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Chapter 117. Health Advice for International Travel (Part 3)

Rabies Domestic animals, primarily dogs, are the major transmitters of rabies in developing countries (Chap. 188). Several studies have shown that the risk of rabies posed by a dog bite in an endemic area translates into 1–3.6 cases per 1000 travelers per month of stay. Countries where canine rabies is highly endemic include Mexico, the Philippines, Sri Lanka, India, Thailand, and Vietnam. The three vaccines available in the United States provide 90% protection. Rabies vaccine is recommended for long-stay travelers, particularly children, and persons who may be occupationally exposed to rabies in endemic areas. Even after receipt of a. | Chapter 117. Health Advice for International Travel Part 3 Rabies Domestic animals primarily dogs are the major transmitters of rabies in developing countries Chap. 188 . Several studies have shown that the risk of rabies posed by a dog bite in an endemic area translates into 1-3.6 cases per 1000 travelers per month of stay. Countries where canine rabies is highly endemic include Mexico the Philippines Sri Lanka India Thailand and Vietnam. The three vaccines available in the United States provide 90 protection. Rabies vaccine is recommended for long-stay travelers particularly children and persons who may be occupationally exposed to rabies in endemic areas. Even after receipt of a preexposure rabies vaccine series two postexposure doses are required. Travelers who have had the preexposure series will not require rabies immune globulin which is often unavailable in developing countries if they are exposed to the disease. Prevention of Malaria and Other Insect-Borne Diseases It is estimated that more than 30 000 American and European travelers develop malaria each year Chap. 203 . The risk to travelers is highest in Oceania and sub-Saharan Africa estimated at 1 5 and 1 50 per month of stay respectively among persons not using chemoprophylaxis intermediate in malarious areas on the Indian subcontinent and in Southeast Asia 1 250-1 1000 per month and low in South and Central America 1 2500-1 10 000 per month . Of the more than 1000 cases of malaria reported annually in the United States 90 of those due to Plasmodium falciparum occur in travelers returning or immigrating from Africa and Oceania. VFRs are at the highest risk of acquiring malaria. With the worldwide increase in chloroquine- and multidrug-resistant falciparum malaria decisions about chemoprophylaxis have become more difficult. In addition the spread of malaria due to primaquine- and chloroquine-resistant strains of Plasmodium vivax has added to the complexity of treatment. The case-fatality rate of .