size of the problem
The anger in the world kills one person every ten minutes, more than 50,000 deaths annually, mostly concentrated in Africa and Asia. In India alone about 30,000 deaths a year. To raise awareness populations and governments towards this silent massacre, for some years was established World Rabies Day: This year the event is September 28. E 'need for a broad international effort to achieve the elimination of animal rabies and, therefore, than that of humans. It is therefore a demanding action on public health and veterinary health.
Risk in the traveler
As operators of Travel Medicine, we must focus our attention on the risk of rabies in the individual traveler. It is estimated that each month from 2 to 4 travelers to endemic areas in 1000 receive a bite of mammals: in most cases they are at risk of exposure to rabies, almost invariably fatal.
The risk of rabies for a traveler in an endemic area is higher if the stay is prolonged (greater than or equal to 30 days), if you engage in certain activities (cycling, hiking, exploring caves), if you visit rural areas or areas inhabited by stray dogs, if the accommodation is insecure (eg. sleeping in tents or on mats placed in open space) or if there is an exhibition of professional (veterinarians, zoologists). The exposed person may underestimate the risk, as is the case in relation injuries from the bite of a bat, typically mild.
Children are particularly at risk: they tend to spontaneously get close to animals and also when they are small they can not detail the circumstances of the assault. In addition to animal bite injuries in children are usually more severe.
What happens if the traveler is not exposed vaccinated?
The unvaccinated traveler, as you know, in case of animal bite or other exposure to rabies risk and should receive the rabies immunoglobulin (RIG, Rabies Immune Globulins) is a series of 4 doses of vaccine at regular intervals. If the traveler has previously received a series of 3 doses of vaccine (pre-exposure prophylaxis) will only receive two additional doses of vaccine without RIG. The problem is that in developing countries access to a full and proper post-exposure prophylaxis is not always guaranteed, in particular, the RIG are often not available, so the hypothesis that the traveler remains exposed without treatment does not appear remote.
Vaccination against rabies in Italy
Modern rabies vaccines produced from cell cultures are very effective and extremely sure, but my impression is that in Italy are under-used. Travelers at risk are informed about the availability of the vaccine and the risk of failure to pre-exposure prophylaxis? Not necessarily, because of this issue, speaks very little during the training. In contrast, compared with foreign colleagues, especially northern Europeans and Americans, I noticed the attention they devote to the anger in the counseling of the traveler.
probably weigh negatively on the rabies vaccination reminder of the adverse reactions that occurred in the past following the administration of rabies vaccines derived from brain tissue mice and that were closely related to that particular medium. But such an attitude today is no longer a scientific basis, being merely a prejudice.
Main few references:
Wunner WH, Briggs DJ. Rabies in the 21 st Century. PLoS Neglected Tropical Diseases 2010 4 (3): e591. doi: 10.1371/journal.pntd.0000591
Gautret P, Schwartz E, Shaw M et al. Animal-Associated Among related diseases and injuries returned travelers: a review of the GeoSentinel Surveillance Network. Vaccine 2007, 25:2656-63 doi: 10.1016/j.vaccine.2006.12.034
The site of the World Rabies Day: http://www.worldrabiesday.org
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