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Background: After an animal-associated injury (AAI) in rabies-endemic regions, post-exposure prophylaxis (PEP) is needed to prevent infection.1,2 PEP consists of rabies vaccinations (RV) and in some cases also additional rabies immune globulins (RIG). Not always PEP medication, and RIG in particular, is accessible. Along with an increased number of exposure notifications among Dutch travellers, this might lead to treatment delay and thus to increased health risks. Until now, research mainly focused on factors associated with exposition, but none on which factors are associated with PEP delay. This study aimed to identify which general sample characteristics are associated with PEP delay while being abroad.Methods: A quantitative retrospective observational study was conducted. The study population consisted of insured Dutch international travellers who actively contacted their medical assistance company (2015-2019) because of an animal-associated injury (AAI) (N = 691). The association between general sample characteristics and delay of different PEP treatments was studied using survival analysis.Results: Travellers without pre-exposure prophylaxis (PrEP) had an increased hazard, and therefore a shorter delay, for receiving their first RV as compared to travellers with PrEP (HR:1.11, 95%CI:1.01-1.22). The travellers needing both RV and RIG had a decreased hazard, and therefore a longer delay, as compared to travellers only needing RV (HR:0.81, 95%CI:0.67-0.96). General sample characteristic associated with RIG administration delay was travel destination. Travellers to Central and South America, East Mediterranean and Europe had a decreased hazard, and therefore a longer delay, for receiving RIG treatments relative to travellers to South East Asia (HR:0.31, 95%CI:0.13-0.70; HR:0.34, 95%CI:0.19-0.61; HR:0.46, 95%CI:0.24-0.89; HR:0.48, 95%CI:0.12-0.81, respectively).Conclusions: Our results suggest that the advice for PrEP should be given based on travel destination, as this was found to be the main factor for PEP delay, among travellers going to rabies-endemic countries. [ABSTRACT FROM AUTHOR]

The article discusses the current rabies outbreaks in Indonesia, particularly in popular tourist destinations. Before the COVID-19 pandemic, Indonesia reported a high number of rabid animal bites and deaths annually. However, during the pandemic, the number of rabies exposures decreased but rebounded rapidly in 2022. Limited access to post-exposure prophylaxis (PEP) has been a challenge, with only 69% of cases receiving treatment. Efforts are being made to improve PEP coverage, but there are still issues with equitable access to vaccines and immunoglobulin. The article emphasizes the importance of promoting rabies pre-exposure prophylaxis (PrEP) for travelers and implementing strategies to enhance PrEP and PEP uptake. Additionally, broader preventative measures, such as mass vaccination programs for dog populations and awareness campaigns, are crucial for rabies elimination in tourist destinations. [Extracted from the article]

Background: Human coexistence with other animals can result in both intentional and unintentional contact with a variety of mammalian and non-mammalian species. International travellers are at risk for such encounters; travellers risk injury, infection and possibly death from domestic and wild animal bites, scratches, licks and other exposures. The aim of the present analysis was to understand the diversity and distribution of animal-related exposures among international travellers.Methods: Data from January 2007 through December 2018 from the GeoSentinel Surveillance Network were reviewed. Records were included if the exposure was non-migration travel with a diagnosis of an animal (dog, cat, monkey, snake or other) bite or other exposure (non-bite); records were excluded if the region of exposure was not ascertainable or if another, unrelated acute diagnosis was reported.Results: A total of 6470 animal exposures (bite or non-bite) were included. The majority (71%) occurred in Asia. Travellers to 167 countries had at least one report of an animal bite or non-bite exposure. The majority (76%) involved dogs, monkeys and cats, although a wide range of wild and domestic species were involved. Almost two-thirds (62.6%) of 4395 travellers with information available did not report a pretravel consultation with a healthcare provider.Conclusions: Minimizing bites and other animal exposures requires education (particularly during pretravel consultations) and behavioral modification. These should be supplemented by the use of pre-exposure rabies vaccination for travellers to high-risk countries (especially to those with limited access to rabies immunoglobulin), as well as encouragement of timely (in-country) post-exposure prophylaxis for rabies and Macacine alphaherpesvirus 1 (herpesvirus B) when warranted. [ABSTRACT FROM AUTHOR]

