Rabies – what you need to know

Rabies in Thailand

The rabies virus has been detected across 40 provinces in Thailand including popular tourist areas, Bangkok and Chiang Rai. Three infected people have died this year. Rabies is passed on to humans from infected animals and is almost always fatal.

Authorities say the outbreak is “under control” and aim to vaccinate 10 million dogs and cats by September. The World Health Organisation say vaccinating dogs is the most effective means of preventing rabies in humans however warns travellers about dogs and cats throughout Thailand.

Dr TY Ho explains more about the virus and what action to take if you think you might be infected:

What is rabies?

Rabies is a viral illness that causes inflammation of the spinal cord and brain. It is spread mostly by dogs but can also be carried by cats, bats, monkeys and other mammals. You don’t even need to be bitten to get it. Exposure can occur from the saliva of an animal lick on a scratch or mucous membranes. Being scratched by the animal is also a possible mode of transmission of the virus. Untreated rabies is almost invariably fatal. Death can occur within days of the onset of symptoms (typically wild behaviour, a fear of water and suffocation). The duration between exposure to the onset of symptoms depends on how close the wound is to the brain and can range from days to many weeks.

It is endemic in Asia, though thankfully Singapore has been free of this since 1953. Further to the current outbreak in Thailand, two young siblings died of rabies in Sarawak in 2017. A young French girl also succumbed to rabies in Cambodia in 2015. Rabies has been endemic on the tourist island of Bali since 2008.  Almost 25,000 people die from rabies in SE Asia annually – that’s 45% of the world’s rabies deaths.

A study in Thailand was done on 870 foreign backpackers. Of the 870 individuals surveyed only 18% had received rabies vaccine but 3% had already been bitten by an animal during their trip. Trips with lots of outdoor activities or where there are many stray dogs are at higher risk.

Mitigating the risk of rabies and what action to take if you think you might be infected:

  1. Consider pre-exposure vaccination. Although not cheap, the three required doses are still far cheaper than the post-exposure treatment with rabies immunoglobulin. The vaccines take 3-4 weeks to complete so you should plan to get them at least 4-6 weeks before your tip. The vaccine is now thought to last a lifetime but at the point of exposure, an additional two more doses are needed. Immunoglobulin is not required for those who have had the vaccine. Pre-exposure prophylaxis is especially important if you are travelling to to areas where good medical care is not easily available.
  2. Always thoroughly clean the wound with plenty of soap and water for five minutes. Wash exposed mucous membranes with plenty of water.
  3. Get medical attention as quickly as possible. If not previously vaccinated, the immunoglobulin should be administered within the next few days. A delay of a week renders this treatment useless. You will also need at least four doses of the rabies vaccine over a few weeks. For monkey (macaque) bites, there is also the risk of Herpes B virus that will need to be treated for.
  4. Many medical providers do not have access to rabies immunoglobulin and if you are unable to find this you will need to arrange for immediate evacuation to a provider who does have it.
  5. Avoid animals (including pets) when travelling. Children are at higher risk of exposure as they may approach animals and may not report exposure should it occur. Furthermore, bites tend to be closer to the head hastening the spread of the virus.
  6. Always seek medical aid as soon as possible.

If you are planning on going to Thailand and have not had a rabies vaccine please visit one of our IMC Clinics and discuss with a Doctor.

Dr TY Ho is based in IMC Camden.
For appointments please call 6733 4440


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