One of these cases had no detectable rabies antibody, but the other 22 cases had detectable levels less than 0.5 IU/mL. The traveler with no detectable rabies antibodies was also known to be a non-responder to hepatitis B immunization after nine doses of the vaccine. Of the 23 non-responders, 12 learn more (52%) had their first blood tests done before day 28, and 10 (44%) were over 50 years of age. Five of the non-responders did not return for a booster vaccine dose or a repeat serology test, and were advised to consider themselves nonimmune. Of the remaining 18 cases, 16 had antibody levels of >0.5 IU/mL when tested at a later

date (range 3–51 d after clinic visit 3), indicating that they developed adequate antibody levels after “Dose 5” given at clinic visit 3, and/or had developed higher antibody levels with

time. The other two cases developed adequate antibody levels after “Dose 6,” and one of these cases had chronic lymphocytic leukemia and Type 2 diabetes mellitus. Taking into account the 397 travelers who seroconverted on the first serology test performed at clinic visit 3, and the 16 travelers who seroconverted after “Dose 5,” the overall seroconversion rate using the TRID2 schedule was 98.3% (95% CI: 96.6–99.3) after three clinic visits and five ID vaccine doses. There were no reports of significant side effects with the TRID2 schedule, and the two vaccine doses required at clinic visits 1 and 2 were acceptable to travelers. This case series demonstrated that the TRID2 schedule is highly effective, inducing immunity in 94.5% of travelers after the first two clinic visits, and immunity in H 89 order 98.3% of travelers after three clinic visits. The major advantage of the TRID2 schedule over the standard ID schedule is that travelers were able to complete the course of vaccines and have their immunity confirmed in a shorter time (4 wk compared with 7 wk). Also, only three clinic visits were required for the TRID2 schedule, compared to four visits with the standard ID schedule. We found the TRID2 schedule to be a safe, convenient, acceptable, and

affordable way of protecting travelers from rabies, and the majority of travelers had their immunity confirmed prior to travel. Accelerated schedules of ID rabies vaccines have been shown buy Lonafarnib to be safe and effective for pre-exposure vaccination,8,10,11,14 and are routinely used for rabies PEP in some countries. In the post-exposure setting, the Thai Red Cross regimen involves two 0.1 mL ID doses given on day 0, and repeated on days 3, 7, and 28 is one of the PEP schedules recommended by the WHO.1 The schedule used in the TRID2 course should therefore also be safe and effective. Previous studies have demonstrated that 0.1 mL ID doses given at days 0, 7, and 21 to 28 were effective,6,7 and “Dose 5” of the TRID2 schedule would therefore ensure that travelers are afforded at least as much protection as those who are immunized with the standard ID course.