title: The global availability of rabies immune globulin and rabies vaccine in clinics providing direct care to travelers.
abstract: BACKGROUND
  Rabies, which is globally endemic, poses a risk to international travelers. To improve recommendations for travelers, we assessed the global availability of rabies vaccine (RV) and rabies immune globulin (RIG).
  
  
  METHODS
  We conducted a 20-question online survey, in English, Spanish, and French, distributed via e-mail to travel medicine providers and other clinicians worldwide from February 1 to March 30, 2011. Results were compiled according to the region.
  
  
  RESULTS
  Among total respondents, only 190 indicated that they provided traveler postexposure care. Most responses came from North America (38%), Western Europe (19%), Australia and South and West Pacific Islands (11%), East and Southeast Asia (8%), and Southern Africa (6%). Approximately one third of 187 respondents stated that patients presented with wounds from an animal exposure that were seldom or never adequately cleansed. RIG was often or always accessible for 100% (n = 5) of respondents in the Middle East and North Africa; 94% (n = 17) in Australia and South and West Pacific Islands; 20% (n = 1) in Tropical South America; and 56% (n = 5) in Eastern Europe and Northern Asia. Ninety-one percent (n = 158) of all respondents reported that RV was often or always accessible. For all regions, 35% (n = 58) and 26% (n = 43) of respondents felt that the cost was too high for RIG and RV, respectively.
  
  
  CONCLUSIONS
  The availability of RV and RIG varied by geographic region. All travelers should be informed that RIG and RV might not be readily available at their destination and that travel health and medical evacuation insurance should be considered prior to departure. Travelers should be educated to avoid animal exposures; to clean all animal bites, licks, and scratches thoroughly with soap and water; and to seek medical care immediately, even if overseas.
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. EFJ8@CDC.GOV
authors.forename: Emily S
authors.initials: ES
authors.lastname: Jentes
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Blanton
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Johnson
authors.forename: Brett W
authors.initials: BW
authors.lastname: Petersen
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Lamias
authors.forename: Kis
authors.initials: K
authors.lastname: Robertson
authors.forename: Richard
authors.initials: R
authors.lastname: Franka
authors.forename: Deborah
authors.initials: D
authors.lastname: Briggs
authors.forename: Peter
authors.initials: P
authors.lastname: Costa
authors.forename: Irene
authors.initials: I
authors.lastname: Lai
authors.forename: Doug
authors.initials: D
authors.lastname: Quarry
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rupprecht
authors.forename: Nina
authors.initials: N
authors.lastname: Marano
authors.forename: Gary W
authors.initials: GW
authors.lastname: Brunette
mesh_terms: D000818:Animals; D001733:Bites and Stings / Q000209:etiology / Q000628:therapy; D004199:Disease Vectors; D019353:Endemic Diseases; D005392:First Aid / Q000379:methods; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007116:Immunization, Passive / Q000379:methods*; D038622:Internationality; D020380:Needs Assessment; D011314:Preventive Health Services / Q000379:methods / Q000706:statistics & numerical data; D011818:Rabies / Q000453:epidemiology / Q000517:prevention & control; D011819:Rabies Vaccines / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D014195:Travel; D057236:Travel Medicine / Q000379:methods
chemical_list: D011819:Rabies Vaccines