Rabies update for travel medicine advisors

Rabies is a neglected disease in many developing countries. It is preventable, and the tools to prevent it are known. There is urgent need for more funding, for study of innovative dog population–control measures, and for sustainable canine immunization. Safe and effective tissue-culture rabies vaccines and human and equine rabies immunoglobulins (HRIG and ERIG) are not readily available in many regions where rabies is endemic. This and the continuing presence and spread of rabies have increased the risk for travelers, who cannot rely on being able to receive optimal postexposure treatment in many parts of the world. Alternatives to HRIG or ERIG are not available. Travelers who leave the safe environments of tourist hotels and buses in regions of Asia, Russia, Africa, and Latin America where canine rabies is endemic may be at risk of life-threatening exposure to rabies. Rabies, the infectious disease with the highest known case-fatality rate, remains a worldwide threat. More humans die of rabies than die of Japanese encephalitis, leprosy, and polio [1, 2]. Rabies is not notifiable in many countries, making preva-lence statistics unreliable. Global estimates indicate that there are ∼50,000 annual human deaths [3]. In Asia, Africa, Russia, parts of South and Latin America, and most of the newly in