Travellers

Travel Health Information Sheets

                                                 

Updated September 2012

Rabies

 

                                        Photograph courtesy of Hilary Simons

What is rabies?

Rabies is a fatal illness caused by a virus that spreads to humans from contact with animal saliva. This can happen when an infected animal bites or scratches you.

Rabies can be carried by any mammal living on land. This includes pets, domestic animals such as guard dogs and wildlife. If you are in a country with rabies and are bitten, scratched, licked on open skin (such as a cut or patch of eczema) or an animal spits in your face, you are at risk. You must carry out the recommended emergency first aid and see a doctor or nurse as soon as possible.

Signs of rabies usually appear 20 to 90 days after you are bitten or scratched. Very rarely, signs of rabies can appear very quickly (in a few days) or may be delayed for several years.

Symptoms start with:

  • Fever, head and muscle ache

  • Extreme tiredness.

  • Numbness and tingling can occur at the site of the bite/scratch.

As the virus spreads through the body, the disease either develops into ‘furious’ or the less common ‘dumb’ rabies. There is no treatment.

A person with furious rabies can have anxiety, confusion, hallucinations, hyperactivity and seizures (fits). Fear of water, throat spasms and inability to drink, usually with a feeling of extreme terror, develops. Coma and death follow in the next few days.

Weakness and paralysis, spreading across the body from the site of the bite/scratch is seen in dumb rabies. Muscles gradually become paralysed, coma slowly develops and your heart and lungs fail. Death occurs within weeks.

Once symptoms develop, nothing can stop rabies and both types are fatal. The World Health Organization estimates that between 50,000 and 60,000 people die of rabies every year worldwide.

Where is Rabies?

Rabies is found all over the world, apart from Antarctica:  

Click here to view bigger map (opens in a new window 325KB PDF)

                    Map courtesy of the World Health Organization 2012.

Rabies in wild animals, especially foxes, has spread through mainland Europe. Animal vaccination campaigns have helped reduce this, but rabies remains common in Eastern Europe and Turkey.

Since 1902, there have been 24 deaths from rabies in travellers from the UK. The three most recent British deaths were: a tourist who visited India for two weeks (2005), a volunteer at an African animal sanctuary (2009) and a lady who visited family in South Asia (2012). All of these travellers became ill and died after they returned home to Britain.

Rabies vaccine: before you travel

The rabies vaccine is a course of three injections, which need to be started at least 21 days before you go. These injections are given into the muscle of your upper, outer arm. If you do not have enough time to finish the course, still see your doctor or nurse to discuss having one or two doses.

Your travel clinic or GP surgery can advise if you need the vaccine course before your trip. Travel agents are not usually qualified to give vaccine advice and may not be aware of current rabies recommendations.

Rabies vaccine is recommended if:

  • You live, travel frequently to or spend long periods in countries with rabies.

  • You cycle or run in risk areas.

  • Your work puts you at risk.

If your only risk of rabies is travel, once you have had the three dose course, you may not need any more doses of the vaccine, unless you have any potential rabies exposure. Seek advice from your doctor or nurse.

 

If your job involves animal contact  - if you are a vet, dog handler, work in a zoo, are a customs officer or if you volunteer in an animal sanctuary or handle bats, you need booster doses of the vaccine after your initial course. Working with the rabies virus in a laboratory also significantly increases your risk. Get advice from your doctor or nurse if think your job puts you at risk of rabies. As well as booster injections, you may need regular blood tests to check your level of protection.

There is a worldwide shortage of an injection made from blood that gives immediate short term protection against rabies (this is called rabies immunoglobulin). You must have this injection if you had a potential rabies exposure and have not had the full rabies vaccine course (three injections). If you have any kind of exposure while travelling, try to find a main hospital used to dealing with rabies exposures. If immunoglobulin is not available, you need to travel urgently to a country with immunoglobulin supplies for effective treatment. It is important to remember about this shortage when deciding whether or not to have the vaccine before you go.

Carry your rabies vaccination record when you travel. You must show this to the doctor or nurse treating you after any potential rabies exposure. You will need more doses of the vaccine after any potential exposure, but you will not need the rabies immunoglobulin injection.


How can I prevent rabies?

Get advice about having the pre-exposure vaccine course before you travel.

Avoid ALL animals in risk countries:

  • Do not touch or stroke any animals, even pets.

 

  • Avoid wild animals that are ill or seem unusually tame.
  • Cycling and running attracts animals, especially stray dogs.
  • NEVER feed animals.
  • Dispose of litter carefully; this helps you avoid attracting scavenging animals.
  • Immediate first aid measures are important after any exposure – then get urgent medical treatment, even if you think the risk is low:

 

Emergency first aid after a bite/scratch/lick:

Wash the bite/wound - ideally by flushing it under running tap water for at least 15 minutes.

Do not scrub the wound.

Clean it with lots of soap or detergent. This is to try to get rid of any infected animal spit (saliva).

Apply disinfectant - neat alcohol or iodine solution.

Do not cover or applying pressure to the wound - this to stop any rabies virus being pressed further into the body.

If an animal spits in your face, immediately splash your face with lots of water to stop saliva getting into your eyes, mouth or nose.

Get to a doctor or clinic as soon as possible. Do not delay, even if you had the full 3 dose vaccine course previously.

Avoid getting bites or scratches stitched - this can damage the wound and increases the risk of introducing rabies virus into your body’s nerves.

Are there any risks from the Rabies vaccine?

Rabies vaccine has been given safely for many years. Most people do not experience any problems or side effects. Very occasionally, mild reactions can occur, including:

  • Sore arm (at the site of the injection).

  • Head and muscle aches.

  • Mild fever.

Who should not have the vaccine?

As with any vaccine, there is a risk of allergic reaction, but this is very rare. You must tell your doctor or nurse if you have ever had a severe allergic reaction to a previous dose of the rabies vaccine (or any vaccine) or any of the ingredients in the vaccine. Allergic reactions are uncommon.

What if I cannot have the vaccine?

This is extremely unlikely, but if you are unable to have the vaccine, you must be very careful to avoid contact with animals in risk countries. You must get urgent medical attention after any potential exposure, no matter how low risk it seems.

                         Photograph courtesy of the National Geographic.

Where can I get more information about Rabies?