Background: Since 2000, a steady increase of vaccines used for both rabies Post-exposure prophylaxis (PEP) and rabies Pre-exposure prophylaxis (PrEP) given to Danish travellers was observed. This study aims to evaluate whether the increase of PEP and PrEP was due to increased travelling, increased awareness of the need for PrEP, or more animal bites per travel, leading to more PEP being administered, in order to assess the need for changing the recommendations. We also described in which countries Danish travelers most frequently reported possible exposure to rabies, and evaluated the timeliness of rabies PEP, including rabies immunoglobulin (RIG).Methods: We included all Danes reported to the National Database for Rabies Treatment as having started rabies PEP either abroad or after returning to Denmark, between 2000 and 2012. Data on the yearly number of Danish travelers from 2004 to 2012 to Thailand were collected to calculate the incidence of animal bites at this destination. We also included data on rabies vaccines sold for PrEP or for booster vaccination in Denmark.Results: PEP after possible exposure to rabies abroad increased yearly by 8.8 %. Likewise vaccines sold for PrEP increased by 8.2% annually. The number of Danish travelers to Thailand increased by 7.3% per year, resulting in a stable incidence of animal bites per 100,000 travelers. Seventy-five % started PEP in the country of exposure, while only 10 % received RIG.Conclusions: The yearly increase in PEP and PrEP are parallel to the yearly increase in number of travelers, and can thus be explained by the increased rate of traveling, and not by a rise in awareness of rabies risk or more bites per traveler.Even short term travelers should be given the option of including PrEP in their travel immunisation program, as PEP and especially RIG is not always available in rabies-endemic countries. [ABSTRACT FROM AUTHOR]

Background: Travel and aquatic activities are increasing in tropical regions. The risk and the spectrum of marine envenomation are unknown in travellers. This work aims to evaluate the prevalence and the characteristics of marine envenomations in returning travellers.Methods: We retrospectively studied the medical charts of all returning travellers presenting with a health problem in a French tropical disease unit between 2008 and 2013, with focus on travellers complaining of marine envenomation. Characteristics of each type of envenomation are described.Results: Of the 3315 travellers seen during the study period, 43 consulted for a presumed marine envenomation. Six patients were excluded, leaving 37 cases of confirmed marine envenomation. It corresponds to a prevalence of 1.1%. Sex ratio was balanced with 18 men and 19 women. Median age was 42 years (range 25-68 years). Median travel duration was 14 days (range: 6-62 days). The main travel destination was Southeast Asia in 10 cases, followed by islands of East Africa in seven cases. Median elapsed time between envenomation and consultation was 14 days (range: 2-130 days). The purpose of travel was tourism in all cases. The main clinical aspects were oedema, sting marks, cellulitis and flagellations. Eleven cases were presumably caused by corals, 10 by stonefish, 8 by jellyfish, 2 by weever fish, 2 by starfish, 2 by stingray, 1 by lionfish and 1 by sea anemone.Conclusion: Prevalence of marine envenomation is low in returning travellers. They are mostly caused by corals, stonefish and jellyfish. [ABSTRACT FROM AUTHOR]

Background Authorities have pledged to eliminate canine rabies by 2020 in Cambodia, a country with a very high rabies burden. Logistic and financial access to timely and adequate postexposure prophylaxis ( PEP) is essential for preventing rabies in humans. Methods We undertook a survey of the few identified sites where PEP rabies vaccination and rabies immunoglobulin ( RIG) are available in Cambodia. We examined the Rabies Prevention Center at Institut Pasteur du Cambodge (rpc@ipc) database and rpc@ipc order forms for 2012 to assess vaccine and RIG use. We conducted a rapid internet survey of centers that provide rabies vaccine and RIG in Cambodia, other than rpc@ipc. Results The cost of a full course of intramuscular or intradermal PEP in Cambodia, with and without RIG, was also estimated. Rabies vaccination is free of charge in one foundation hospital and is accessible for a fee at Institut Pasteur du Cambodge (IPC), some institutions, and some Cambodian private clinics. In 2012, 27,500 rabies vaccine doses (0.5 mL) and 591 equine RIG doses were used to provide intradermal PEP to 20,610 persons at rpc@ipc following animal bites. Outside of rpc@ipc, an estimated total of 53,400 vaccine doses and 200 RIG doses were used in Cambodia in 2012. The wholesale cost of full rabies PEP was estimated at 50% to 100% of a Cambodian farmer's monthly wage. Conclusions Local populations and travelers cannot be sure to locally access adequate and timely PEP due to high costs and low access to RIG. Travelers to high-endemic areas such as Cambodia are strongly encouraged to undergo pre-exposure vaccination or seek expert advice, as per World Health Organization ( WHO) recommendations. State-subsidized, pre-positioned stocks of human vaccine and RIG in bite management centers would extend the rabies prevention centers network. Support from Institut Pasteur du Cambodge for staff training, cold chain, and quality control would contribute to reducing the risk of rabies deaths in Cambodia. [ABSTRACT FROM AUTHOR]

The article presents a study of fatal and severe box jellyfish stings in Malaysia in 2000-2010 . It mentions the uses of internet-base retrospective health data aggregation to document the health significance, and clinical spectrum of box jellyfish stings. It suggest that frequency and severity of jellyfish stings in Southeast Asia have been underestimated. It adds that the use of marine stinger treatment and prevention principles may help reduce the severity and incidence of stings.

