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BACKGROUND: Developing recommendations for travel-related rabies pre-exposure prophylaxis (preEP) is a nuanced process requiring detailed risk assessments. Such risk assessments should include evaluation of a traveler’s age, length of stay, planned activities, local rabies epidemiology, and availability of biologics at the destination. However, detailed information outlining the endemicity of rabies and the availability of biologics in many parts of the world can be limited.
METHODS: Current CDC recommendations regarding PreEP classifies destination countries into five categories: 1) canine rabies present and therefore of concern to travelers; 2) canine rabies present but not a significant concern to travelers; 3) little or no canine rabies reported; 4) rabies present in other carnivores; and 5) bat lyssaviruses present/likely/unknown. CDC subject matter experts (SMEs) in rabies and travel medicine evaluate existing literature, surveillance sources, and personal communications with regional health experts to determine individual country classifications on a regular basis. While this system provides additional information about rabies endemicity and availability of rabies biologics, it is heavily reliant on expert opinion.
RESULTS: To improve this process and make it more data driven, an open access list of country-specific risks is proposed based on standardized questions regarding endemicity of canine, wildlife, and bat lyssaviruses and the availability of biologics.
CONCLUSIONS: This list would provide an opportunity for input from a broader pool of rabies SMEs and be more responsive to local changes in epidemiology and biologics. In addition, providing individual risk levels for primary reservoir groups (e.g. canine, wildlife, and bats) and availability of biologics will give more detailed information that can be used by travel health clinicians when counseling patients.