Data regarding age, gender, country of exposure, the animal implicated in the exposure, prior preexposure vaccination, postexposure management with immunoglobulin and/or vaccine, site of injury, and time delay between date of exposure and treatment initiation were collected. Some travelers had started the treatment overseas and we considered human diploid cell vaccine (HDCV), purified chick embryo cell vaccine (PCECV), or purified vero cell rabies vaccine (PVRV) to be appropriate, as indicated in the HPA guidelines.

These vaccines can be Alpelisib safely interchanged.11 The management of the exposure was compared with HPA guidelines on the basis of the risk assessment (Table 2). Data analysis was performed using SPSS software (version 13 for Windows; SPSS Inc, New York, USA). A total of 142 patients attended PEP (Figure 1). Three of the medical records were not available and these were omitted from the analysis. Of the remaining 139 patients, 68 (48.9%) were female and 71 (51.1%) were male. The mean age of the cases was 35 (range: 2–84, SD: 16.8) with 8 missing data. Seven (5.3%) were younger than 10 years and 4 (2.9%) were older than 65 years (Figure 2). Exposures predominantly occurred in Thailand (31; 22.3%) and Turkey (31; 22.3%). Other countries involved were India (10; 7.2%) and Sri Lanka (5; 3.6%) (Figure 3). Most injuries involved the lower limb (67; 48.2%) followed by the Idelalisib hands

(26; 18.7%). Other sites of injuries include the trunk (25; 18%). Four patients (2.9%) had multiple sites of injuries. Dogs were implicated in the majority (69; 49.6%) of exposures, followed by cats (32; 23%) and monkeys (23; 16.5%). There were seven (5%) exposures to bats (Figure 4). Methisazone Two individuals did not have any animal exposure, but one had involved a contact with a positive rabies case abroad, with vomitus spilled on the body, and the other was a worried wife whose husband had been bitten by a confirmed rabid dog at multiple sites of the body. Most documented exposures were described as unprovoked (65; 46%). However, 27 (19%) individuals had no documentation of whether

exposures were provoked. PEP had been initiated overseas in 86 (61.9%) of the cases. Only 3 of the 78 (3.8%) cases meeting the UK criteria for administration of RIG received it while overseas. An additional 11 patients with initial treatment overseas received RIG on return to the UK; most patients were seen more than 7 days after the initiation of PEP. Because an antibody response to the active immunization is presumed to have occurred after 7 days, administration of RIG is unnecessary.12 Only 10.1% of the exposed travelers had received preexposure immunization. The median time from exposure to receiving rabies PEP was 1 day (range: 0–1,720 days; interquartile range: 0–7 days), regardless of whether it was initiated overseas or in the UK.