Rabies

How do you know if an animal is infected with Rabies?

In short you don’t. It could look agitated and unwell or it could be a placid cute puppy / kitten. Always assume every animal (mammal) has rabies.

When should I seek medical attention?

If you are bitten or scratched by an animal and the skin is broken. If you are licked on a cut / eyes/mouth seek treatment as it is transmitted through saliva.

What do I do immediately after a bite or scratch?

Scrub the wound with soap and water for approximately 15 minutes, and then apply either a high percent local alcohol or iodine/antiseptic. The idea of this is to try and flush the virus away before it enters the blood stream.  Medical attention and post exposure treatment should be sought immediately.

What happens if I am infected with Rabies?

Once bitten / scratched you have as long as it takes for the rabies virus gets to your nervous system, once there it is fatal. How long it takes to get there differs from situation to situation, but it may be days, weeks, months or rarely even years. If for example you were bitten on your face, it is likely you will have less time than if you were licked on a cut on your toe. If you don’t seek treatment and wait until you had symptoms it will be too late to treat it and it will be fatal.

Why bother having pre exposure vaccines if you have to get vaccines afterwards anyway?

If you’ve had pre exposure vaccines, then if you’re bitten/scratched and infected with rabies your body instantly recognises the virus and starts to fight it.

I’m going to be within 24 hours of a hospital so do I need the vaccines before I go?

You may be within 24 hours of a hospital, but it may not have the treatment (immunoglobulin) you require available.

What treatment do I need if I’m scratched/bitten and have never received a course of pre exposure rabies?

If you have never had the pre exposure vaccines, and are bitten or scratched you need to be assessed immediately that day. You won’t know if the animal has rabies or not so you must always assume it has.  If the exposure is considered medium or high risk then you will require a blood product called immunoglobulin ideally within 24 hours of the bite. This is in simple terms is the pooled blood of approximately 1000 immunised people that is injected around/into the wound. It works by injecting rabies antibodies instantly and directly to where the virus might be and killing it. The problem is that many countries / hospitals don’t have this blood product as it is expensive and in short supply so you may need to fly to another country / home to get it.  Even if you are able to get it, you may not want it as it may be the old style ‘horse’ based blood product or similar or it may not have been stored properly / safely. It can often be a risk receiving a blood product abroad.  The vaccines alone can take time to work so it’s important that you seek immediate medical attention.

What’s the treatment after an exposure if I have the vaccines before I travel?

If you have 3 injections prior to travel you will just require 2 doses of the vaccine 2-3 days apart. Your body will instantly recognise the virus and start to fight it. The vaccine is readily available everywhere. It is advisable that you get this as soon as possible.

I am travelling for a month backpacking. Do I need the Rabies vaccine?

If you are sensible and stay away from all animals then the chance of you getting bitten or scratched is low. If however you are unlucky enough for it to happen, and you haven’t had pre exposure vaccines, your trip will be seriously impacted on. Firstly you will need to find a ‘safe’ clinic that can give you immunoglobulin and/or consider flying to an alternate country. You will also need to find a clinic that can administer the rabies vaccine on days 0, 3,7,14 and 28. This can be a logistical nightmare. If you have 3 vaccines prior to travel, you would just need to find a clinic to administer the vaccine after an exposure on days 0 and 3 – a lot less impact and stress on your trip. This is why most travellers choose to have the pre exposure vaccines.

I leave in less than 7 days is it worth having one vaccine?

If you are travelling to a high risk country and are considered at reasonable risk then one injection is likely to be better than none. In the event that you are bitten or scratched and are unable to obtain immunoglobulin, your body would at least be primed to start fighting the virus and in fact immunoglobulin would most likely be deemed unnecessary thereby lowering your risks of having a blood product. The post exposure vaccines are also likely to work a bit quicker. Ideally if you have one before you travel it would be best to try and complete your pre exposure course while at the destination. www.istm.org lists travel clinics in many countries.