Animal bites and rabies exposure in Australian travellers

Objectives: To examine the circumstances of animal exposure in a case series of Australian travellers who required rabies postexposure 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 postexposure prophylaxis overseas. Results: Animal bites and scratches occurred most commonly among travellers 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 postexposure 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.