Work

Rabies post-exposure prophylaxis in international travelers at a tertiary hospital in Barcelona

Year: 2025

Type: article

Abstract: Background Rabies remains a critical global public health concern, even in countries without enzootic transmission. International travelers returning from endemic regions are at risk after animal-associated injuries (AAI). Delays in administering post-exposure prophylaxis (PEP) substantially increase the risk of fatal outcomes. Data on factors contributing to delayed PEP among travelers are limited. This study aimed to describe travelers seeking rabies PEP at a referral hospital in Spain and identify determinants of treatment delay to inform public health strategies. Methods A retrospective observational study was conducted at a hospital in Barcelona. We included international travelers who sought PEP between April 1, 2024, and March 31, 2025, following an AAI abroad. Demographic, clinical, and exposure-related data were extracted from electronic health records. Logistic regression was used to identify factors associated with same-day vaccination. Results Seventy-three international travelers sought rabies PEP at our center. Median age was 33 years (IQR 29-38); 56% were female, and 60% were Spanish nationals. Only 23% received pre-travel advice, 5.5% had PrEP, and 92% had no prior rabies vaccine. Most exposures occurred in South-East Asia (45%) and the Eastern Mediterranean (15%). Dogs (47%) and monkeys (29%) were the main animals involved; bites accounted for 74% of injuries. Lower extremities were most affected (44%). Median time from AAI to first vaccine dose was 1 day (IQR 0-5). In 73% of cases, the first dose was given in the country of exposure; 33% received immunoglobulin. No patient or exposure-related characteristics were significantly associated with same-day PEP initiation. Conclusions This study highlights variability in the characteristics and management of travelers seeking rabies PEP. Although no factors were linked to same-day treatment, delays were common, reinforcing the need for better pre-travel counseling and timely access to care. Key messages • Delays in rabies PEP are common among international travelers, emphasizing the need for improved pre-travel counseling and timely access to care after animal-associated injuries. • Most travelers seeking rabies PEP in our center lacked pre-exposure vaccination, with many facing treatment delays, particularly after exposures in South-East Asia and the Eastern Mediterranean.

Source: European Journal of Public Health

DOI: 10.1093/eurpub/ckaf161.981