8% to 6%.[4] In contrast, unpurified ERIG has a reported incidence of causing signs consistent with serum sickness ranging from 15% to 46%.[4] World Health Organization (WHO) recommends that whenever ERIG is used appropriate precautions concerning anaphylaxis are taken. In the United States, two

human RVs are licensed for preexposure vaccination or PEP use: human diploid cell and purified chick embryo cell.[5] Worldwide, these and other modern cell culture-based rabies vaccines (eg, Vero cell and purified duck embryo cell) that meet minimum potency requirements are recommended by WHO for use in human rabies preexposure vaccination and PEP.[1] learn more In contrast, nerve tissue vaccines (NTV), produced in animals, are still used in some countries, but are associated with high rates of adverse events; WHO has recommended their use be discontinued. Even when RV is readily available in the United States, most US international travelers are unvaccinated.[6] As the availability of RIG and RV for travelers abroad remains largely unknown, it is crucial for US international travelers to have an understanding of whether the vaccine is available and type used at their destinations or

have an emergency evacuation health plan in case of an exposure. We sought to describe the availability, type, and costs of RIG and RV for travelers by conducting a survey of travel medicine practitioners and other health care providers, to improve travel recommendations for international travelers. We developed a web-based survey, called the Evaluation of MG-132 the Global Availability of Rabies Immune Globulin

and Rabies Vaccine for Travelers: Direct Care Survey, and distributed the hyperlink to members of a travel check medicine professional organization, an international evacuation and travel health insurance company, and members of international professional organizations specializing in rabies and PEP care. These organizations were chosen because of their geographic diversity and because their members might provide direct rabies postexposure care to travelers. Specifically, the survey asked respondents to provide information about their clinic’s experiences in treating patients in 2010. The survey was available in English, Spanish, and French and accessible from February 1 to March 30, 2011. Two reminder e-mails were sent to encourage participation. This survey was determined to be a nonresearch activity by the US Centers for Disease Control and Prevention (CDC) Human Subjects Advisors. The survey contained approximately 20 questions, although the exact question count varied due to each participant’s responses. Questions included whether the clinic evaluated patients for possible rabies exposure, whether they administered PEP, how accessible RIG and RV were when needed, the types of RIG and RV used, where travelers would be sent if RIG and RV were not available, and what barriers hindered obtaining the biologics.