The article discusses box jellyfish stings in seawater in and around Thailand. It presents various cases of jellyfish stings which were reported between 1985 and 2008. It states that the two most reliable types of stings to diagnose in the field or in a clinical context are from chirodropids and Irukandjis. It also suggests to update sting prevention strategies, targeting the highest risk populations and activities.

The Irukandji syndrome is a jellyfish envenomation caused by Carukia barnesi or related jellyfish. In literature, the distribution of “Irukandji-like” syndromes is restricted to Australia. We report a case of probable Irukandji syndrome in Thailand. With this report, we hope to promote awareness to aid sting prevention and stimulate research. [ABSTRACT FROM AUTHOR]

Background. Jellyfish stings are a common occurrence among ocean goers worldwide with an estimated 150 million envenomations annually. Fatalities and hospitalizations occur annually, particularly in the Indo-Pacific regions. A new topical jellyfish sting inhibitor based on the mucous coating of the clown fish prevents 85% of jellyfish stings in laboratory settings. The field effectiveness is unknown. The objective is to evaluate the field efficacy of the jellyfish sting inhibitor, Safe Sea™. Methods. A double-blind, randomized, placebo-controlled trial occurred at the Dry Tortugas National Park, FL, USA and Sapodilla Cayes, Belize. Participants were healthy volunteers planning to snorkel for 30 to 45 minutes. Ten minutes prior to swimming, each participant was directly observed applying a blinded sample of Safe Sea (Nidaria Technology Ltd, Jordan Valley, Israel) to one side of their body and a blinded sample of Coppertone® (Schering-Plough, Kenilworth, NJ, USA) to the contralateral side as placebo control. Masked 26 g samples of both Safe Sea SPF15 and Coppertone® SPF15 were provided in identical containers to achieve 2 mg/cm2 coverage. Sides were randomly chosen by participants. The incidence of jellyfish stings was the main outcome measure. This was assessed by participant interview and examination as subjects exited the water. Results. A total of 82 observed water exposures occurred. Thirteen jellyfish stings occurred during the study period for a 16% incidence. Eleven jellyfish stings occurred with placebo, two with the sting inhibitor, resulting in a relative risk reduction of 82% (95% confidence interval: 21%–96%; p= 0.02). No seabather’s eruption or side effects occurred. Conclusions. Safe Sea is a topical barrier cream effective at preventing >80% jellyfish stings under real-world conditions. [ABSTRACT FROM AUTHOR]

Presents a study that assessed the number of insect bites, the extent of the insect biting nuisance and the impact on expedition activities of British youth in Alaska. Methodology; Results and discussion.

A woman stung by the box jellyfish Carybdea marsupialis (Cnidaria, Cubozoa) at a Spanish Mediterranean beach showed systemic manifestations over several months [pain far from the inoculation point, arthralgia, paresthesia, hyperesthesia, increase in eosinophils and immunoglobulin E (IgE)] in addition to the skin condition. [ABSTRACT FROM AUTHOR]

This article presents a case study of zebra bite to a South African tourist. The patient encountered the zebra in the doorway of her accommodation. The animal knocked the patient over and bit the posterior surface of her left lower leg. This resulted in a degloving injury. The patient was seen at a hospital, where the partially avulsed skin, which had a proximally based attachment, was sutured back to the leg. After suturing, the patient was transferred to a hyperbaric oxygen unit. The trial of hyperbaric oxygen therapy was undertaken with the intention of assisting healing and survival of the sutured skin, a significant portion of which had turned blue. Signs of cellulitis was noted after a number of hyperbaric oxygen sessions. The distal part of the sutured skin was noted to have a collection of blood-stained serous fluid underneath it, this piece of skin was judged to be nonviable and was debrided. The defect in the leg was covered with a skin graft harvested from the thigh, and oral antibiotics were prescribed. When the wound was inspected under general anesthesia, it was noted that the skin graft had taken well. Further management was by outpatient wound care. As healing progressed, the patient was seen by an occupational therapist for the provision of pressure garments, silicone sheeting, and mobilization exercises. Tourists should be reminded that animal bites, including those from equine species, may transmit rabies in some settings.

