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Rabies Rare but Deadly

This year saw the first fatality in the UK from rabies for a number of years. The question many people planning travel ask is; ‘if it is so rare, why do more and more travel clinics recommend the vaccine for independent travellers?’

Earlier this year a grandmother in her fifties was bitten by a puppy in India. On her return she started to develop symptoms and despite eventually being diagnosed with rabies, she sadly died a few days later.


Rare, but Deadly

Like so many independent travellers, the lady from Kent had not been given the vaccine prior to travel. The vaccine it is not available for free on the NHS and private travel clinics or your GP may charge £100 - £180 to administer it; enough to put many people off.

Many travellers dismiss the threat of rabies, it is not something we are very familiar with in the UK; being an island, we have been lucky to be free of rabies for decades. The last fatality from an infection following a dog bite which occurred on UK soil, was over 100 years ago, in 1902.

So with the UK being effectively rabies free, there is a very low level of awareness of the dangers. The rest of the world, especially Asia and Africa, are much more familiar with the threat and with over 55,000 deaths occurring each year from rabies, you can understand why; 40% of these, are in children under 15 years of age.

Some leading experts in this field believe that this estimate of 55,000 fatalities world-wide is a gross underestimation; the vast majority of the cases are in resource poor areas, where the cause of death may often never be investigated.

However it is known that 10 million people receive post-exposure treatment and over 350,000 lives are saved annually from rabies worldwide, by the administration of the vaccine and Immunoglobulin treatment.

The important message when it comes to rabies is; infection may be rare in UK travellers, but it is also deadly. However rabies is not rare and is considered to be the 10th biggest killer from infection worldwide.


Avoid Domestic, Stray and Feral Dogs

Rabies is transmitted either through the bite of an infected animal carrier which penetrates the skin or from an infected animal’s saliva (through a lick or other contact) entering the body via a scratch or abrasion on the victim.

Effectively the infected animal’s saliva (or blood in extreme circumstances) has to get into the human victims bloodstream, but it generally will not penetrate undamaged skin; now think to yourself, is there anywhere on your body where the skin is damaged in any way…. the answer is probably yes…

Rabies can also be transmitted through human mucous membranes (the eyes, nose or mouth) coming into contact with the saliva of an infected animal, such as through a lick or other contact.

Rabies is transmitted by infected mammal carriers, including bats, cats, racoons, skunks, wolves and other wild canine species. However the vast majority of fatal rabies cases are from infected domesticated dog species; 99% of fatal rabies cases are from domestic, stray or feral dogs.

Rabid dogs will behave either very aggressively or be overly friendly and can sometimes be identified by excess of foaming from the mouth, but this symptom is not always present.


The First 24 Hours are Crucial

The incubation period for rabies varies from a few days to many years. It can depend on where the bite is on the body, as the virus has to travel from the wound infected area to the brain; it is once it reaches the brain that the victim will start to display the symptoms.

The human symptoms of rabies include; headache, fatigue, fever, muscle spasms, hydrophobia (a fear of water), delirium, convulsions, hyperactivity, paralysis, inflammation of the brain, coma, respiratory failure, death.

Symptoms are what usually save us from the worst consequences of an illness or infection, it is the body’s way of telling us something is wrong. Unfortunately with rabies, once the symptoms are displayed it is nearly always too late to save the victims life.

It is critically important to get medical attention as soon as a possible after a rabies infection has occurred; don’t delay, with rabies the first 24 hours are crucial.

If you are bitten or come into ‘contact’ with a potential carrier in an endemic area, even if no symptoms are displayed, seek qualified medical assistance and insist on treatment. Rabies has been known to lie dormant in the human body for years, before suddenly and for no apparent reason, the symptoms start; in the vast number of cases the death of the victim follows shortly after.

If you are bitten by a dog or other potential carrier in an area where rabies is endemic or known to be present, immediately wash the contact point for at least 5 minutes with plenty of water and soap or detergent. Then apply ethanol (alcohol), iodine tincture or aqueous iodine solution and seek urgent medical treatment; make sure you explain that you have been bitten / licked by a potential carrier of the disease in an endemic area.

On an open wound allowing some limited bleeding can also help, avoid immediate stitching, staples or tight bandages. This limited bleeding can sometimes drain some of the infected saliva from the wound rather than allowing it to make its way into the body. It must be said that there is a fine balance between the benefit of allowing a wound to bleed and the harm from excessive bleeding on the body or risking a more severe outcome from blood-loss.


Rabies Vaccination

The rabies vaccination works a little differently to other vaccinations. The full vaccination comes in a series of 5 injections, 3 pre-travel jabs and if infection is suspected 2 post-infection injections.

