Both clinics (n = 2, 100%) from Mexico, Central America, and the Caribbean and 80% (n = 4) of clinics from South America reported seldom or never having RIG accessible, respectively. Overall, the majority (76%; n = 114) of clinics reported using HRIG at their clinics (Table 1); 65 and 4% of these reported that an international pharmaceutical company or a local producer manufactured the HRIG, respectively (data not shown). However, 24% of

those reporting the use of HRIG did not know the manufacturer. Of the clinics reporting the use of ERIG (n = 15), six also reported the use of HRIG. Clinics reporting only ERIG use were from South Asia (n = 3); Eastern Europe and Northern Asia (n = 1); BI 2536 Middle East

and North Africa (n = 2); West, Central, and East Africa (n = 1); East and Southeast Asia (n = 1); and Tropical South America (n = 1). Of those using ERIG (n = 15), 80% reported using purified ERIG, 13% reported heat-treated digested ERIG FAB fragment, 7% reported heat-treated purified ERIG, and 7% reported not knowing the type of ERIG that was used. When asked where the travelers would be referred if RIG was not available, 63% (n = 119) of respondents reported that they would refer travelers to a clinic within the same city or elsewhere in their country, and 5% (n = 9) stated that they would refer only to clinics outside their country or send travelers back to their from home country. Ninety-one percent (n = 158) of all respondents reported that RV was often or always accessible (Table 2; Figure 3b). The use of human diploid cell and purified chick embryo cell vaccines

was most signaling pathway common in North America (60 and 31% of respondents, respectively) and Western Europe (56 and 34%, respectively). Vero cell vaccine was the predominant vaccine reported in Asia and Africa. Four clinics, in Tropical South America (n = 1), Eastern Europe and Northern Asia (n = 1), and the Middle East and North Africa (n = 2), reported the continued use of NTV. Most clinics (57%) responding to our survey indicated that they used the five-dose intramuscular administration schedule (Table 2). Thirty-two percent reported using the four-dose intramuscular administration schedule; 65% of these respondents were from North America. The Updated Thai Red Cross intradermal regimen was used by 56% of clinics in South Asia. When asked where the travelers would be referred if RV was not available at their clinics, 69% (n = 132) reported that they would refer travelers to clinics in the same city or elsewhere in their country, and 1% (n = 1) stated that they would refer only to clinics outside their country or send travelers back to their home country. Approximately one third of 187 respondents stated that patients presenting with wounds from an animal exposure seldom or never adequately cleansed those wounds (Table 3).