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Japanese encephalitis, rabies vaccination low among travelers to Asia
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A low proportion of travelers to Asia completed their vaccination series against rabies and Japanese encephalitis, according to study results presented at the American Society of Tropical Medicine and Hygiene annual meeting in Washington, D.C.
"Clinicians should consider a multi-trip assessment (cumulative risk concept) when advising on rabies and Japanese encephalitis vaccination for travelers to Asia, and improve counseling on preventing animal bites," study researcher Xaviour J. Walker, MD, of Mount Auburn Hospital in Cambridge, Mass., told Infectious Disease News. "They should also develop outreach strategies so that travelers with complex itineraries obtain timely pre-travel assessment at least 4 weeks prior to travel."
Xaviour J. Walker
Walker and colleagues in the Boston Area Travel Medicine Network collected demographic and travel information on 15,317 patients who had received pre-travel consultations, including previous vaccinations, reasons for travel, trip duration and the type of immunization advice they had received.
One-third of the patients (n=5,091) in the study planned to travel to eastern, southeastern and southern Asia. Among those, 52% were female (mean age, 36 years). The median trip duration was 17.8 days, and 28% of the patients were planning to travel to Asia for more than 4 weeks. Only 5% had previously completed their rabies vaccination series, and 6% received the complete series before their most recent departure. Three percent of the travelers previously received the complete Japanese encephalitis series, and 8% were immunized before their most recent departure. Completed vaccinations against rabies (17%) and Japanese encephalitis (24%) were most common among those traveling for the purposes of education, research, missionary or volunteer work. Patients visiting family and friends had the lowest completion rate for rabies (2%) and Japanese encephalitis (5%).
Among travelers who had no previous vaccination against rabies and whose trips lasted longer than 4 weeks (n=991), 59% were seen by a clinician no earlier than 21 days before traveling. Forty-six percent of travelers who had no previous vaccinations against Japanese encephalitis and whose trips lasted longer than 4 weeks (n=994) were seen no earlier than 28 days before traveling. These time constraints limit the completion of rabies and Japanese encephalitis vaccinations.
A majority of the travelers received advice about vector precautions (97%), but fewer travelers were advised about rabies infection and the risks associated with animal contact (77% to 88%).
According to the researchers, an insufficient amount of time to complete the complex, multi-dose vaccination series may have been a reason for the low completion rates. Consequently, travelers should be advised to schedule consultations at least 4 to 6 weeks ahead of departure.
"Cost may have also influenced vaccination decision," the researchers wrote. "Health care providers should ensure rabies and animal bite prevention education in pre-travel consultations, in addition to emphasis on vector avoidance." — John Schoen
Xaviour J. Walker, MD, can be reached at xwalker@mah.harvard.edu.
For more information:
Walker XJ. Abstract #724. Presented at: American Society of Tropical Medicine and Hygiene annual meeting; Nov. 13-17, 2013; Washington, D.C.
Disclosure: The researchers report no relevant financial disclosures.