hand by a crab-eating macaque monkey inflicted 2 days earlier near Monkey Beach. The bite broke the skin, but she immediately irrigated the wound under a nearby faucet for about 5 minutes. The wound does not look infected. She can move her hand normally and sensation is intact. She is afebrile and otherwise feels fine. She received three doses of rabies vaccine 2 years earlier, prior to moving to Thailand. What is your advice?A recent review from France looked at rabies transmission from nonhuman primates (NHPs) to humans.1 The report cites 159 rabies cases that occurred in NHPs, documented from 1960 to 2013 and 25 human rabies cases following NHP-caused injuries. The review cited data from 14 surveys and studies involving a total of 2000 travelers seeking care for rabies post-exposure prophylaxis (PEP). Nearly one third had been injured by monkeys. If representative of the experience of travelers, this high number of monkey injuries may differ from what occurs in local resident populations. For instance, in Thailand, a large Asian country with high rabies prevalence in feral and stray dogs, Bangkok's Thai Red Cross Animal Bite Clinic collected common animal bite statistics between 2008 … Corresponding Author: Nicholas J. Riesland, MD, Lake Forest Park, 3404 NE 163rd Street, Lake Forest Park, Seattle, WA 98155, USA. E-mail: nickriesland{at}gmail.com

Expert Review of Evidence Bases for Managing Monkey Bites in Travelers