The 3 pre-travel injections don’t actually provide a barrier to infection, but rather just gives the recipient a little more time to get the last two shots of the vaccine course, if they are infected by a carrier. The three pre-travel injections are given over the course of 4 weeks.

It is this idea that the vaccine for rabies doesn’t actually provide a barrier to infection which some people give as another reason for not having it.

However if you are bitten by a rabid dog and are unvaccinated you will require Immunoglobulin (horse or human blood product containing antibodies) which can cost £600 - £1000 and is very difficult to obtain or unavailable in some countries. If you have not been vaccinated, it is important to obtain the Immunoglobulin within 24 hours and then follow it up with the standard 5 shot vaccination.

In many endemic areas, vaccinations and especially immunoglobulin can be scarce, especially in resource poor countries; it may not even be available in the major capital cities. If none is available it may be worth contacting the British consulate, they may in some circumstances be able to help you source a supply, but this should not be relied upon and they certainly will not have any stock or priority access to medications.

It is this lack of availability in much of the rest of the world and the urgency with which treatment is required that makes the rabies vaccination such an important line of protection against infection.

Those who receive post infection treatment having had the original pre-infection vaccination also have a better survival rate than those who receive the Immunoglobulin and subsequent 5 injection vaccinations.


Prevention Better than Cure

It is estimated that 70% of those who are bitten by dogs during travel never seek treatment, despite rabies being just one of many infections which can be transmitted through an animal bite.

As with all medical risks, it is always better to avoid the virus rather than relying on treatment.

With the vast majority of infections coming from domestic, stray or feral dogs, it is strongly recommended that you do not interact with these animals in areas of the world where rabies is endemic (see WHO map for details).

Don’t rely on your instincts when deciding which dogs to stroke and which to avoid, instinctively we avoid aggressive dogs, but are attracted to friendly tame ones. The effect of the rabies on dogs can be either to make them very aggressive or over friendly. Trust the knowledge that any dog in an endemic region may be a rabies carrier. Avoid all contact with unusually friendly, tame or aggressive dogs.

Try to avoid attracting dog to your living / working quarters. Don’t feed them or leave scraps of waste food around which might attract strays or feral dogs.

Puppies may seem cute and cuddly, they are just but as likely to carry rabies as the less ‘cute’ dogs. It is thought that the grandmother who died earlier this year was infected by a puppy.

Do not rely on bandages and plasters as a barrier, but covering any open wound, scratch and abrasion will be beneficial and help reduce the chance of accidental infection.

Keep wounds dry, clean and use appropriate anti-sceptic products. In tropical / humid climates wounds can take much longer to heal, meaning wounds can be ‘open’ a lot longer and turn septic, this makes infection from a rabies carrier easier.

It is a fact that about 15% of all travellers to Thailand, a country where rabies is endemic, come into contact with a dog during their stay. Thailand gets 850,000 visitors (FCO statistics 2011) from the UK every year, therefore in Thailand about 125,000 people come into contact with a potentially infected animal.


Consider the Merits of a Rabies Vaccination

The decision as to whether to get a vaccination for rabies before you travel is one we recommend you make in conjunction with your GP rather than a travel clinic. The vast majority of travel clinics will also provide great information, but they are commercial companies where there can be a commercial pressure influencing decision making.

If your GP recommends that you obtain the vaccination, they may still have to direct you to a private travel clinic in order to obtain the vaccination, but at least you will have obtained an independent opinion.

The risk factors you should discuss with you GP are:

  • Your destination – is it an endemic rabies area (see WHO map for details).
  • Vaccination / Immunoglobulin availability at your destination(s) –is it possible to get post-infection and post-vaccine treatment at your destination.
  • Duration of travel – How long will you be in the endemic area
  • Type of accommodation – will you be staying with locals, local accommodation, camping, hostels, guest houses or hotels?
  • Your planned activities – Will you be undertaking work during your travel, if so would that work be ‘high-risk’ working in resource poor areas or working with animals.



The rabies vaccine may be very expensive, but the rabies virus is deadly. You may think you can’t afford to get vaccinated; but can you afford not to?

Important Information: The experts at Safe Gap Year are not qualified medical practitioners or travel doctors. Any information provided on specific medical issues is done in good faith and on the basis of our own research and experience. Anyone planning travel should consult their doctor prior to travel and seek a qualified up-to-date medical opinion.


Source


Author – Peter Mayhew is the Managing Director of Safe Gap Year. He delivers independent travel safety training and provides expert advice on all issues of travel safety to individuals, organisations and public bodies. Peter is a frequent contributor to travel industry publications and media organisations.

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