Rabies is a serious viral infection that is spread to humans by being bitten, scratched or licked on a wound or mucous membrane by an infected animal. The infection causes inflammation of the brain and nervous system. It is always fatal once symptoms develop, but can be prevented if treatment is given quickly after exposure. In the UK, rabies is not found in the animal population (except bats) and infections are almost always picked up by travelers abroad.
Tens of thousands of people die each year from rabies, mainly in Asia and Africa, and 40% of people bitten by suspect rabid animals are children under 15 years of age. While rabies can be transmitted by any infected animal to humans, the World Health Organization estimates that dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans.
COUNTRIES AT RISK
Rabies occurs worldwide and more than 15 million people each receive a post-bite vaccination. Human rabies is present in 150 countries and territories and on all continents except for Antarctica. Low risk areas include the UK, mainline Europe, Australia, North America, Japan and Singapore. Travelling to anywhere else in the world carries some risk.
Symptoms normally develop within two to twelve weeks, although it can be as short as four days and as long as one year. Initial symptoms are flu like and include temperature, headache, feeling unwell and scared or anxious. Half of people also get tingling and pain on the infection site. After a few days more severe symptoms begin to develop and the person may experience aggressive behaviour, hallucinations, agitation and producing lots of saliva. Once symptoms develop there is no cure and it is nearly always fatal.
ADVICE FOR TRAVELERS
If you're in a part of the world known to be affected by rabies, always seek medical advice as soon as possible if you're bitten or scratched by an animal, particularly a dog. You can also catch rabies if you have an open wound that is licked by an infected animal. Travelers aboard are advised to avoid contact with animals in infected areas.
If you've been bitten or scratched, you should:
• Wash the wound thoroughly with soap and water under a running tap for 15 minutes
• Apply antiseptic or alcohol to clean the wound
• Leave the wound open
• Go to the nearest hospital or medical center and explain that you've been bitten
All mammals carry the rabies virus, but the following are more commonly infected; dogs, bats, raccoons, foxes, jackals, cats, mongooses and monkeys. Dogs tend to account for the majority of human deaths.
Rabies is vaccine preventable and is given as a course of three injections. It is recommended for travelers to high risk countries and there is no access to prompt and safe medical care or you plan to take part in activities which may expose you to rabies, such as jungle trekking, cycling or running or are planning to stay in the country for more than four weeks. The vaccine is normally given over 3-4 weeks, however if there is insufficient time, and accelerated regime can be given where three doses are given over seven days.
WHAT IS RABIES POST-EXPOSURE TREATMENT?
Once you get symptoms of rabies there is no treatment and has an almost 100% mortality, so treatment needs to be sought as soon as you are exposed. If travelers have been (bitten, scratched or licked) by an animal, you'll need to seek medical advice immediately, in the local country, to determine whether you need to have a course of treatment to prevent rabies, even if you have had a pre-exposure vaccine. A complete course of rabies is four to five vaccines so you may need more vaccines to stay protected. If you have not had any pre-exposure rabies vaccine you will need the full four or five doses and high risk patents may also need immunoglobulins. Once you return to the UK, contact your GP, even if you received treatment abroad as you may need to continue the course of rabies vaccine.
NUMBER OF DOSES
From birth onward: Three doses
second dose given minimum 7 days after first and third dose given minimum 14 days after 2nd dose.
If there is not enough time an accelerated regime can be given where three injections are given over seven days on day 0, 3 and 7
Booster: Low risk-12 months if at continuing risk
High risk- 12 months then every 3-5 years.