What is Rabies?
Rabies is a fatal viral infection of the brain, which is passed from animals to humans. Unfortunately there is no cure for rabies once the disease has developed and virtually all those infected will die.
Countries in our region, which are particularly affected, are Indonesia (Bali), India, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. Rabies free countries include Singapore, Taiwan and Japan.
Travelers should avoid contact with all mammals, particularly dogs, cats, monkeys and bats. Children in particular need supervision as they will be unaware of the potential danger.
Although post-exposure treatment is possible (see below) it is essential to understand that such treatment must be commenced within 48 hours of exposure, and requires Rabies Vaccine and HRIG (Human Rabies Immunoglobulin), which are rare and may not be readily available near the place of exposure.
There is a world shortage of HRIG and access to this medication is difficult even in Singapore. HRIG is also very expensive.
First aid advice if exposed
Bites, scratches and licks to open wounds and abrasions by animals should be washed for up to twenty minutes with warm soapy water immediately. This is believed to decrease the risk of transmission of the virus by 90%. Then you must seek urgent medical advice from the local health authorities. The wounds will need further medical treatment and you may need a tetanus vaccination as well. Contact your regular doctor or travel medical insurance hotline to coordinate your care.
Rabies vaccination prior to travel
Travelers should consider rabies vaccination prior to their journey. Pre-exposure vaccination is mandatory if the risk of exposure to animals is high, e.g. zoologists, botanists, cavers etc.
The pre-exposure vaccination program involves three injections of the rabies vaccine over 28 days. You need a further two vaccinations if actually exposed to rabies, however you do not require HRIG (Human Rabies ImmunoGlobulin). We therefore recommend the pre-exposure rabies vaccination to all those who are at high risk of exposure and traveling in countries where rabies is a problem. Because the vaccine is expensive and most tourists feel that they are at low risk, they frequently decline the pre- exposure immunization and opt for the post-exposure vaccination instead.
Post exposure vaccination if exposed
Post exposure vaccination does exist for rabies and this must be commenced within 48 hours of the bite or scratch to ensure effectiveness.
The treatment consists of HRIG (Human Rabies Immunoglobulin) injected into the wound and a course of 5 rabies vaccinations over 28 days.
Problems experienced by patients requiring post-exposure treatment include:
- Limited access to medical care whilst traveling.
- The possibility that Rabies Vaccine and/or HRIG is not available in the country of travel.
- A world shortage of HRIG and access to this medication quickly is difficult — even in Singapore. HRIG is also very expensive.
- Cheaper versions of the medication are used in some countries, (e.g. equine). These have a greater chance of adverse reactions or side effects.