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Rabies

Introduction

Rabies is a serious viral infection which affects the brain and nerves. The virus is spread through the saliva of infected animals, usually following a bite or scratch.

Recommendations for Travellers

Before you travel, you should:

If you are travelling to a country where rabies is considered a risk, you should:

  • avoid contact with animals, especially dogs, cats and monkeys
    • some animals can be infected with rabies without being aggressive or behaving strangely
  • be aware that children are more likely to approach animals
    • check them for wounds, and encourage them to tell you if they are bitten, licked or scratched by an animal
  • see the animal bites page for advice on how to prevent being bitten by bats and animals 

Exposure to Rabies

A rabies 'exposure' happens if you are in a country with a rabies risk, and an animal:

  • bites or scratches you, or
  • licks your broken skin, or
  • licks your eyes, nose or mouth

If this happens, you must follow the information below (even if you had rabies vaccines before your trip).

What to do if you think you may have been exposed to rabies virus:

If you think you have been exposed, you should immediately do wound care:

  • wash animal saliva off the skin with soap and water and flush broken skin and wounds under a running tap for several minutes
  • rinse your eyes, mouth or nose thoroughly with clean water if they came in contact with animal saliva
  • apply an antiseptic solution such as iodine or alcohol if available
  • cover any wounds with a clean bandage or dressing, apply pressure if the wound is bleeding heavily

You must seek medical attention as soon as possible for post exposure treatment. A doctor will:

  • assess your wound, and treat it
  • decide if you require antibiotics or a tetanus booster
  • give you the appropriate post-exposure treatment, this will usually involve 4 doses of rabies vaccines given over 3 weeks (if you haven’t been fully vaccinated) and may involve 'Human Rabies Immunoglobulin'

'Human Rabies Immunoglobulin' (HRIG) is a specialised medicine that contains antibodies that can immediately protect you against rabies.

  • Following a rabies exposure in a high risk country it may be recommended as part of the treatment if you never been vaccinated against rabies.
  • This needs to be given as soon as possible after the exposure, so you need to access medical facilities within 24 hours.
  • This treatment is not available in some countries, and may require you having to travel to another nearby country, or even return home to access the necessary treatment.

Rabies vaccination before you travel

A full 'primary' course of rabies vaccines (before travel) consists of three doses given over 3 to 4 weeks.

  • A more rapid schedule of vaccination may be possible if you are due to travel before you can complete the course, you can discuss this option with your travel health practitioner.

If you complete a full 'primary course' of rabies vaccines before you travel you will develop antibodies in your blood against the rabies virus. These will help protect you if you have a rabies exposure, but you must still seek medical attention after a rabies exposure and do immediate wound care.

  • After a rabies exposure you only need 2 extra doses of rabies vaccine given over 3 days:
    • These are booster doses to ensure your antibody levels are high enough to combat the rabies virus.
  • You will not need Human Rabies Specific immunoglobulin (HRIG).

You should consider a course of rabies vaccinations before you travel (pre-exposure) if you:

  • will be living in, or travelling to, a country where rabies is considered a risk
  • are planning on undertaking activities such as trekking, cycling or running in a 'high risk' country, as these increase your risk of being attacked or bitten by an animal
  • will be working or living in remote or rural areas with no easy access to medical facilities
  • will be working with, or regularly handling animals or bats, as part of your job or activities
    • those animals who have been vaccinated will develop antibodies in their blood against rabies virus.

Available vaccines

There are two brands of rabies vaccines available in the UK. These are called:

Overview of the Disease

Rabies is an acute viral infection that infects the spinal cord and the brain. Rabies virus is present in the saliva of infected animals. People are usually exposed to rabies:

  • through a bite or scratch from a rabid animal
  • when an infected animal licks an area of broken skin or licks your eyes, nose or mouth

Dogs are the most common animal that infects humans. Other animals such as monkeys and cats may also spread rabies Bats from all countries are considered to be a rabies risk.

Rabies is found in all continents of the world except Antarctica. Most human cases of rabies occur in Asia and Africa.

The Illness

Without treatment, rabies symptoms may appear around 3-10 weeks after exposure, but may start much sooner or later than this. Once symptoms appear, rabies is almost always fatal.

Early symptoms of rabies might include:

  • a headache
  • a high temperature (fever)
  • feeling weak or generally unwell
  • pain, numbness or tingling at the site of the bite

Symptoms usually progress a few days later and may include:

  • muscle spasms
  • seeing or hearing things (hallucinations)
  • confusion or aggressive behaviour
  • inability to move (paralysis)

Treatment

There is no specific treatment available for rabies once symptoms develop, except for making the person as comfortable as possible.

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