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Rabies Vaccine Disposition: Trends in Vaccination Among Israeli Travelers

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  • 1 Center for Geographic Medicine and Department of Medicine C at Chaim Sheba Medical Center, Tel Hashomer, Israel;
  • | 2 Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel;
  • | 3 Ministry of Health, Northern District Health Bureau, Nazeret Ilit, Israel

ABSTRACT.

Travelers are a risk-group for rabies; however, few are protected. We describe changes in pre-travel vaccination rates and post-travel referrals after animal contact. We conducted a nationwide, retrospective study for 2014–2018. The ratio of rabies vaccine courses distributed to travelers and the number of Israeli-tourist-entries to endemic countries was calculated, as was the proportion of travelers referred to a post-travel clinic after animal contact. During the study period, the ratio of pre-travel vaccine courses distributed nationally to outgoing tourism to endemic countries was stable at ≈0.7%; 13% of 256,969 pre-travel consultations included recommendation for rabies vaccination. Backpackers were more likely to be immunized (40.2%) than business travelers (4.4%) or travelers planning organized/high-end travel (2.0%). However, rates of rabies vaccination among backpackers showed a decline during the study period. Post-travel referrals after animal contact were stable at 2% of all referrals; most were exposed in Asia (69.5%) and 51% were bitten by dogs. Only 38% received post-exposure prophylaxis abroad. We conclude that only a minority of Israeli travelers, including backpackers, receive rabies pre-exposure prophylaxis. The proportion of travelers with potentially rabid animal contact is not decreasing; however, many exposed travelers do not receive post-exposure prophylaxis during travel. Because rabies control programs have been compromised in endemic countries during the COVID-19 pandemic, the need to provide rabies protection to travelers has become more urgent. After the ACIP’s adoption of the World Health Organization’s (WHO) 2-dose regimen, a revision of current vaccine guidelines is required to provide a simplified, more inclusive rabies vaccine policy.

Author Notes

Address correspondence to Eyal Meltzer or Eli Schwartz, Center for Geographic Medicine and Department of Medicine C, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel. E-mails: emeltzer@tauex.tau.ac.il or elischwa@tauex.tau.ac.il

Authors’ addresses: JEyal Meltzer and Eli Schwartz, Center for Geographic Medicine and Department of Medicine C at Chaim Sheba Medical Center, Tel Hashomer, Israel, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, E-mails: emeltzer@tauex.tau.ac.il and elischwa@tauex.tau.ac.il. Remez Yanuka, Ministry of Health, Northern District Health Bureau, Nazeret Ilit, Israel, E-mail: remez.yanuka@zafon.health.gov.il.

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