Overall, 86 (45.7%)

subjects had prior treatments from other hospitals in Thailand or abroad. The majority of patients received the conventional five-dose Essen intramuscular regimen. The rest received varied protocols such as the 2-1-1 (Zagreb) schedule (WHO approved) or the original or modified Thai Red Cross intradermal (TRC-ID) method. Suckling mouse brain vaccine was used in one traveler in Vietnam in 2007. Three (1.6%) patients, who attended different hospitals during their courses, received more than one schedule of rabies vaccination. They were initially given the Essen intramuscular regimen for PEP and later switched to TRC-intradermal protocol at other hospitals. Before attending QSMI, 34 travelers with WHO category III exposure did not receive RIG according to WHO recommendation IDH inhibitor drugs as a result of unavailability or misinterpretation of the severity of exposure by local health care providers. Eventually, RIG

was given to 118 of 121 (97.5%) patients where it was indicated. Two selleck screening library travelers appeared later than 7 days after having started vaccination elsewhere and RIG was contraindicated at this late time when native antibodies were appearing. One traveler refused RIG without giving any reason. Fifty (42.4%) patients received purified equine rabies immunoglobulin (ERIG). None of these developed serum sickness or other significant complications. About one fourth of recipients could finish their PEP schedules at QSMI. At least 28 (14.9%) patients had to continue the vaccination course abroad—either at their home countries or next destinations. Among 594 individuals who received PrEP, 454 (76.4%) persons just started their first dose and 165 (27.8%) travelers received all three injections of PrEP at Carnitine palmitoyltransferase II QSMI (Table 4). The rest may have had their follow-up elsewhere. Travelers from Japan (263; 44.3%), UK (51; 8.5%), the United States (49; 8.2%), Germany (33; 5.6%), and France (23; 3.9%) were the top five nationalities

that received PrEP. The number of Japanese asking for PrEP was higher in 2006, the year with reported cases of imported human rabies in Japan, and this trend has sustained since then. Two (0.3%) travelers were bitten by suspected rabid dogs before their PrEP series was completed and full PEP schedule plus RIG were provided instead as <7 days since vaccination had elapsed. Forty-one (6.9%) travelers concurrently took antimalarial drugs such as mefloquine or doxycycline, and all received intramuscular rabies vaccination. As long as the rabies reservoirs in endemic regions are not controlled, travel in the affected area carries the risk of exposure. Owned and vaccinated domestic dogs in endemic zones cannot be considered entirely free of rabies. A single dose of rabies vaccine given to dogs was unable to reliably maintain protective antibody levels past 6 months, and 3% to 9% of rabid dogs had a history of rabies vaccination.