These cases were communicated by A.A. Movsesyants, Head of Rabies Department at the

L. A. Tarassevich State Research Institute for Standardization and Control of Medical Biological Preparations in Moscow, Russian Federation. Three of these patients were bitten by stray or aggressive domestic dogs, and one was bitten by a fox. Exposures occurred in the Ukraine, Azerbaijan, Kazakhstan, or Kyrgyzstan. None of the Ipilimumab male Russian patients, age 21 to 58 y, sought medical attention and all died (Table 1). An 11-y-old boy from Georgia, as described by PROMED, who received post-exposure prophylaxis after being bitten by a dog in Azerbaijan, died later in Georgia, probably because of an inappropriate interval between exposure and treatment. Based on literature review and personal communications,

we collected the most complete set of reports of imported rabies cases available to date. We reviewed 42 human deaths due to imported rabies, which we defined as rabies that was contracted outside the country where death occurred. We found that the risk for an individual traveler to contract rabies was small relative to the number of people traveling to such areas. For example, over 45 million international travelers went to Africa learn more in 2009.40 We report 14 fatalities in travelers to Africa; however, there may be substantial underreporting. Interestingly, we only found published cases that had occurred in the United States, Europe, and Japan, countries where scientific

publishing is very common. Of the 14 fatalities from Africa, 13 travelers came from Europe and 1 from the United States. To determine whether more human rabies cases occur in travelers within Asia or Africa would require further investigation by other means. Given that once symptoms of rabies are evident, the disease is expected to be fatal in virtually all cases, it is important to consider rabies prophylaxis and vaccination as a vital preparation Baricitinib to ensure the safety of those planning to visit areas with high rabies incidence.1,2,8–12 A striking finding in this review of cases was that in 38 of the 39 cases where the animal cause of rabies was known or strongly suspected, the patient had exposure to a member of the family Canidae.13–38 Given that contact with dogs is known to represent the highest risk for contracting rabies in humans, this finding is not surprising.1,2,8 Travelers to areas with a high prevalence of rabies in the animal population should be cautious when approaching dogs, including puppies. Healthcare providers should be trained prospectively when advising travelers, and those who seek advice at travel clinics or their general practitioner should be informed about the risk of contracting rabies and the very high mortality rate. Travelers who do not routinely seek medical advice could also be reached through travel agencies or the media.