Rabies is a viral illness that affects the nervous system and brain. It is almost always fatal once symptoms arise, but it is preventable. It kills approximately 59,000 people per year with over half of them being children younger than the age of 15.
It is caused by an infection with the rabies virus or other lyssavirus family viruses such as Australian bat lyssavirus. Rabies does not occur in animals in Australia; however, some bats carry Australian bat lyssavirus (ABLV), a closely related virus that can extremely rarely spread from bats to humans (only 3 recorded cases since 1996).
Although it is not natively found in Australia, there are several countries in which rabies is still common including India, Thailand, Nepal, China, Vietnam, Indonesia, Iran, Afghanistan, Egypt, Venezuela, South Africa, Somalia and many others.
For Australians, the greatest risk of rabies comes from being bitten, licked, or scratched by an infected animal (such as a dog, monkey, fox, cat, or bat) while traveling to areas in which it is endemic. Exposure to rabid dogs accounts for 99% of rabies deaths worldwide.95% of cases occur in Africa and Asia.
The best prevention is to avoid contact with any mammal while travelling. This includes patting dogs and cats which many travellers unfortunately tend to do.
Rabies is nearly 100% fatal without pre-exposure vaccination or prompt post-exposure treatment. After being potentially exposed to the virus through a bite or scratch, post-exposure treatment is almost 100% effective if it is started before symptoms begin. Symptoms may take days, weeks or months to arrive, but once they do, rabies is almost certainly fatal.
Therefore, prompt medical attention post exposure to the rabies virus is essential. Those who are traveling to areas in which medical care is limited and where the rabies virus is endemic should speak to a medical provider about potentially getting the rabies vaccination and other recommended vaccinations.
Two rabies vaccines are available in Australia. Each one requires three intramuscular doses - an initial dose, a second dose after 7 days and a third at 21 or 28 days. Both vaccinations are very effective at preventing rabies.
If you are planning on traveling to a country in which animals are known to carry rabies and you think you may come in contact with them, you may be recommended to receive a rabies vaccination before you travel as a preventative measure.
If your travel or work activities bring you in contact with potentially infected animals, you may also need a pre-exposure vaccination. Your doctor or travel health clinic will help you determine whether you should be vaccinated before your departure or not.
You should consult a travel health clinic or schedule an appointment with your doctor no later than 6 to 12 weeks before you depart overseas from Australia. This is essential to ensure you have enough time to receive the vaccination and for it to build your immunity, as it takes one month to administer the vaccine over 3 spread out doses.
In addition to receiving a pre-travel vaccination, there are several critical steps that must be taken after any potential exposure to the rabies virus.
1) Cleanse the wound with soap and water as quickly as possible for 15-20 minutes. This may help to prevent infection, however post-exposure treatment is still needed.
2) Apply iodine or alcohol to the wound if it is available. Do not bind the wound tightly, only cover it lightly with medical gauze or leave it exposed to air.
3) Seek medical attention as quickly as possible as it is essential to begin post-exposure treatment promptly.
Do not wait to find out if the animal has rabies before seeking treatment, as this can take days. Also, do not wait until you return home. Seek medical attention while you are abroad from a medical provider or clinic with experience in treating rabies. If you are overseas your insurance provider may be able to help with accessing medical care.
Treatment includes delivery of a post-exposure vaccination and treatment with the blood product Human Rabies Immune Globulin (HRIG). This product can be very difficult to find, so patients may need to be flown to somewhere where it is available.
Those who have previously been vaccinated against rabies will still require post exposure treatment, however only 2 doses of the vaccine are required over 3 days. Previously vaccinated individuals will also will not require the blood product (HRIG) in the event of exposure. Those who have not been vaccinated will need 4-5 doses over 14 -28 days, as well the blood product (HRIG).
Prompt treatment ensures that HRIG can be injected at the wound site if needed, which provides a quick source of protective antibodies to control the spread of the virus, giving the vaccine more time to generate protective antibodies.
Numerous countries throughout the world have animals with rabies, and there have been outbreaks in recent years in popular tourist destinations like Bali. The vast majority of rabies cases (95%) occur in Africa and Asia particularly in India, China, Vietnam, Thailand, Indonesia and Nepal.
Children under the age of 15 account for over half of the cases. Children also tend to be bitten in more risky areas, such as around the head and neck. They are also often less likely to report an animal bite, meaning they may not receive prompt treatment.
Rabies is transmitted through the saliva of an infected animal to a human. Contact can occur through broken skin, the nose, mouth, or eyes. Most commonly, it is transmitted through the bite or scratch of an infected animal, usually a dog. Other animals such as bats, foxes and cats can also carry rabies.
The virus must travel to the brain before it can cause symptoms. This can occur as quickly as one week, although in some cases it can take weeks or months. The period of time depends on various factors, such as the exposure site, the type of rabies virus and immunity.
The first symptoms of rabies are flu-like, including headache or fever which can last for days. There may be an itching sensation at the bite location.
Within days the disease will progress to agitation, confusion, cerebral dysfunction and anxiety. Other symptoms include hydrophobia (fear of water), abnormal behaviour, hallucinations, delirium, convulsions, muscle spasms, sensitivity to light or sounds, paralysis and insomnia.
Rabies is not curable after symptoms arise and is almost 100% fatal.
If you are exposed to an animal that may have rabies, prompt treatment is essential to ensure the virus does not progress to an infection. Treatment is given to all who have been bitten, not only if there is suspicion the animal may have rabies. This is because all cases are fatal.
Rabies is most common in Asia and Africa particularly in countries like India, China, Vietnam, Thailand, Indonesia and Nepal.
Individuals who have been vaccinated are far less likely to contract rabies. However, it is recommended that even those who have been vaccinated seek medical care to have 2 booster vaccines on day 0 and 3 after exposure.
These vaccine boosters activate the immune system more quickly. If you have not been vaccinated prior, the treatment consists of a blood product (HRIG) which can be difficult to access as well as 4-5 vaccines over 14-28 days.
You may be recommended to receive a rabies vaccine by your medical provider if you are traveling to a country where you may be exposed to the virus.
The best way to protect yourself from rabies is to avoid touching or patting any mammals including dogs, cats and monkeys and consider a pre-exposure vaccination before you depart overseas. If bitten by an animal, seek medical attention as soon as possible after thoroughly washing the wound.
Follow the Critical Steps After Rabies Exposure mentioned above. Cleanse the wound thoroughly, apply alcohol or iodine if it is available and seek medical attention as quickly as possible. Your insurance company may be able to assist in this process.
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.
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:
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