Rabies post-exposure prophylaxis started during or after travel: a GeoSentinel analysis

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

Response to letter to the editor-Re: Travelling to China for the Beijing Olympic and Paralympic Games: internal migration of the commercial sex workforce may be an important HIV risk factor for travellers

[Extract]We wish to thank Smith and Wei¹ for the opportunity to raise further awareness of the problem of human immunodeficiency virus (HIV) for those travelling to the Beijing Olympic and Paralympic Games. Our paper² does not purport to give an in-depth analysis of every issue confronting travellers; none-the-less, a sub-section was devoted to this important topic. Smith and Wei¹ correctly refer to the problem with estimates of HIV figures³ and we included generally accepted estimates from the World Health Organization. Smith and Wei¹ also discuss the problem of casual sex amongst travellers, as highlighted by a number of surveys, as well as the problem of itinerate workers and internal migration of the commercial sex workforce in China potentially being a source of spread of HIV within China, as has been the case in other countries. It is not known to what extent this will present an issue for short-term travellers to China, but it is certainly likely that a significant proportion of travellers to the Beijing Games will engage in casual sex, either with other travellers or with members of the local population.\ud \ud Steffen et al⁴ estimated that the risk of HIV infection amongst Swiss travellers travelling to developing countries was approximately 0.01% per 100,000 per month, which is relatively small compared to other travel health and safety-related concerns. In addition, education concerning protection against HIV and other sexually transmitted infections, including personal protective measures, has been an integral part of the pre-travel health consultation for many years,⁵ as these diseases are prevalent worldwide. Therefore, the paramount issue for travellers and athletes going to the Beijing Olympic and Paralympic Games will be to ensure that they seek pre-travel health advice, in the first instance, so that they will have the opportunity to be informed on the range of issues that may confront them during their travel to China and the region, including HIV

The international athlete: travelling healthy to global sporting events

[Extract] The contemporary athlete is a global traveller [1]. The 2004 Summer Olympie and Paralympic Games in Athens attracted an estimated 25,000 athletes and support staff from 201 countries and serves as good example of the interest highprofile international sports receive [2]. Even lower-profile recreational sports such as marathons, triathalons and golf are attracting more and more athletes willing to travellong distances to compete [3]. Depending on the sport, these competitions range in duration from one day to several weeks and often represent the ultimate challenge for participating athletes. However, a fact that is often overlooked is that the nature of international travel poses obstacles to the health, safety and maximum performance of athletes

Travelling to China for the Beijing 2008 Olympic and Paralympic Games

The 29th modern Olympic Summer Games, conducted once every 4 years since 1896, will be held in Beijing, China, from 8 to 24 August 2008. There will be approximately 28 major and 302 minor events in 37 venues in the prominent cities of Beijing, Hong Kong and Shanghai, and also in Qingdao (a coastal town in Shandong Province), Qinhuangdao (northeast of Beijing), Shanghai, Shenyang (an industrial city in Liaoning Province) and in Tianjin (on the coast near Beijing). Following the Olympic Games, the Paralympic Games will be conducted from 6 to 17 September 2008 in Beijing and 20 Paralympic Sports will be represented. This paper focuses on health and safety issues for travellers to China in general, although it makes specific references to advice for visiting Olympic and Paralympic athletes and team staff, who will be travelling to the games. It must be remembered that travel health advice can change, and that travellers should be advised to seek up-to-date travel health advice for China closer to their departure.\u

Malaria after international travel: A GeoSentinel analysis, 2003-2016

BACKGROUND: More than 30,000 malaria cases are reported annually among international travellers. Despite improvements in malaria control, malaria continues to threaten travellers due to inaccurate perception of risk and sub-optimal pre-travel preparation. METHODS: Records with a confirmed malaria diagnosis after travel from January 2003 to July 2016 were obtained from GeoSentinel, a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. Records were excluded if exposure country was missing or unascertainable or if there was a concomitant acute diagnosis unrelated to malaria. Records were analyzed to describe the demographic and clinical characteristics of international travellers with malaria. RESULTS: There were 5689 travellers included; 325 were children <18 years. More than half (53%) were visiting friends and relatives (VFRs). Most (83%) were exposed in sub-Saharan Africa. The median trip duration was 32 days (interquartile range 20-75); 53% did not have a pre-travel visit. More than half (62%) were hospitalized; children were hospitalized more frequently than adults (73 and 62%, respectively). Ninety-two per cent had a single Plasmodium species diagnosis, most frequently Plasmodium falciparum (4011; 76%). Travellers with P. falciparum were most frequently VFRs (60%). More than 40% of travellers with a trip duration ≤7 days had Plasmodium vivax. There were 444 (8%) travellers with severe malaria; 31 children had severe malaria. Twelve travellers died. CONCLUSION: Malaria remains a serious threat to international travellers. Efforts must focus on preventive strategies aimed on children and VFRs, and chemoprophylaxis access and preventive measure adherence should be emphasized