25 May 2012

Case of human rabies imported into the United Kingdom

The Health Protection Agency (HPA) has reported a confirmed case of human rabies in a London resident who had returned from South Asia. The case is receiving treatment in hospital in the UK. All contacts  have been assessed and offered vaccination if appropriate [1].

In the last 10 years there have been four cases of imported human rabies reported in the UK;

•  2001 – a visitor from Nigeria, who had sustained a dog bite overseas five months previously [2]
•  2001 – a traveller who had returned from the Philippines [3]
•  2005 - a traveller who was bitten by a puppy in Goa, India [4]
•  2008 - a traveller who had returned from working in an animal sanctuary in South Africa [5].

Advice for travellers

Rabies is transmitted following contact with the saliva from an infected wild or domestic animal (including bats), most often via a bite or lick to an open wound.  

Travellers to rabies endemic areas, including South Asia, should avoid contact with wild and domestic animals. If bitten, scratched, or licked by a warm blooded animal, however trivial the wound might seem, the site of exposure (e.g. mucous membrane) should be washed with plenty of soap and water and medical advice urgently sought, even if previously vaccinated. An individual risk assessment will be undertaken to determine the need for post-exposure prophylaxis (PEP) with rabies vaccine and/or immunoglobulin. If medical treatment is not sought while abroad, then it should be sought on return to the UK, even if it is some time after the event. PEP is extremely effective at preventing rabies if you are bitten, even when this is given some time after an exposure.

 

Although rabies vaccine is not routinely advised for all travellers, pre-exposure immunisation should be considered for those who are at increased risk or who are travelling to remote areas where medical care is not readily available. Risk of exposure is increased by type of activity (e.g. running, cycling), occupation (e.g. veterinarians) and longer duration of stay. Children are at increased risk as they are less likely to avoid contact with animals and to report a bite or lick.

Travellers should always seek travel health advice well in advance of their visit overseas to ensure that the risks of all travel associated illness, not just rabies, have been explained. Country specific information, including information on rabies, can be found on the NaTHNaC Country Information Pages.

Advice for health professionals

Human to human transmission has not been reported; the risk of rabies transmission from an infected human to other humans or animals is considered negligible [1]. All those in contact with this imported case have been contacted and offered medical advice.

HPA guidelines on assessment and post exposure management of rabies are available [6].

References

1.Health Protection Agency. Confirmed case of rabies in London. 23 May 2012. Press Release. [Accessed 25 May, 2012]. Available at: http://www.hpa.org.uk/NewsCentre/NationalPressReleases

/2012PressReleases/120523ConfirmedcaseofrabiesinLondon/

2. Johnson N, Lipscomb DW, Stott R et al. Investigation of a human case of rabies in the United Kingdom. J Clin Virol. 2002 Dec;25(3):351-6.

3. Smith J, McElhinney L, Parsons G et al. Case report: rapid ante-mortem diagnosis of a human case of rabies imported into the UK from the Philippines. J Med Virol. 2003 Jan;69(1):150-5.

4. Solomon T, Marston D, Mallewa M et al. Paralytic rabies after a two- week holiday in India. BMJ 2005; 331(7515):469-70.

5. Health Protection Agency. Case if imported rabies in the UK. HPR 19 December 2008 [Accessed 24 May 2012]. Available at: http://www.hpa.org.uk/hpr/archives/2008/news5108.htm#rabies

6. HPA Colindale Clinical Rabies Service, April 2010. [Accessed 24 May 2012]. Available at: http://www.hpa.org.uk/Topics/InfectiousDiseases/Infections

AZ/Rabies/Guidelines/

Links

Health Protection Agency: Rabies

NaTHNaC Health Information Sheet: Rabies

Health Protection Agency: Rabies - Guidelines on pre and post exposure prophylaxis