Highland Travel Medicine

Rabies

Rabies

 is a deadly disease, caused by a virus that is transmitted by the bite of a rabid animal to an unimmunized animal. The infected animal bites another animal and the virus is shed into the bite wound, which can acutely get into the nerve ends at the wound and cross into the brain of the victim. After infection, symptoms of rabies may not manifest for 1-3months, maybe longer. Symptoms progress from non-specific findings to paralysis, coma and death. There is no definitive treatment for rabies.

Any mammal can become infected with rabies, but bats and carnivores seem to be the most common animals infected. Dogs tend to be the reservoir in developing countries and bat bites are to most always be presumed infected.

Occurence
Rabies is found in every part of the world, except Antartica. There are endemic areas, such as Central and South America, Africa and Asia, but areas of alarming cases change. The World Health Organization is a good resource for sporadic outbreak. The risk for a traveler increases with journeys to rabies-endemic areas. The exact rate of occurrence is unknown, but suspected to range from 16-200 incidences per 100,000 travelers. Therefore, people should avoid street dogs and monkeys near tourist attractions. Children are at a substantially higher risk of being bitten by a rabid animal. Parents of traveling children should reinforce the important of avoiding strange animals and avoid feeding the animals.

Prevention
The best way to prevent rabies is to avoid being bitten by any animal. Do not pet or feed wild or strange animals. If there is a significant risk of exposure, there is a vaccine available. If a wild animal bites you, immediately wash the area with clean water, then wipe with antiseptic cleaner (such as alcohol or iodine). Seek immediate medical attention.

Vaccination
Prior to travel, one may chose to vaccinate himself against rabies. This is a three part series: Day 0, Day 7 and Day 28. This allows the body to make enough antibodies to rabies, that if a traveler were bitten by a rabid animal while abroad, the traveler would have enough immunity to only require two more rabies vaccine post exposure. This allows the traveler to forgo the need for Rabies Immunoglobulin (RIG), which is a shot of antibodies gathered from a pool of hyper-immunized volunteers. RIG is difficult to locate, expensive and may not be available in foreign countries. However, RIG is absolutely necessary if no pre-exposure vaccines were given. If someone who is unimmunized is bitten by a rabid animal, he must receive the RIG dose as soon as possible and a series of rabies vaccines on Day 0, 3, 7, 14 and 28. The vaccine is approved for all ages and is not contraindicated in pregnant women.