Survey of rabies preexposure and postexposure prophylaxis among missionarypersonnel stationed outside the United States

Background: Of the 36 cases of human rabies that have occurred in the Unite d States since 1980, 12 (33%) were presumed to have been acquired abroad. I n the United States, it is recommended that international travelers likely to come in contact with animals in canine rabies-enzootic areas that lack i mmediate access to appropriate medical care, including vaccine and rabies i mmune globulin, should be considered for preexposure prophylaxis. In 1992, the death of an American missionary who had contracted rabies while station ed in Bangladesh highlighted this high-risk group. Methods: To assess their knowledge of rabies risk, rabies exposures, and co mpliance with preventive recommendations, we asked 695 missionaries and the ir family members to complete questionnaires about their time stationed abr oad. Results: Of the 293 respondents stationed in countries where rabies is ende mic, 37% reported prior knowledge of the presence of rabies in their countr y of service. Only 28% of the personnel stationed in rabies-endemic countri es received preexposure prophylaxis. Having preexposure prophylaxis specifi cally recommended increased the likelihood of actually receiving it (O.R. 1 5.6, 95%CI 7.4 - 34.9). There were 38 reported exposures (dogs = 66%, anoth er human = 20%), proven or presumed to be rabid. Three of the people expose d received rabies immune globulin and vaccine; 11 received vaccine alone; 8 received only basic first aid, and 16 received no treatment. Conclusions: Although American missionaries stationed abroad are at an incr eased risk for exposure to rabies, compliance with established preventive m easures was low. Prior to being stationed abroad, an educational rabies-pre vention briefing, including encouragement to receive preexposure prophylaxi s, could be an effective intervention for missionaries to decrease their ri sk of rabies.