Rabies

What is it?

Rabies is spread through a bite, scratch or a lick on broken skin from an infected animal. It is nearly always fatal. Rabies in animals occurs in all continents except Antarctica, although some countries and islands are reported to be rabies-free. In Asia, Africa, Central and South America, classical rabies virus is endemic in stray dogs and is also present in domestic dogs. In Mexico and Central and South America, vampire bats carry the classical rabies virus.

The World Health Organization estimates that between 40,000 and 70,000 human deaths occur worldwide each year following a bite from a rabid animal. Most of these deaths occur in developing countries, particularly in Africa and South East Asia.

Map courtesy of WHO

 Who should get a rabies vaccine?

• Vaccination is advised for all those travelling to risk areas that will be remote and more than 24 hours away from a reliable source of vaccine.
• The risk of exposure increases with the length of stay, and if you are staying for 4 weeks or more in a rabies endemic country you should consider having rabies pre-exposure vaccine before your trip, even if you will have access to medical facilities. Even when pre-exposure vaccines have been received urgent medical advice should be sought after any animal bite. If you have not had a course of pre-exposure rabies you will need a treatment called Rabies Immunoglobulin (RIG) within 24 hours of being bitten. In many countries the availability of rabies RIG is scarce, therefore it is recommended you get a full course of rabies vaccines before you travel.
• Those doing bike rides or runs in risk countries.
• Those who are working with animals abroad.
• You are going to live, travel frequently to or spend long periods in countries with rabies.
• Those at occupational risk. e.g. bats workers.

Every year more than 15 million people worldwide seek treatment following a rabies exposure. Up to 900 UK travellers seek rabies post-exposure treatment, on return to the UK, following a potential rabies exposure every year.

Rabies Vaccine Schedule

Three doses given on Day 0, Day 7 and Day 21 or 28

Booster – every 10 years or if bitten, scratched or licked on an open wound when travelling.

Children – can be given to infants and  children of any age

Cost Per Dose
£52.00 – intradermal route (ID)

£80.00- intramuscular route (IM)

ID or IM rabies? 

Your nurse may recommend the IM route based on your medical history and other risk factors- see below. Children may require the IM route- your nurse will discuss this in more detail at your appointment.

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Rabies Vaccine Shortage

There continues to be  a shortage of rabies vaccine in the UK.

Sussex Travel Clinic can offer the rabies vaccination via the intraderamal (ID) route.

What is the ID route?

A smaller dose of vaccine is given just under the skin and therefore the cost of the vaccine is reduced. ID injection is a less painful method than the usual IM injection method. Intradermal vaccination has been shown to be as safe and immunogenic as intramuscular vaccination but is used ‘off label’ in the UK. This does not mean it is unsafe . ID rabies is approved for use by the World Health Organisation ( WHO). Rabies vaccine administered by ID technique should only be administered by those trained in ID technique. All nurses at Sussex Travel Clinic are trained to give ID injections.

To read more on Rabies and intradermal techinque visit the WHO website.

ID Rabies is given on day 0, 7 and 21 or 28.

Read our rabies blog post to find out why you should get a rabies vaccine.

Watch this video produced by Jane Chiodini – Travel Nurse Specialist to see the benefits of having a course of rabies vaccine before you travel.

 

For further disease and country recommendations information visit:

Travel Health Pro

Post Exposure Rabies Vaccines- What to do if you have a rabies exposure when travelling.

If you have not had any rabies vaccine before travel you will need to get a blood treatment called rabies immunoglobulin (RIG) which
will give you short term protection and a full course of rabies vaccine( 5 doses). You must have RIG if you have a potential rabies exposure such as a bite, scratch or lick on an open wound, and have not had the full pre exposure rabies vaccine course (three injections). There is currently a worldwide shortage of RIG. If you have any kind of exposure while travelling, try to find a main hospital used to dealing with rabies exposures. If immunoglobulin is not available, you need to travel urgently to a country with immunoglobulin supplies for effective treatment. It is important to remember about this shortage when deciding whether or not to have the vaccine before you go. Contact your insurance company immediately if you need rabies treatment.

If you have had a full course of rabies vaccines before you travel, you still need to find a hospital as soon as possible to get two more rabies boosters. Be reassured that having pre exposure rabies before you travel is the best option. No one who has had pre exposure vaccines has ever caught rabies.

First aid after a rabies exposure

• Wash the wound with soap and running water for several minutes
• Apply a disinfectant to the wound such as an iodine solution or 40-70 percent alcohol
• Apply a simple dressing to the wound
• Seek immediate medical advice
• If you have not had a recent tetanus vaccine you may need a booster. You may also need a course of antibiotics.
• Suturing of the wound is not recommended until you have had the wound assessed and started your post exposure rabies treatment.

Post Exposure Rabies Vaccines- What to do if you have had a rabies exposure when travelling and recently returned to the UK.

Sussex Travel Clinic does not routinely offer post exposure rabies treatment. If you have had a rabies exposure when travelling and need to complete a course of rabies vaccine on return to the UK, you can get rabies post exposure treatment free of charge via the NHS. You should contact your NHS GP as soon as possible and tell them that you have had a rabies exposure when travelling. Your GP will be able to access advice and vaccines from the Rabies Reference Laboratory. If you do not have a NHS GP then you can access the same advice and treatment via your local A & E department.