What You Should Know About Rabies Before Your Trip

What is Rabies?

Rabies is an infectious viral disease of the brain and nervous system that is fatal once symptoms have started. Up to 99% of cases is through bites or scratches from domestic dogs. Rabies infection causes an estimated 59,000 human deaths each year, with 40% of the victims being children under the age of 15years. Annually, over 15 million people worldwide receive post bite vaccinations. Preventing hundreds of thousands of rabies deaths each year.

The incubation period generally ranges from 1 to 3 months, but symptoms can manifest within a week in severe cases. In rare instances, symptoms may also emerge years after exposure. The location and severity of the bite or scratch influence the onset of symptoms, with wounds closer to the head exhibiting faster spread compared to those on extremities.

How can you contract Rabies?

Rabies can be transmitted through bites, scratches, or saliva contact with open wounds from any warm-blooded mammal. Both domestic and wild animals carry the virus (including bats). Common sources of exposure include dogs, cats and monkeys, necessitating treatment due to the risk of Rabies.

What countries can Rabies be found in?

Rabies is endemic on all continents except Antarctica. The majority of human deaths, approx. 95%, occur in regions of Asia and Africa where access to post-exposure healthcare is limited.

What are the 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 behaviour. 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 Rabies Vaccine

Pre-exposure prophylaxis through the rabies vaccine is the most effective preventive measure. The standard treatment comprises three doses administered over a month before potential exposure. This will give you antibodies to start fighting the virus following a potential exposure. 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 receive the post exposure treatment.

It is essential to seek booster doses and medical assessment before travel, as per updated WHO guidelines. ¹

There are 2 methods the Rabies Vaccine can be administered. One method is intramuscularly, which is how most vaccines are administered, into the muscle. Several Travel Clinics administer the vaccine intradermally, which means the doses are injected under just a couple of layers of skin. Both give equal amounts of immunity. At times of shortages of the Rabies vaccine in the UK, Travel Clinics may only offer the intradermal way of administration to conserve their stock.

How long does the Rabies Vaccine Last?

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 be risk assessed 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,

Avoiding Rabies Exposure

To minimise the risk of Rabies exposure, avoid contact with animals while travelling. A healthy-looking animal could be carrying the virus, so it is best to not approach any animal. 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.

What Should You Do If You Are Bitten, Scratched or Exposed to Animal Saliva?

Immediate treatment is crucial following a bite, scratch or saliva contact. Clean 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 healthcare facility 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.

What is the Post Exposure Treatment for Rabies?

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 depending on whether you have had any Rabies vaccines before this exposure.

If you are unvaccinated the treatment involves a course of up to 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 travellers is that this treatment, particularly immunoglobin, may not be readily available in less developed countries.

If you have had pre-exposure vaccines the treatment involves 2 doses following exposure and there is no need for the Immunoglobulin.

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.

When should I start my Rabies Vaccines?

We recommend you book a Travel Health Consultation as soon as you have your date for your trip. This will give you time to arrange your vaccines with enough time to complete the course and build up adequate immunity.

Book a consultation here with our Travel Jab Guru Nurse Specialist to find out if Rabies vaccination is recommended based on your travel plans and health history.

If you have a last-minute trip planned, we can advise on the different courses you may still be able to receive and the level of protection you would have.

Extra Tips

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.

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.

¹ Ref: Rabies (who.int)

Further information: NaTHNaC – Rabies (travelhealthpro.org.uk)

Written By Amanda Howarth – March 2024