Current advice is cAMP inhibitor that rabies PEP is given for significant exposure, regardless of the time interval from the exposure. One person received PEP following an exposure to bats in Australia. Although Australia is described as rabies free,11 Australian bat lyssaviruses are found in the country13,14 and there have been fatal cases of rabies after exposure to bats in Australia.15,16 National recommendations

are that PEP is given after exposure to bats in Australia.13 This study looked at 10 years of data from a major tropical and travel center in Northwest England, which provides rabies PEP service. The travel clinic has an average 9,000 visits per year. In line with UK guidelines, preexposure vaccination with rabies is currently only recommended for individuals with prolonged travel to a rabies endemic country; occupational risks such as animal handlers, veterinary staff or wildlife workers; children who are less likely to report an injury; and for travelers to places where medical assistance is less reliable. In our study, individuals aged 20–50 (62.6%) were most at risk, with the extremes of age making up less than 10% of the cohort, contrasting with reports from New Zealand that suggested children remained a vulnerable group.17 This indicates a difference in the mean age group of

the Palbociclib order travelers who visited our center, compared to those who sought PEP in New Zealand. It is important to educate all ages about the risk of rabies, the importance of prompt reporting of all injuries, and the value of vaccination. Southeast Asia is the region where most rabies exposures occurred. These places are considered to be of high risk for rabies2 and although only 4.8% of total visits by UK residents are to Asia, more than half of all rabies exposures occurred there. We noted that the number of exposures to Thailand

is similar to that of Turkey. However, there are 1.6 million (2.8%) Sodium butyrate visits to Turkey and 0.3 million (0.6%) visits to Thailand. Hence, there is greater risk of exposure in Thailand than in Turkey. Although we did not record formal data on the duration of these trips, our experience suggests that most travelers whom we see going to these destinations are on short-term holidays. Moreover, medical care would have been readily available in these countries. Hence, most of these travelers would not fulfill the criteria for rabies vaccination before travel. Dogs continued to be the predominant animal involved in the exposures. It is not known if the animals were proven to be rabid subsequently. Seven animals were known to be alive 15 days after the exposure incident and hence the rabies PEP was stopped. In general, we have noticed that individuals either leave before the completion of 15 days of observation or are unaware of the need to do this. The 15 days of observation is based on the HPA guidelines, differing from the World Health Organization (WHO) guidelines.