PREEXPOSURE RABIES PROPHYLAXIS FOR THE INTERNATIONAL TRAVELER - A DECISION-ANALYSIS

To determine for which travellers pre-exposure rabies prophylaxis is i ndicated, a decision tree-based model has been developed which enables the comparison of one million travellers going to rabies-endemic area s who receive a pre-exposure rabies prophylaxis to one million travell ers also going to rabies-endemic areas who are not vaccinated. Using d ata obtained from a review of the literature, probabilities were assig ned to each significant outcome. When numbers were not available, esti mates were used and tested with a sensitivity analysis. Routine pre-ex posure prophylaxis would prevent 0.054 cases per million adult travell ers per month at a cost of 5 billion (thousand million) Canadian dolla rs. In the worst-case scenario, which concerns children, the cost per case prevented per year of stay would be $275 000 dollars. Our decisio n analysis leads us to believe that routine pre-exposure prophylaxis g iven to travellers hending for rabies-endemic regions of the world is not indicated. We conclude that pre-exposure rabies prophylaxis is a m edical decision that must be individualized for every traveller and sh ould be particularly considered for children at high risk of being exp osed to rabies, who are leaving for a long stay (more than one year) a nd who will not have rapid access to medical services and rabies immun obiologics.