Rabies is a virus spread from infected animals or humans through bites, scratches and exposure of broken skin to animal saliva. If not properly treated and rabies develops, the disease is nearly always fatal. Rabies is present in most countries in the world. Countries which pose the greatest risk to Australian travellers include India and Bali, however tens of thousands of deaths occur in Asia and Africa every year.
Travellers to rabies affected countries should therefore always avoid close contact with either wild, stray or domestic animals; in particular, dogs, cats, monkeys and bats. Nearly half of those bitten by suspect rabid animals are children under 15 years of age. In general, young children are more likely to approach animals and less likely to report bites and scratches. Because of their small size they also receive worse injuries and are harder to treat.
No tests are available to diagnose rabies infection in humans before the onset of disease therefore all exposures are treated the in the same way.
Vaccination prior to travel can be useful for some travellers.
The most common scenario with rabies is purely an exposure to a bite or scratch from an animal overseas. This is then treated to prevent rabies from developing.
True rabies is an infection of the brain and nervous system, causing confusion, aggressive behaviour, hydrophobia (fear of water) followed by coma and death.
Avoiding exposures to animals remains the best prevention but vaccination is recommended for higher risk travellers.
Yes. Vaccination is highly effective at preventing rabies and makes treatment of an exposure much simpler and less stressful, as well as avoiding the need to use blood products.
There have been some significant changes to Rabies vaccination courses in the last 12 months. WHO now accepts two intramuscular (into the muscle) doses given 7-14 days apart as adequate pre-exposure prevention. This has made access to Rabies vaccination easier and more affordable. A booster dose is still recommended in Australia after 12 months. This is thought to give over 10 years protection.
Following vaccination, if exposure occurs overseas two booster vaccine doses are then given 3 days apart.
Recommendation for pre-travel rabies vaccination is based on an assessment of the likelihood of contact with potentially rabid animals and the availability of adequate and timely healthcare for post exposure treatment. Those considered at high risk are travellers working with animals, those travelling to remote places (where treatment is difficult to find) and those travelling for a long time or living overseas. However, any traveller can decide to vaccinate if there is risk.
India and Bali are where most travellers from Australia are exposed. Timor Leste was recently declared an at risk country.
Those travellers not pre-vaccinated require a more complicated treatment regime to prevent rabies developing. This is often more difficult or impossible to obtain in developing countries.
The first step after any bite or scratch is local treatment of the wound immediately after exposure. This includes thorough washing of the wound with soap and water. Then sterilise the wound with iodine or chlorhexidine. Seek medical advice as soon as possible. Apply pressure to the wound if bleeding, but do not stitch. As soon as possible obtain a course of rabies vaccine following WHO guidelines. Human Rabies immunoglobulin (blood product) is also highly recommended but often not available overseas. Correct treatment soon after exposure to rabies is effective. Deaths only occur when there is a treatment delay, inadequate treatment or no treatment at all.
Once fully vaccinated, the duration of protection is thought to be at least 10 years. For animal workers booster vaccination is recommended every two years. In both instances boosters are required after an at risk event.
Bats, including those in Australia, carry a similar virus to rabies. It is called Lyssavirus. In essence it is prevented and managed in the same way.
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