IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

Paul Filitchkin - dog

Rabies: A global and travel health issue

Rabies around the world

Rabies is a global health issue with a long history. One of the earliest developments in vaccine research was Louis Pasteur’s discovery of how to artificially reduce, or attenuate, a virus’ virulence which he used to successfully administer the first post-exposure rabies treatment in 1885.

The virus that causes rabies is present on all continents except Antarctica. While only specific travellers may need pre-exposure rabies vaccinations, rabies remains a significant and complicated public health issue in many countries.

Most human rabies infections in developing countries – the majority occurring in Asia and Africa – are caused by dog bites, and vaccination of domestic and feral dogs is an effective way to reduce the risk. Many mammals like bats, monkeys, skunks, foxes, raccoons, coyotes, and wolves can also transmit rabies, which is a risk for travellers planning outdoor activities. The WHO estimates that over 15 million people worldwide receive post-bite vaccinations every year.

Avoid risks, prevent rabies

Rabies is a viral infection transmitted by an infected animal’s saliva through scratches or bites. The virus attacks the Central Nervous System targeting the brain and the spinal cord, and if untreated, is fatal.

Luckily, there are many precautions you can take when it comes to preventing rabies. Avoid contact with any animal, including feeding or petting monkeys at temple sites.

If you are bitten or scratched, clean the wound with soap and water thoroughly as soon as possible then pour an antiseptic and irrigate with water. Seek medical attention immediately.

Keeping your distance from animals may not be realistic on ecotourism trips, or if you’re planning activities like cave exploring, camping, trekking, and visiting farms. Moreover, rabies can also be an occupational hazard for veterinarians and wildlife researchers. In these cases, your health provider or travel clinic may recommend that you get the pre-exposure rabies vaccine series.

Rabies is an especially significant risk to children. The WHO reports this sobering statistic: 40% of people who are bitten by suspected rabid animals are children under 15 years of age. Children are more likely to play with animals and get bitten so they should be cautioned not to pet animals and told to report scratches or bites to an adult immediately. Emphasize that they should not be scared or ashamed to report a bite or scratch.

Ed Gregory - wild monkey Vaccination and HRIG

If you get the three pre-exposure vaccine series (given over 3 or 4 weeks), it provides adequate initial protection, but you will require 2 additional post-exposure doses if you are exposed to rabies. The pre-exposure series simplifies medical care if you have been bitten by a rabid animal and gives you enough time to travel back from a remote area to seek medical attention.

If you do not have the pre-exposure shots, you will need human rabies immunoglobulin (HRIG) plus 4-5 rabies vaccine shots, depending on your health status (given over 3 or 4 weeks). HRIG is in short supply worldwide, so having the pre-exposure rabies vaccine series is critical if you are in areas where HRIG is not available.

Note that in remote communities with poor healthcare, post-exposure vaccination and HRIG may not be available or may be beyond the financial reach of local medical facilities. HRIG is very expensive to produce in large quantities. Plasma needs to be collected from humans who have been immunized against rabies, and not everyone produces high enough concentrations of rabies antibodies for production purposes. After undergoing an extended purification process, the plasma needs to be screened for any remaining infectious agents like viruses. As a result, production can’t keep up with the worldwide demand, especially in resource-limited countries, making it a neglected tropical disease.

Photos (top to bottom) by Paul Filitchkin, Pexels and Ed Gregory, Stokpic.


More information about rabies

Rabies information for travellers – IAMAT

Rabies – World Health Organization

World Rabies Day – Global Alliance for Rabies Control (GARC)

 

By Tullia Marcolongo and Daphne Hendsbee.

Travel Health Journal