Immediate and long-term recalls of a pre-travel consultation are suboptimal. We aimed to assess the role of online consultation for travellers.We randomized travellers into two study groups. In the intervention arm, each traveller was given a short pre-travel consultation of 8-12 minutes, combined with the option of smartphone support before and during the trip. In the control arm, each traveller was given a standard length pre-travel consultation of 18-22 minutes. Endpoints included knowledge about potential risks, travellers' satisfaction, time allocated to each traveller and clinical events.We enrolled 75 patients in the intervention group and 74 patients in the control group. Online consultation was used 33 times, by 24 travellers, both before and during the trip. Important health hazards that were addressed included animal and insect bites (8), treatment of diarrhea (4), malaria prophylaxis (2) and altitude sickness prophylaxis (5). Other consultations consisted mainly of reassurances of worried travellers and provision of data. Knowledge about travel-related risks was higher in the control group before travelling (8.86 ± 1.12 vs 8.34 ± 1.32, P = 0.014), and there was a trend towards higher levels of knowledge also during the trip (8.29 ± 1.35 vs 7.89 ± 1.39, P = 0.06). Travellers' satisfaction before and during the trip was similar in both groups: median 10 (10, 10) in both groups before traveling (P = 0.51) and median 9 (8, 10) in both groups during the trip (P = 0.71). In the intervention group, time allocated to each traveller was <12 minutes. There were no differences in the number of clinical events (P > 0.2 for all comparisons).Online WhatsApp support addressed several important travel-related hazards but, when combined with a shortened pre-travel consultation, was associated with a lower level of knowledge about health risks. Therefore, such smartphone support should augment, rather than replace, pre-travel consultation. [ABSTRACT FROM AUTHOR]

To warn physicians and parents about the risk of macaque bites, we present two pediatric cases (a 4-year-old boy and a 10-year-old girl) of bites sustained while on holiday. The young boy developed febrile dermohypodermitis and was hospitalized for IV antibiotic treatment. He received an initial antirabies vaccine while still in the holiday destination. Except for local wound disinfection and antibiotic ointment, the girl did not receive any specific treatment while abroad. Both were negative for simian herpes PCR. When travelling in countries or cities with endemic simian herpes virus, parents should keep children away from monkeys. Travel agencies, pediatricians and family physicians should better inform families about the zoonotic risk. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old man with human rabies after an uncommon mode of exposure to hon-human primates (NHP). It notes that the patient had history of monkey bite which he did not receive post-exposure prophylaxis. He died within the day of hospital admission where he found agitated, delirious and had hallucinations.

A 20-year-old male soldier was hit by the jellyfish. The ophthalmic examination revealed that epithelial keratitis and corneal oedema in the right eye. We prescribed 3% NaCl eyedrops and 0.3% Norfloxacin eyedrops in the treatment of the corneal jellyfish stings. Two weeks later, the cornea in the right eye healed. In this case report, 3% NaCl eyedrops was effective in the treatment of acute phase of jellyfish stings of the cornea. [ABSTRACT FROM AUTHOR]

A case of confirmed rabies in a French resident is a wake-up call for improved access to timely and adequate rabies post-exposure prophylaxis for all those living in Cambodia, as well as for improved pre-exposure prevention in travellers to Cambodia and other highly endemic settings. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old Belgian woman who was admitted to the hospital with a flu-like syndrome, during a trip to Southern Germany. Topics include diagnosis of meningoencephalitis and completion of a 10-day course of intravenous ceftriaxone, diagnosis of TBE based on specific antibody detection, and no change in tick-borne encephalitis virus (TBEV) immunofluorescence and neutralization assay results.

We present a 31-year-old man who, after a Conus textile sting acquired in New Caledonia, developed a cutaneous abscess on a buttock. The abscess was accompanied by pain, paraesthesia, general malaise, and fever. Complete remission was achieved by sodium hypochlorite packs and oral amoxicillin/clavulanic acid, metronidazole, and tramadol. [ABSTRACT FROM AUTHOR]

Describes the first case of spirillary rat-bite fever or sodoku in a short-term traveler. Information on sodoku; Isolation in the mouse or guinea pig after intraperitoneal inoculation of blood or lymph node samples; Risk of infection after a rat bite.