What you need to know about Rabies and why the vaccination is one of the best you can get!
Rabies is an infectious viral disease of the brain and nervous system that is fatal once symptoms have started. The virus is spread from both wild and domestic animals through a bite, scratch or lick to an open wound or mucosa (such as eyes or mouth). The most common human rabies transmission is from domestic dogs however cats, monkeys, bats and rodents can also transmit infection.
Where can rabies be found?
Rabies is a serious public health problem in over 150 countries particularly in Africa and Asia. Countries in south America and some in Europe are also considered high risk for rabies. You can find out the level of risk for rabies in each country through the UKHSA.
Symptoms of rabies infection
The most common symptoms of rabies are a fever with pain and unusual tingling sensation at the site of the wound. As the virus spreads to the central nervous system it causes progressive and fatal inflammation of the brain and spinal cord. Some people will experience hydrophobia (fear of water), aerophobia (fear of drafts or fresh air), Death is inevitable and usually within a few days.
Rabies symptoms may not present until 2 – 3 months post bite but can also present as soon as a week to as long as a year after exposure, or even decades. The location and severity of the bite/scratch will affect how quickly the symptoms start to manifest; a bite nearer the head would spread quicker than a scratch on the foot.
How to avoid being bitten or scratched
We would advise that you do not pet any animals travelling. An animal that looks quite well could be carrying the virus, so it is best to not approach any animal at all. Monkeys are used to tourists feeding them and will often clamber on someone looking for food. We would always advise that you do not try feeding monkeys or any other animals. Treat every animal as a potential carrier of rabies and avoid petting or feeding any that you come across.
Rabies vaccination
The best form of prevention is to complete a course of rabies vaccination– pre-exposure prophylaxis. These vaccines stimulate antibodies to fight the virus following a potential transmission. There are two brands of rabies vaccines. Rabipur and Verorab. Both vaccines are interchangeable. At Nomad we offer rabies IM and Rabies ID (Intradermal). Our travel health specialist will advise which route is suitable for you. Three vaccines are required over 28 days but can be given on an accelerated course over 7 days for last minute travellers.
Investment travel vaccine
The Rabies vaccines are highly effective. The fact that many countries across the globe are high risk for rabies and it is very likely you are travelling to one makes this vaccine worth investing in, particularly if you are travelling for a month or more, backpacking, travelling remotely or visiting a country with limited access to medical facilities. The best thing is that boosters are generally not required and only a small number of travellers would need to consider this. It is important to have a discussion with your travel health specialist prior to departure to determine if a booster is required for you.
What to do if you’ve been bitten or scratched/ licked on open wound or mucosa
If you have been bitten, scratched or licked on an open wound / mucosa, immediate treatment is needed. You should wash the wound with clean running water (bottled or purified water), an antiseptic should be applied; iodine or an alcohol-based. If you do not have anything like that, vodka or whiskey can be used to clean the wound. You should cover the wound and get to a hospital as quickly as you can. If you are not vaccinated, you will need to start post-exposure treatment as soon as possible, ideally within a few hours of potential infection.
Important information you need to know if you have had a potential rabies exposure abroad and HAD pre- exposure vaccines before travel
After cleaning the wound, you will need to seek medical attention immediately and receive two further rabies vaccines on day 0 and 3 days later to ensure you are safe.
Important information you need to know if you decided NOT to have the rabies vaccine course before travel
If rabies pre-exposure vaccinations have not been received prior to travel, then post exposure treatment will need to be sought immediately. It is important to understand the risks with this. Healthcare facilities to treat post-exposure are not always easily accessible and treatment may not be available. In a high-risk country treatment is likely to require immunoglobulin. This is injected around the wound site and 4 doses of the rabies vaccine are given over a further period of days. For some people with weakened immune systems, the post exposure rabies treatment required may be slightly different.
Immunoglobulin is a blood product. In the UK, immunoglobulin is Human derived (HRIG). This can be hard to come by in some poorly resourced countries. Sometimes Equine Rabies Immunoglobulin (ERIG) may be available which is produced from horse plasma. Both are screened to ensure safety, however if neither are available than it may mean having to travel across the country to a major city or even travelling to a different country to find post exposure treatment. This can take time and will increase both anxiety, stress and the risk that symptoms of infection start to present.
It is important to remember that rabies is 100% fatal once symptoms are present, so never delay seeking treatment
In January, it was reported that falsified unsafe and ineffective rabies vaccines were circulating in Zimbabwe. It is important to consider that there is always a risk that could also happen in other countries. Pre- exposure rabies vaccination is therefore always the best option, and every traveller should consider receiving these before departure.
Resources
https://travelhealthpro.org.uk/disease/148/rabies
https://travelhealthpro.org.uk/news/476/worldwide-rabies-risk-reminder
