Understanding Rabies: A Vital Travel Health Advisory

What Is Rabies and Why Is It Important?

You need to know about rabies because the threat of rabies can seriously spoil anyone’s trip.

Rabies is a viral disease that affects the central nervous system, causing inflammation of the brain and death. It is usually transmitted through the bite, scratch, or lick of an infected animal. The rabies virus is present in mammals in most resource-poor countries. Rabies is not present in Australia except in the occasional flying fox.

Important Notice for Travellers

Getting an animal bite while overseas is literally a nightmare. If you are bitten, and not correctly treated, you will die. Thankfully, of course, few travellers die, but it is not uncommon for travellers to suffer a bite, scratch or lick over open wound. At which point there is a threat of rabies. This can ruin a trip. Trying to get adequate treatment, worrying about the disease, finding treatment, and experiencing pain and suffering from the treatment is all very stressful.

I know this is a long post but I must declare my bias – I have spent a lot of time helping travellers who have been bitten in countries where Rabies treatment is not readily available. They are very stressed.  I want travellers to understand about rabies so it does not happen to you.

Australians are generally in “blissful ignorance” about rabies – until something happens, and then the nightmare begins. Generally, in countries with rabies disease, best practice treatment is not easily available.

If you will be travelling to an area where rabies is present you need to

• Understand rabies disease and how it is contracted
• Know what to do if you are bitten
• Seriously consider having PRE-vaccination for rabies before you go.

Rabies Disease and How It Is Contracted

The disease is transmitted by an animal bite, scratch or lick over an open wound. Sometimes the bites are VERY small. Rabies can be found in mammals in many countries. Dogs are the most common cause of rabies in people, but cats, monkeys, bats, and other mammals can also carry the virus. Rats are rarely reported to carry rabies, but any mammal in a rabies area should be considered potentially infected.

“Don’t pat animals ” is not a solution. Many travellers are not “patting animals” when they are bitten; they are just doing the usual travel activities: walking on a beach or around a temple, getting out of a taxi, taking photos, shopping, or dining.

Rabies risk exposures are actually more common than catching the disease Hepatitis A (and yet we consider vaccination against Hepatitis A to be essential for all travellers).

Rabies exposures DO occur on short overseas trips. It’s not that short trips are especially risky, there are just more short trips.

Even vaccinated animals can sometimes carry rabies. A study in Thailand showed that 3-6% of rabid dogs had been vaccinated. Never delay vaccination while waiting to observe the animal for signs of rabies.

It is, in fact, almost impossible to accurately predict who will get bitten. Sometimes it just happens “out of the blue”.  Australian travellers need to be aware of this disease.

What To Do If You Have An Exposure

If you are bitten, scratched, or licked by a mammal while overseas in a rabies-infected country… this is a serious matter!

URGENT medical care is required or you might die: If you wait to get treatment until after you get symptoms, it will be too late – there is no possible treatment.

It is also important to know that Rabies disease can incubate for many years after the bite before symptoms appear.

If you have never had a rabies vaccination, and you have an exposure, you need a product called RIG (Rabies Immune Globulin) injected into the wound, PLUS a rabies vaccine at day 0, 3, 7 and 14 days.

The RIG gives you instant protection while your body processes the vaccine. RIG is commonly a blood-based product which raises the spectre of contamination.  Storage of vaccines in poorer countries can also be suspect.

If you have had PRE-exposure rabies vaccination, it greatly simplifies the treatment after an exposure.  The main benefit of pre-exposure rabies vaccination is that you don’t need the RIG, and you only need two more doses of vaccine. Rabies vaccine is relatively easy to get overseas whereas RIG is not.

The safest rabies vaccines are modern ones administered in the arm. Older, animal brain-based vaccines, which are cheaper and given in the stomach, cause more side effects. Always ensure injections are administered with sterile needles and syringes.

If you are back in Australia and you have had a bite or risk exposure while overseas you need to seek medical care immediately from a healthcare provider experienced in managing rabies-prone wounds. If you are in Australia,  state health departments eg Queensland Health currently fund post-exposure rabies vaccinations.  For our patients, post-exposure vaccinations are available at our clinic. My staff and I regularly treat travellers exposed to rabies risk and have the vaccine in stock. If you need Rabies Immunoglobulin (RIG) in Australia, it can usually be obtained within 24 hours from the health department.

For more information, visit the WHO Rabies page here.

More info about who needs rabies vaccine

Cost of rabies vaccine here

Rabies vaccine – how many doses 

Info about lyssavirus in Australia

If you are travelling overseas, or wish to discuss Rabies vaccination or ensure you are up to date with your Rabies vaccination – book an appointment with one of our doctors today.