The Jan. 4, 2019 issue of CDC’s Morbidity and Mortality
Weekly Report (MMWR) reported the case of a US citizen, who was bitten by a
puppy while traveling in India in 2017 during a Yoga camp. The patient did not
seek rabies medical treatment (postexposure prophylaxis), although she cleaned
the wound. Upon his return to the US, the patient developed rabies and died during
hospitalization despite aggressive treatment. A total of 250 health care
workers were assessed for exposure to the patient, 72 of whom were advised to
initiate postexposure prophylaxis (PEP). The patient had no record of a
pretravel health screening, did not receive rabies preexposure vaccination
before the trip, nor had she ever been vaccinated against rabies.
This case highlights the importance of pretravel
preparation, including medical guidance, for international travelers.
India is a favorite travel destination not only for
tourists, it is also growing in popularity as a hub for medical tourism. Also,
many people come to India to learn yoga and meditate. Often, these purposes
necessitate long stay in the country.
India is endemic for rabies accounting for 36% of the
world’s human rabies deaths with 18,000-20,000 rabies deaths occurring every
year. About 30-60% of reported rabies cases and deaths in India occur in
children under the age of 15 years as bites that occur in children often go
unrecognized and unreported. Majority of human rabies cases are due to dog
bites (SEARO).
CDC guideline for rabies vaccination for travelers
recommends pre-exposure rabies vaccination (3 doses given on days 0, 7 and 21
or 28) before travel, especially for those who will be involved in outdoor
activities (such as camping, hiking, biking, adventure travel, caving) or those
who come for yoga retreats and so are likely to stay longer in the country.
But, if bitten or scratched by an animal, prompt post-exposure prophylaxis
should be sought, even if pre-exposure vaccination has been taken.
Despite these guidelines, most people do not take
pretravel consultation, including for recommended vaccinations, particularly
when visiting countries with high incidence of emerging or zoonotic pathogens.
Rabies is a 100% preventable disease, but is almost
always fatal once symptoms appear.
Pretravel rabies vaccination should be a valid option for
all international travelers, especially those traveling rabies endemic countries
and are likely to stay for long durations in the said country with outdoor
activities.
Dr KK Aggarwal
Padma Shri
Awardee
President Elect Confederation
of Medical Associations in Asia and Oceania (CMAAO)
Group
Editor-in-Chief IJCP Publications
President
Heart Care Foundation of India
Past National
President IMA
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