Delayed and incomplete rabies post-exposure prophylaxis among international travelers: A seven-year retrospective study at an emergency center in eastern Thailand

Background

Rabies remains a significant global health concern. The aim of this study was to identify risk factors associated with delayed and incomplete post-exposure prophylaxis (PEP) for rabies among international travelers in eastern Thailand.

Methods

A retrospective study was conducted using the medical records of 528 international patients from January 2016 to December 2022. Logistic regression was used to analyze factors associated with delayed and incomplete PEP.

Results

PEP was delayed in 10.1 % of the patients and incomplete in 45.6 % of the patients. The factors associated with delayed PEP included an age of 35–60 years (AOR: 3.08, 95 % CI: [1.07, 8.86]), superficial wounds (2.86, 95 % CI: [1.38, 5.92]), and a single wound (1.88, 95 % CI: [1.01, 3.49]). Incomplete PEP was associated with ages 18–34 and 35–60 years (2.04, 95 % CI: [1.25, 3.32]; 2.28, 95 % CI: [1.27, 4.09]) and exposure to a non-dog mammal (2.05, 95 % CI: [1.29, 3.25]). Previous rabies immunization (0.19, 95 % CI: [0.10, 0.36]) and an intradermal vaccination regimen (0.58, 95 % CI: [0.39, 0.84]) were associated with a lower risk of incomplete PEP. There was no difference in delayed and incomplete PEP for rabies between Southeast Asian and non-Southeast Asian travelers.

Conclusion

In this study, a large proportion of international travelers had delayed or incomplete PEP for rabies. The patient's age and wound characteristics and the animal type were key factors that influenced PEP adherence. These findings highlight the need for targeted interventions to improve adherence to rabies PEP among international travelers in regions where rabies is endemic.