Rabies is spread through bites or licks on broken skin from an infected animal. It is estimated that there are between 50000 and 60000 deaths from rabies worldwide each year. Over half these deaths occur in South East Asia. Rabies is present in over 150 countries worldwide, most other cases occur in Africa and Latin America. According to the World Health Organisation (WHO) it is estimated 10 million people worldwide receive post-exposure treatments each year after being bitten by a suspected rabid animal. Over 99% of rabies deaths in humans are from dog bites. Rabies is nearly always fatal.
Since 2001 there have been 4 deaths in UK travellers. These cases were acquired in Nigeria, the Philippines, Goa and South Africa. 3 cases were dog bites and none of the cases were known to have received pre or post exposure vaccination.
Advice for traveller’s
· If you are travelling to a high risk area for 1 month or more or will be more than 24 hours from treatment or are unsure about the availability and quality of rabies vaccine and rabies immune globulin (RIG) you should consider a course of pre exposure rabies vaccine.
· Certain activities such as cycling and running increase your risk of being bitten. Working with animals aboard carries a high risk.
· You should see you doctor or nurse at least 6 weeks before travel to start the course. Rabies vaccine is administered on days 0, 7 and 21 or 28. If you do not have time to complete the course before travel it is still worth considering starting the course as it will prime your immune system.
· Post exposure vaccination and treatment should be administered as soon as possible, even if you have received pre exposure vaccine. In many counties availability of rabies immunoglobulin are in short supply and therefore a pre exposure course is recommended.
· Pre exposure vaccine does not mean you do not need treatment if bitten. If bitten wash the wound with cold running water for 5 minutes, apply iodine or alcohol to the wound , get to hospital as soon as possible and carry your vaccination card if possible.
· Ensure you have medical insurance in place.