Uptake and determinants of rabies pre-exposure prophylaxis among at-risk travelers

Rabies pre-exposure prophylaxis (PrEP) can be given before travel and simplifies post-exposure prophylaxis (PEP). We studied the knowledge about rabies, the uptake of PrEP, and reasons for deciding for or against PrEP in at-risk travelers. We also examined how healthcare professionals (HCPs) counsel on rabies prevention.

The author(s)

  • Caroline Aurensan Healthcare
  • Elaine Melander Healthcare
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Methods

On behalf of Bavarian Nordic, Ipsos MORI conducted two online surveys in the USA. Fieldwork from February 24th to April 23rd 2021:

  • 689 participants aged 18-85 years, visited one of 91 rabies endemic countries in the past 3 years for at least 1 week, involved in at least 1 of 7 at-risk activities, heard of rabies, positive towards vaccination and chose to take part (surveyed travelers).
  • 76 HCPs, with responsibility for advising/ making decisions about vaccination requirements for their patients, personally recommend or prescribe vaccines for rabies, positive towards vaccination and chose to take part (surveyed HCPs).

Results

A minority (36%) of surveyed travelers classified rabies as a life-threatening disease.

A third of surveyed HCPs (37%) did not discuss rabies vaccination with at-risk travelers, 18% discussed only PEP, 23% only PrEP and 22% both.

A minority (21%) of the surveyed travelers reported to have received rabies vaccination since they were 18. Among those participants (n=145), the most common reasons for deciding to get PrEP were for their own peace of mind (35%) and following an HCP recommendation (32%).

Of those who decided not to receive the rabies vaccine (n=319), the most common reasons were that they did not think their risk of rabies was sufficient (23%) and that the HCP did not suggest it (23%).

Conclusions

The survey demonstrated potential knowledge gaps around rabies and low PrEP coverage among surveyed travelers. It also highlighted the role of HCP recommendation and showed that more than half of HCPs did not discuss PrEP with at-risk travelers.

Detailed technical note

On behalf of Bavarian Nordic, Ipsos MORI conducted two online surveys:

  • On behalf of Bavarian Nordic, Ipsos MORI conducted two online surveys in the US. A survey with 689 participants who chose to take part in the study:
    • Fieldwork took place from 4th March to 23rd April 2021.
    • To qualify for participation in the survey, respondents had to:
      • be a US resident
      • be aged between 18 and 85 years old
      • have visited at least one of 91 rabies endemic country in the past 3 years for at least 1 week and have taken part in one of 7 at-risk rabies activities
      • have heard of rabies
      • Vaccine rejecters were not included in the survey (potential respondents had to describe their views on vaccination by rating 3 statements on a 7 point agreement scale where 1 means completely disagree and 7 means completely agree. The survey included only those who selected 5-7 for ‘I trust vaccines to help prevent disease‘ and  ‘I believe vaccines reduce the risk of getting the disease’ and also selected 1-4 for ‘I try to avoid vaccines because I think they are not safe’.)
  • A survey with 76 Healthcare professionals from the US who chose to take part in the study:
    • Fieldwork took place from 24th of February to 13th of April 2021
    • To qualify for participation in the survey, respondents had to:
      • Have been practicing in their medical specialty for at least 2 years and less than 40 years
      • Have responsibility for advising or making decisions about vaccination requirements for their patients
      • Personally recommend or prescribe vaccines for rabies
      • Vaccine rejecters were not included in the survey (potential respondents had to describe their views on vaccination by rating 3 statements on an 7 point agreement scale where 1 means completely disagree and 7 means completely agree. The survey included only those who selected 5-7 for ‘I trust vaccines to help prevent disease‘ and ‘I believe vaccines reduce the risk of getting the disease’ and also selected 1-4 for ‘I try to avoid vaccines for my patients because I think they are not safe and can have side effects’.)
    • Quotas were imposed so the sample consisted of:
      • 40 HCPs working in a vaccination centres (work in a vaccination/ travel centre or in a setting that offers yellow fever vaccination)
      • 45 being the main decision maker on which specific vaccine brand/ product is prescribed in their practice 

To view the question text used to obtain the data shown, please download the document below. 

The author(s)

  • Caroline Aurensan Healthcare
  • Elaine Melander Healthcare

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