Human rabies, a disease of the poor - Also in travelers?

摘要

Like other neglected zoonotic diseases, rabies is a disease of the poor. Of the worldwide estimated 55 000 human deaths, the majority of deaths occur in developing countries where rabies is endemic. India alone, for instance, accounts for about 20 000 annual human death cases. In particular, it is the less wealthy and less well-educated individuals that for a variety of reasons fail to seek the proper medical treatment after an exposure. However, an exposure in a,rabies-endemic country may occur not only to local residents but also to travelers, and awareness among travelers from countries, where rabies is much less in focus, has led to deaths. We have published a list of 42 rabies cases in travelers from Europe, North America, or Japan to rabies endemic countries between 1990 and 2010. The majority of these travelers have been exposed in countries of Asia, Africa, or Latin America and unsurprisingly almost all of the individuals did not receive appropriate post-exposure prophylaxis (either not seeking medical attention or vaccination being withheld or incomplete).1 Carrara and co-workers expand the list to worldwide cases between 1990 and 2012, adding a number of cases that we did not mention.2 While it can be debated, who to include in such a survey (e.g. whether to include only travelers crossing state borders, or only crossing continents, etc.), the circumstances of the cases are similar.