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Background: There is little data available on the actual risk to travelers of being possibly exposed to rabies. This data would be useful in advising travelers who are considering rabies pre-exposure immunization. In addition, it is not known how many travelers are already pre-immunized when they are bitten by a possibly rabid animal. The current study was performed to determine the rate at which travelers to Nepal are possibly exposed to rabies, and to determine risk factors for possible rabies exposure.

Methods: A prospective 3-year study was carried out at the Canadian International Water and Energy Consultants (CIWEC) Clinic Travel Medicine Center in Kathmandu, Nepal, during the years 1996 through 1998. All non-Nepalese and non-Indian patients who presented with animal bites or scratches were eligible to be included in the study.

Results: Ninety-nine persons presented with possible rabies exposures to the CIWEC Clinic during the study period; 56 were tourists, and 43 were resident expatriates. The incidence of people presenting to the CIWEC clinic with possible rabies exposures was 1.9 per 1,000 persons/year for tourists, and 5.7 per 1,000 persons/year for resident expatriates (p < .0001). The incidence of possible exposure to rabies while trekking was 1.2 per 1,000 persons/year. Women were significantly more likely than men to present with a possible rabies exposure, accounting for 61% of patients (p = .0027). Younger people were more likely to have bite exposures to the face and head than older patients. The length of time between exposure and treatment averaged 1.6 to 5.0 days. Among patients presenting with animal bites, 56% of foreign residents, and 21% of tourists had been pre-immunized against rabies.

Conclusions: Foreign residents of Nepal are significantly more likely to be exposed to rabies than tourists. Trekking does not increase the chances of being exposed to rabies. Children have a higher risk of being bitten on the face and head, and females are more likely than males to be bitten or scratched by a possibly rabid animal.