We would strongly encourage the development of a more rigorous model to adequately assess rabies exposure and attack rates. We agree that our personal recommendation[2] is broader than that of the WHO.[3] However, ours is a recommendation for travelers from

developed countries, where adequate supplies and monetary resources can be assumed to exist. Further, some controversy exists GSK1120212 chemical structure in the expert community regarding the breadth of vaccination recommendations. For example, Gautret and co-workers recently highlighted that because “ (…) it is not [always] possible to rely on the WHO rabies risk map (…) current guidelines for targeted delivery of pre-exposure rabies vaccine should be amended”.[4] Naturally, our voluntary affiliations find more with a manufacturer

of rabies vaccine suggest that we are likely more predisposed to believe in the value of vaccination than the general public may be. We do not dispute such a possibility. Nevertheless, we also observe that travel in many urban areas carries the risk of exposure to potentially rabid animals, such as packs of feral dogs that inhabit some cities in Asia. In addition, it is very important, in our opinion, selleck chemical to understand that symptomatic rabies is an irreversible, fatal disease. We do not feel that any person dwelling in a developed country, where access to appropriate rabies prophylaxis is possible, should ever be at risk of death from a preventable disease.

Thus, the assertion that no Canadians contracted rabies during our observation period is not quite as germane as it might first appear. It could very well be that Canadian travelers are more likely to have been vaccinated against rabies and to take appropriate precautions than those from other countries. And past experience by traveling Canadians is no guarantee of the future safety of all travelers from that country. Schofield and Tepper are absolutely correct that careful adherence to our recommendation would, in fact, tend toward the overuse of rabies vaccine. However, until there is some form of treatment for this universally deadly disease, we feel that it would be remiss not to advise all persons who can possibly afford such an intervention to take advantage of an opportunity to prevent a possibly fatal outcome. “
“We thank Dr Malerczyk and colleagues[1] for their useful catalog of the reported cases of imported rabies in the developed world.