What is Rabies
Rabies is an infectious viral disease of the brain and nervous system that is fatal once symptoms have started. The most common way that humans contract rabies, up to 99% of cases is through transmission from domestic dogs. Every year more than 15 million people worldwide receive a post bite vaccination. This is estimated to prevent hundreds of thousands of rabies deaths each year.
The common incubation time is between 1- 3 months, but rabies symptoms can start within 1 week if the bite is severe and has been known to present many years later in some cases. The location and severity of the bite/scratch affect how quickly the symptoms start to manifest; a wound nearer the head would spread quicker than a bite on the foot.
How can you catch Rabies?
Rabies is transmitted from any warm-blooded mammal through a bite, scratch or lick on an open wound. Rabies can affect both domestic and wild animals alike. We most commonly treat bites from dogs, cats and monkeys requiring treatment due to the potential exposure to rabies.
Where can Rabies be found?
Rabies is endemic on all continents except Antarctica. 95% of human deaths due to rabies infection occur in Asian and African regions where healthcare facilities to treat post-exposure are not as easily accessible.
Symptoms of Rabies
It is worth noting that rabies is usually fatal once symptoms are detectable so never wait and see! 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, progressive and fatal inflammation of the brain and spinal cord develops. Some people will experience hydrophobia (fear of water), aerophobia (fear of drafts or fresh air), hyperactivity and excitable behavior. People with these symptoms die quickly, normally within a few days from a cardiac arrest. The disease can also cause paralysis of the muscles that slowly worsens until death occurs. This is a longer form of the disease, which often gets misdiagnosed causing the underreporting of deaths due to rabies.
The best form of prevention is pre-exposure prophylaxis, otherwise known as the rabies vaccination. The course of treatment is 3 doses of the rabies vaccine spaced out over a month prior to travel. This gives you some antibodies to fight the virus following a potential transmission. You will still need post exposure treatment if you are licked, bitten or scratched, but the pre-exposure treatment means you’ll only need 2 doses of post exposure vaccination rather than the usual 4 doses plus immunoglobulin. This gives you more time to seek appropriate treatment, vital if you are having to travel to another country to get these doses the antibodies will be the fighting the virus. No traveler who received all doses of the rabies pre-exposure vaccine has ever died from rabies exposure.
In Nomad clinics we can administer rabies vaccines in 2 ways. One method is intramuscularly, which is how most vaccines are administered, into the muscle. Or we can administer intradermally, which means the doses are injected under just a couple of layers of skin. If you have time we will always go for the longest amount of time between doses to ensure the best possible immune response. Having the vaccine over 21 days will still give you adequate cover, though.
The rabies vaccine is known to last a long time, but further doses are always required following a bite/scratch. In addition, a recent WHO update on the rabies guidelines, state travellers should always come to a clinic to be reassessed before travel as a booster may be required. The booster maybe needed depending on the country, length of stay or type of activity that individual traveller is undertaking, your Nomad travel nurse will assess your risk during consultation.
Rabies vaccination side effects
The side effects of the rabies vaccine depend on what administration route you choose. Intramuscular vaccines can cause headaches and nausea which we find to be more common in dehydrated people, so we will always advise you drink plenty after the vaccine. With the intradermal route you will have a red mark which may be itchy for a while after the vaccine. It is normal to have 3 red marks at the end of the course of intradermal rabies, but they all disappear over a few weeks. On occasion, people will feel lethargic after having vaccines and they may feel achy, as if they are having a cold, this is all normal.
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 you come across.
What to do if you’ve been bitten or scratched
If you have been bitten, scratched or licked immediate treatment is needed. You should wash the wound with clean running water (bottled or purified water), an antiseptic tincture should be applied; iodine or an alcohol-based antiseptic. If you do not have anything like that, vodka or whiskey would 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.
Post Exposure Rabies treatment
Once you have cleaned the wound immediately after a bite, scratch or lick, you should immediately seek medical attention at the nearest healthcare facility. They will begin post-exposure treatment. This involves a course of 5 doses of the rabies vaccine over a course of one month on set days. Some patients also require treatment with immunoglobulin, a blood product containing antibodies of 1000 people who have been previously vaccinated against rabies. The problem for travelers is that this treatment, particularly immunoglobin, may not be readily available in less developed countries. Travelers sometimes end up travelling to different countries to find post-exposure rabies treatment. A delay in starting treatment may mean that symptoms may already have started and unfortunately once symptoms start the disease is fatal.
Being prepared for rabies
We recommend you start pre-exposure treatment for rabies 6-8 weeks before travel to allow time to complete the full course and build up immunity. Book a consultation at your nearest Nomad clinic to find out if you are recommended to have rabies vaccination treatement based on your travel plans and health history. If you have a last minute trip planned, we can still start to vaccinate you against rabies and will be able to advise on the level of protection you will have on arriving at your destination. Learn what to do if you get bitten, licked or scratched (feel free to print or save this blog!) so you can start to treat yourself as soon as possible, and make sure you always know where your nearest hospital or healthcare facility is at your destinations so there’s no delay in seeking post-exposure treatment.