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Rabies

Two monkeys sitting on a roof

What is rabies?

Rabies is a serious, and usually fatal, viral infection that affects the central nervous system. It is spread from infected animals (commonly bats, dogs and monkeys) to humans through biting, scratching or the licking of an open wound.

Rabies is a very serious disease and if you begin to show symptoms indicating that it has spread to your central nervous system, it is very unlikely that you will survive. There is currently no cure for rabies. Rabies is most commonly found in Asia and Africa, and it is recommended that travellers to high risk areas (particularly those with limited access to good healthcare) for prolonged periods get vaccinated before they leave.

The rabies vaccine

The rabies vaccine requires three doses, given over the space of a month. The injection is administered into the upper arm and usually has no side effects (although some people experience temporary soreness at the injection site).

What happens if I get bitten or scratched but I’ve already had the vaccine?

If you have received a full course of the rabies vaccine before travelling, and whilst abroad you get bitten, scratched or have an eye or open wound licked by an animal who may be infected with rabies, you still require medical help.

For a person who has received the three doses before travelling, a further two doses of the same vaccine are required after the possible exposure, with the first received as soon as possible after it has happened.

  • 2 x doses of vaccine after exposure (over 1-3 days)

What happens if I get bitten or scratched and I haven’t had the vaccine?

If you are bitten, scratched or have your eye or an open wound licked by an animal and you have not have the initial three doses of the vaccine, you will need to seek emergency medical help.

The protocol for a non-vaccinated person is to receive five doses of the rabies vaccine, with the first injected as soon as possible after the incident. Alongside the vaccine, a dose of immunoglobulin is also required.

  • 5 x doses of vaccine after exposure (over 4 weeks)
  • 1 x dose of immunoglobulin after exposure (as soon as possible)

Immunoglobulin

Immunoglobulin is a substance that provides your body with antibodies to fight the rabies infection. It is always required as treatment (alongside the five doses of vaccine) when there is a high risk of rabies transmission and the person in question has not had their initial three doses of the rabies vaccine.

A major consideration is that immunoglobulin is very expensive and in short supply in many places. This means it can be very difficult to get hold of in certain parts of the world. The upshot of this is that if you have not been vaccinated before travelling, and you are then bitten or scratched by an animal that could be infected, it can be very difficult and stressful to get hold of the treatment you need.

For this reason, the rabies vaccine is recommended to travellers visiting high risk areas for prolonged periods, particularly developing countries where access to healthcare might be limited.

Immediate action following a bite

The first thing to do if you get bitten or scratched is to follow these instructions as closely as possible:

  • Wash the wound thoroughly with water and soap for 10-15 minutes. If you do not have access to running water and soap, you should use any bottled water that you have to hand.
  • If you have access to first aid, apply an antiseptic solution (ideally containing povidone-iodine or 70% alcohol) to the wound.
  • Seek medical help to determine further treatment. Depending on whether or not you have been vaccinated in the past, you will then have to seek further medical help over the next days and weeks for a) one more dose of the vaccine, or b) four more doses of the vaccine and a single dose of immunoglobulin.

How to avoid getting bitten

The best way to avoid rabies is to get vaccinated before you go travelling and, whilst in high risk areas, be cautious about coming into contact with animals who may be infected. The CIWEC Clinic advises the following to travellers to Nepal (although it is generally good advice for tourists in any high risk rabies areas):

  • Do not pet or pick up puppies
  • Do not take in stray dogs
  • Do not carry food while visiting temples
  • Do not get too close to baby monkeys
  • Do not enter houses or temples that are guarded by dogs, unannounced.

If you are unsure whether you are travelling to a high risk area for rabies, you can find out by visiting the NHS site Fit For Travel.

Rabies facts* 

  • Rabies kills over 55,000 people every year worldwide. 
  • Dogs are responsible for 96% of rabies cases in South East Asia.
  • Signs of rabies in dogs include aggression, unusual or erratic behaviour and foaming at the mouth (although in the early stages of disease they show no illness).
  • Bats are responsible for the majority of rabies cases in the USA.
  • Cats, mongooses, wolves and horses have also been known to infect humans with rabies.
  • The rabies virus moves towards the spinal cord and brain from the transmission site at an estimated speed of 12-24mm a day. For this reason, getting bitten or scratched on your face is more of an emergency than getting bitten or scratched on your finger.
  • The incubation period for rabies can vary from a few days to as long as a year.
  • In the majority of cases, infection leads to furious rabies, which is characterised by episodes of hyperactive and aggressive behaviour, hydrophobia (fear of water) and hallucinations. In the remainder of cases, infection leads to dumb or paralytic rabies, which is characterised by weakness, loss of sensation, paralysis and coma.


*Sources:

www.cdc.gov/features/dsrabies
www.cdc.gov/rabies/bats/education
www.who.int/rabies/resources
www.nhs.uk/conditions/rabies