Rabies

Rabies is a deadly, but vaccine-preventable, viral disease. The virus is transmitted to humans through the saliva of infected animals, usually after a bite. In developing countries dogs are the main carriers, however monkeys, cats, bats and most other mammals can also transmit rabies.

While most human cases are the result of bites, a scratch or even a lick from an animal on broken skin should be considered a potential exposure requiring urgent medical assessment.

Based on conservative WHO estimates, 55,000 human rabies deaths occur worldwide each year with the majority of victims being children. Children are at higher risk of exposure due to their lack of awareness of the dangers that animals may present, while their smaller stature makes them more prone to bites in vulnerable places around the face and head.

Although rare in travellers, rabies does occur in many countries around the world, with the highest risk in South Asian countries, notably India.

Prevention

Avoid physical contact with all domestic or wild animals in any setting unless you are absolutely certain the animal has been well vaccinated. The need for vigilance, particularly when travelling with children, cannot be understated. You may have received rabies vaccination as part of your travel medicine consultation. 

Rabies immunoglobulin is often difficult to obtain and is expensive. Travellers may be advised to cut short their trip and return to Australia. If rabies immunoglobulin is not available, cell-culture vaccines should still be administered and immunoglobulin sought elsewhere within one week following the start of the vaccination course.

Treatment

First-aid: Wash the wound gently but thoroughly with soap and water for at least fifteen minutes. Further clean the wound with an alcohol solution (40-70%) before applying Betadine (Iodine), if available. Seek medical advice as soon as possible regarding post-exposure treatment, wound management, and possibly antibiotic therapy. If required, a booster shot to prevent tetanus should also be given.

Post-exposure treatment: If you have NOT received the full course  of rabies vaccinations before departure, or before a previous trip, post-exposure treatment involves:

  • Rabies immunoglobulin injected around the site of the wound.
  • Four doses of cell-culture vaccine on days zero, three, seven, and 14 after the exposure. A fifth dose on day 28 is used in some countries and in people with a depressed immune system.