IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

IAMAT - The International Association for Medical Assistance to Travellers

Travel and Rabies: An Ongoing Concern

When rabies comes up in conversations, it’s often in veterinary clinics where our pets are vaccinated against infection. Rabies however, is also a major concern for travellers.

More than 150 countries report rabies in their animal population putting humans at risk. The majority of human rabies cases are reported from Asia and Africa and 99% of cases are from dog bites. The World Health Organization estimates that 55,000 people die annually, although the illness is often misdiagnosed or under-reported. On a positive note though, the WHO states that 15 million people worldwide receive the post-exposure vaccinations, preventing an estimated 327 000 deaths annually.

It’s not only travellers going on eco-tourism or adventure expeditions that are at risk. In many cities, stray dogs, cats, monkeys, and bats come into contact with humans. They may seem cute and harmless, but it is imperative not to touch or feed mammals (or any other animals for that matter) during your trip.

The rabies virus belongs the Rhabdoviridae family and is transmitted to humans through bites or scratches by infected mammal saliva. If you do get exposed to the virus, symptoms will start appearing anywhere from less than 1 week to 3 months, and rarely, up to several years after being bitten. Symptoms include a tingling or burning sensation around the wound accompanied by fever. The illness progresses to the central nervous system culminating in the inflammation of the brain and spinal cord. If you are not vaccinated or treated immediately, rabies is fatal.

Here’s how to prevent animal bites:

  • Avoid approaching, feeding, or touching stray mammals.
  • Try not to disturb, accidentally surprise or frighten an animal. Often, their instinct is to protect themselves by biting.
  • If a dog is charging at you, picking up a rock (or pretending to) will often deter an attack.
  • If visiting areas where monkeys run loose such as temples, ruins, or in the jungle, do not eat or carry food near them since they will jump on you.
  • If you travel with children, consistently ask them if they have any scratches or bites. Sometimes they forget or are too shy to report them.

If you are bitten:

  • Wash the bite with copious amounts of soap and water. If available, apply povidone iodine (brand name Betadine). In fact, this product should be included in your travel medicine first aid kit.
  • Seek medical attention immediately.

Depending on the type of travel (aid work, missionary, nature field work, archeology, eco-tourism, cave exploring), length (long-term, repeat travel), destination (where rabies is endemic or where there is limited access to emergency medical care) you may want to get the rabies pre-exposure vaccination series – you get vaccinated three times prior to your trip and twice after, if you are bitten by a rabid animal.

If you do not get the rabies pre-exposure shots, you will need five injections of the rabies vaccine. In addition, rabies immune globulin (RIG) will need to be injected into your bite wound. Note however, that RIG is in short supply worldwide and is likely not available in remote regions. It is therefore highly recommended that you get the rabies pre-exposure vaccinations before leaving for a trip if you are going to high risk areas.

For a complete list of countries with rabies risk and protection recommendations, see IAMAT’s World Immunization Chart or our online listing.