title: Rabies exposure in international travelers: do we miss the target?
abstract: BACKGROUND
  Little data exist about the spatial distribution of the risk for travelers of being injured by a potentially rabid animal.
  
  
  METHODS
  Over the last 14 years, animal-associated injuries in 424 international travelers presenting to a travel medicine clinic in Marseille, southern France, were investigated.
  
  
  RESULTS
  The majority of cases were reported from North Africa (41.5%) and Asia (22.2%). Most countries where at-risk injuries occurred (Algeria, Morocco, Tunisia, Thailand, and Turkey) were those for which travelers do not usually seek advice at a specialized travel clinic, because these countries are not at risk for specific travel-associated diseases like malaria or yellow fever. The probability of travelers being attacked by each animal species varied significantly according to the destination country. Dogs were more frequently involved in Algeria, cats in Tunisia and the Middle East, and non-human primates in sub-Saharan Africa, Madagascar, and Asia.
  
  
  CONCLUSIONS
  We suggest that rabies pre-exposure vaccination should be offered to individuals traveling regularly to North Africa to visit their relatives and who are at high risk of exposure to potentially rabid animal attacks. Pre-travel advice when addressing rabies prevention should consider the specific epidemiology of animal-related injuries in the traveled country, as well as the traveler's characteristics. Travelers should be advised about which species of animal are potentially aggressive in their destination country so that they can more easily avoid risk-contacts.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hôpital Nord, AP-HM, Chemin des Bourrelys, 13915 Marseille, Cedex 20, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gautret
authors.forename: Eric
authors.initials: E
authors.lastname: Adehossi
authors.forename: Georges
authors.initials: G
authors.lastname: Soula
authors.forename: Marie-Josèphe
authors.initials: MJ
authors.lastname: Soavi
authors.forename: Jean
authors.initials: J
authors.lastname: Delmont
authors.forename: Yolande
authors.initials: Y
authors.lastname: Rotivel
authors.forename: Philippe
authors.initials: P
authors.lastname: Brouqui
authors.forename: Philippe
authors.initials: P
authors.lastname: Parola
mesh_terms: D000293:Adolescent; D000328:Adult; D000352:Africa, Northern; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000829:Animals, Domestic; D000835:Animals, Wild; D001208:Asia; D001733:Bites and Stings / Q000453:epidemiology / Q000517:prevention & control; D002415:Cats; D002648:Child; D002675:Child, Preschool; D004285:Dogs; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D011819:Rabies Vaccines / Q000627:therapeutic use; D018570:Risk Assessment; D014195:Travel; D055815:Young Adult
chemical_list: D011819:Rabies Vaccines