Rabies: A global and travel health issue
Rabies is a global health issue with a long history. One of the earliest developments in vaccine research was Louis Pasteur’s discovery of how to artificially reduce, or attenuate, a virus’ virulence which he used to successfully administer the first post-exposure rabies treatment in 1885.
The virus that causes rabies is present on all continents except Antarctica. While only specific travellers may need pre-exposure rabies vaccinations, rabies remains a significant and complicated public health issue in many countries.
Most human rabies infections in developing countries – the majority occurring in Asia and Africa – are caused by dog bites, and vaccination of domestic and feral dogs is an effective way to reduce the risk.
Many mammals bats, monkeys, skunks, foxes, raccoons, coyotes, and wolves can also transmit rabies, which is a risk for travellers planning outdoor activities.
The WHO estimates that over 15 million people worldwide receive post-bite vaccinations every year.
Avoid risks, prevent rabies
Rabies is a viral infection transmitted by an infected animal’s saliva through scratches or bites. The virus attacks the Central Nervous System targeting the brain and the spinal cord, and if untreated, is fatal.
Luckily, there are many precautions you can take when it comes to preventing rabies. Avoid contact with any animal, including feeding or petting monkeys at temple sites.
If you are bitten or scratched, clean the wound with soap and water thoroughly as soon as possible then pour an antiseptic and irrigate with water. Seek medical attention immediately.
Keeping your distance from animals may not be realistic on ecotourism trips, or if you’re planning activities cave exploring, camping, trekking, and visiting farms. Moreover, rabies can also be an occupational hazard for veterinarians and wildlife researchers. In these cases, your health provider or travel clinic may recommend that you get the pre-exposure rabies vaccine series.
Rabies is an especially significant risk to children. The WHO reports this sobering statistic: 40% of people who are bitten by suspected rabid animals are children under 15 years of age.
Children are more ly to play with animals and get bitten so they should be cautioned not to pet animals and told to report scratches or bites to an adult immediately.
Emphasize that they should not be scared or ashamed to report a bite or scratch.
Vaccination and HRIG
If you get the three pre-exposure vaccine series (given over 3 or 4 weeks), it provides adequate initial protection, but you will require 2 additional post-exposure doses if you are exposed to rabies. The pre-exposure series simplifies medical care if you have been bitten by a rabid animal and gives you enough time to travel back from a remote area to seek medical attention.
If you do not have the pre-exposure shots, you will need human rabies immunoglobulin (HRIG) plus 4-5 rabies vaccine shots, depending on your health status (given over 3 or 4 weeks). HRIG is in short supply worldwide, so having the pre-exposure rabies vaccine series is critical if you are in areas where HRIG is not available.
Note that in remote communities with poor healthcare, post-exposure vaccination and HRIG may not be available or may be beyond the financial reach of local medical facilities. HRIG is very expensive to produce in large quantities.
Plasma needs to be collected from humans who have been immunized against rabies, and not everyone produces high enough concentrations of rabies antibodies for production purposes. After undergoing an extended purification process, the plasma needs to be screened for any remaining infectious agents viruses.
As a result, production can’t keep up with the worldwide demand, especially in resource-limited countries, making it a neglected tropical disease.
Photos (top to bottom) by Paul Filitchkin, Pexels and Ed Gregory, Stokpic.
More information about rabies
Rabies information for travellers – IAMAT
Rabies – World Health Organization
World Rabies Day – Global Alliance for Rabies Control (GARC)
By Tullia Marcolongo and Daphne Hendsbee.
Rabies: information for travellers
Rabies is a viral disease that infects the central nervous system — the brain and the spinal cord — and can be fatal if it is not treated promptly.
The disease is spread by bites from infected animals such as dogs, cats, bats, foxes, raccoons, skunks, wolves, monkeys and mongooses.
The rabies virus is found in the saliva of infected animals and most rabies cases develop from bites or scratches from wild animals that break the skin.
Transmission can also occur when a rabid animal licks abraded or broken skin or the eyes, nose or mouth, although this is rare. There have also been rare cases where rabies acquired from bats may not have come from direct contact, but occurred after people visited caves where rabid bats lived, prompting the idea that rabies may be transmitted through airborne particles.
Australian bat lyssavirus
While rabies proper does not exist in Australia, another member of the Lyssavirus family occurs in Australian bats. Anyone bitten by bats in Australia should seek prompt medical attention, as Australian bat lyssavirus produces an illness similar to rabies and can be treated with rabies vaccine.
Symptoms may begin between 9 and 90 days after a bite from an infected animal, but it usually takes at least a month before symptoms first appear. The first symptoms include a tingling, itching or cold feeling at the site of the bite.
This may be followed by a low-grade fever and general feeling of illness. This is then generally followed by chills, difficulty swallowing, restlessness, abnormal behaviour (such as outbursts of anger or extreme excitability), drooling and severe muscle spasms.
There may also be convulsions and paralysis.
Rabies is also called hydrophobia (meaning fear of water) because it causes painful muscle spasms in the throat that prevent swallowing.
If you are bitten by an animal while travelling, you should not take any chances and do not delay in seeking medical treatment. If you are bitten by, or have any exposure to, an animal that may have rabies, you must seek immediate medical attention.
As soon as possible after you have been bitten, the wound should be vigorously cleaned with soap and water and, if possible, give it a second washing with antiseptic. Treatment then depends upon whether you have been vaccinated previously.
Prompt treatment is essential — once the signs and symptoms of rabies appear, the disease has an extremely high fatality rate.
People not vaccinated
In people who have not been previously vaccinated, medical treatment after exposure will consist of a single dose of rabies immunoglobulin (where possible injected into the site of the wound) and rabies vaccine as quickly as possible after the bite, followed by additional rabies vaccine shots given over a period of up to 90 days.
Previously vaccinated people
Immunised people who are exposed to rabies do not need a dose of rabies immunoglobulin, but will still need 2 additional doses of rabies vaccine. The sooner you receive this treatment, the greater your chance of recovery. Your doctor may also give you a tetanus shot.
Rabies vaccination is currently not required for entry into any country. However, if you are planning to travel to an area where rabies is common in both wild and domestic animals (such as Central and South America, India, south-east Asia and most of Africa) you should consider being immunised before you leave.
Vaccination is recommended for travellers who are planning extensive outdoor exposure in rural areas in countries where rabies is common.
Vaccination is essential for anyone expecting to have close contact with animals in these countries. This involves 3 doses of vaccine given over 28 days. You should discuss this with your doctor when planning your trip.
When travelling overseas, stay away from potentially rabid animals wherever possible.
1. WHO. International Travel and Health. 2013. Rabies. http://www.who.int/ith/diseases/rabies/en/index.html (accessed Feb 2013). 2. CDC. The Yellow Book. Chapter 3. Infectious Diseases related to travel. Rabies. Last reviewed July 1 2011. http://wwwnc.cdc.
gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/rabies.htm (accessed Feb 2013).3. Mayo Clinic. Rabies. Last updated Jan 28 2011. http://www.mayoclinic.com/health/rabies/DS00484/ (accessed Feb 2013).4. Australian Immunisation Handbook, 9th edn.
3.1 Australian bat lyssavirus infection and rabies. http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-lyssavirus (accessed Feb 2013).
5. eMIMS March 2013. Merieux inactivated rabies vaccine. Prescribing Information.
(accessed Feb 2013).