05 Apr 2018

Worldwide rabies risk reminder

A reminder for travellers of the worldwide risk of rabies Worldwide rabies risk reminder

TravelHealthPro is reminding travellers of the worldwide risk of rabies. Human rabies is present in 150 countries and territories and on all continents except for Antarctica [1, 2].

Tens of thousands of people die each year from rabies, mainly in Asia and Africa, and 40% of people bitten by suspect rabid animals are children under 15 years of age. While rabies can be transmitted by any infected animal to humans, the World Health Organization estimates that dogs are the main source of human rabies deaths, contributing up to 99% of all rabies transmissions to humans [1].

Advice for travellers

Rabies is a virus spread by contact with saliva from any infected wild or domestic animal (including bats) often via a bite, scratch or a lick to an open wound. Human rabies is usually fatal.

All travellers should avoid contact with any wild and domestic animals, including pets. Pre-exposure vaccine can be considered by adults and children at increased risk of rabies or who are travelling to remote areas where medical care and rabies post-exposure treatment with rabies vaccine may not be available.

Risk of rabies exposure increases with activities like cycling and running. Certain jobs, including vets, animal control and wildlife work are a significant risk. Volunteering in animal sanctuaries is also high risk. Longer stays increase risk of exposure. Children are at greatest risk, as they are most likely to touch animals, and may not report being bitten, scratched or licked.

As soon as possible after an animal bite, scratch or a lick to open skin, the wound/area must be flushed under a running tap for several minutes, then thoroughly washed with soap/detergent and water to remove saliva. A disinfectant such as 70% alcohol or iodine solution needs to be applied and the wound covered with a simple dressing. If animal saliva exposure (usually by spitting) to mucous membranes such as eyes, nose or mouth has occurred, wash thoroughly with clean water as soon as possible [3]. Urgent medical help must be sought, even if the wound or incident seems very trivial. Prompt post-exposure treatment is needed, even for travellers who already had a full pre-exposure vaccine course, as further vaccine doses are necessary.

Travellers who did not have, or did not complete a rabies vaccine course before travel may need treatment with a blood product called rabies immunoglobulin, as well as a full vaccine course after any potential exposure. In many world regions, both rabies immunoglobulin and vaccines are unavailable. An urgent flight to the UK/nearby country for appropriate treatment and vaccines is then required. Travellers must ensure they have comprehensive travel insurance that covers medical evacuation costs.

Travellers and health professionals can check our Country information pages, vaccine recommendation section to see if rabies is present in bats, wild animals and/or domestic animals at the specific destination.

Advice for health professionals

All travellers to countries where rabies is known or presumed to occur should be advised of the importance of first aid and of seeking urgent reputable medical attention if they are bitten, scratched or licked by any mammal. This advice is important for all travellers, whether or not pre-exposure vaccine was given.

Expert advice and guidance on assessing risk following rabies exposure including post-exposure treatment and public health management of a suspected rabies case in:

  • England and Wales - available from: Public Health England (PHE). Health professionals should contact the PHE Rabies and immunoglobulin service on 020 8327 6204
  • Northern Ireland - available from: Public Health Agency (PHA). Health Professionals should contact the Regional Virology Service or the PHA Duty Room: 028 9024 0503 or 028 9055 3994/7 [3].
  • Scotland - available from Health Protection Scotland (HPS). Health professionals should contact their local infectious disease unit.

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