Travel Information on Rabies

Although human rabies is rare in the United States, there are over 35,000 deaths worldwide each year. Rabies is a viral disease that is primarily of animals, both domestic and wild. In developed countries the risk is less because of programs to vaccinate domestic animals that could carry the disease from wildlife to their owners. The virus is spread though contact with an infected animal's salvia through bites, scratches, or mucus membrane exposure. Even in developed countries travelers should avoid unnecessary contact with animals. Rabies can be prevented with prompt, proper post-exposure treatment. Once the disease develops, rabies is fatal.

The following may assist a traveler in making informed treatment decisions.

Wound Treatment
The wound should receive immediate attention. Scrubbing and irrigation of the wound with soap and water can mechanically decrease the amount of virus in the wound. Applying povidone-iodine is also helpful. Cleansing the wound does not eliminate the need for post-exposure treatment.

Evaluation of Risk
Because many countries lack standardized laboratory procedures or materials, testing of the animal to determine need for treatment, if even possible, may not produce accurate results. Observation of the animal for ten days is effective for only dogs, cats, and ferrets. The safe observation period for all other animals is unknown. Bats frequently carry rabies and their bite can go undetected because of their needle like teeth. Finding a bat in the room with a sleeping or impaired individual or a young child would indicate that an exposure might have occurred and treatment is recommended.

Types of Vaccine
There are several types of rabies vaccine used around the world and their effectiveness and safety vary. Both human rabies immune globulin (HRIG) and tissue culture derived vaccine is necessary for recommended post-exposure treatment. In many locations the traveler may only be offered nerve tissue derived vaccine. Nerve tissue derived vaccine is not as effective and has a high risk of side effects. When nerve tissue derived vaccine is the vaccine available, the traveler should react as if rabies vaccine is not available and make plans to travel to a location that has tissue culture derived vaccine. A delay in starting vaccine of one to two days is acceptable. US consulates usually know whether post-exposure therapy is available. In some areas the traveler may be offered tissue culture derived vaccine but no HRIG. Purified equine rabies immune globulin may be used in its place, but only if HRIG is not available. Travel may be necessary to obtain HRIG. Vaccine can be started and the HRIG be given up to seven days later.

Post-exposure Treatment
Treatment should be started as soon as possible. HRIG is instilled into and around the wound to the extent anatomically feasible and the remainder of the dose is injected, usually in muscle of hip area. Vaccine is also given at the same time at a different location on the body. Vaccine is given on days 0, 3, 7, 14, and 28. Steroids or medication taken to prevent malaria can affect development of immunity. The treating physician should be made aware of your medications.

Pre-exposure Treatment
Receiving proper treatment while traveling has obstacles and for that reason pre-exposure treatment may be recommended for travel to some areas of the world. Pre-exposure vaccination will eliminate the need for HRIG because the vaccine has already produced immunity that can be readily boosted after exposure to a potentially rabid animal. Vaccine given intramuscularly produces longer lasting and higher immune response than the smaller dose that is given intradermally. Evaluation for need for booster should be made for vaccine given in the past.