Rabies
Rabies is dangerous viral infection, which attacks the brain and nervous system. It is carried by a variety of wild and domestic mammals, including dogs, cats, wolves, foxes, jackals, civets, mongooses, racoons and bats. The greatest risk in most countries is from domestic dogs, although vampire bats are a significant risk in parts of South America.
Rabies is usually transmitted to humans through the saliva of an infected animal, through bites, licking of broken skin or scratches.
It is especially common in the Indian subcontinent, parts of Africa, SE Asia, China and Latin America, causing around 60,000 human deaths each year and untold fear and suffering.
The risk to travellers is relatively small, but the consequences potentially major. Without vaccination, rabies is almost universally fatal.
Prevention
- Rabies vaccination is strongly recommended by the WHO for all travellers to regions where rabies is either moderately or highly endemic.
- Unnecessary contact with dogs and other animals should be avoided.
- Vampire bats tend to feed from veins on the feet of sleeping people. A mosquito net is thus a sensible precaution at night in the Amazon.
Rabies vaccination
Pre-exposure vaccination consists of a course of three vaccinations, typically on days 0, 7 and 21-28.
There is some evidence that in people having their first rabies vaccination over the age of 45 years, a booster dose at one year is a good idea.
The current WHO, European and US guidelines are that no further boosters are required following a full, intramuscular course, except in the event of a significant exposure (see below). However, new Scottish guidelines continue to recommend a booster dose every 15 years for the time being.
Treatment - if you are bitten or scratched by a suspect animal:
- Wash out the wound immediately with water, juice or any other readily available fluid for 10 minutes.
- Follow this up with alcohol or povidone iodine solution if available to help sterilise the wound.
- You should seek medical attention locally as soon as possible for assessment.
If you HAVE had pre-exposure vaccines:
You may be advised by the doctor you see locally to have two more rabies vaccinations, three days apart. While the immunity from a full course is now considered to be life-long it is generally thought safest practice to 'wake up' the immune system's memory cells in the event of a rabid bite.
If you HAVE NOT had a full, pre-exposure vaccination course:
You may need to have BOTH:
- Human Rabies Immunoglobulin (HRIG)* injected around the wound as soon as possible,
AND:
- Five standard rabies vaccinations on days 0, 3, 7, 14 and 30 after exposure.
*HRIG is in often in short supply in rabies-endemic countries, and where available, usually only in a major or capital city.
Rabies immunity testing
Some travellers will have had an incomplete course of rabies vaccination, and/or vaccination via the intra-dermal route.
For extra peace of mind, TrExMed offers a rabies immunity testing service. This consists of a simple blood test to see if you have significant, circulating antibody levels to rabies in your blood.
For further information on rabies, please visit the Alliance for Rabies Control web site on: www.rabiescontrol.net
