Nipping overseas? Beware of rabies!

So what, I hear you say, we don't have rabies in Australia.
That's true. But, travel overseas to just about any country and there are lots of reasons to keep this deadly disease in mind.

Did you know:

- The rabies virus is found in the saliva of an infected animal. A single bite, scratch, or even lick of an open wound is enough to pass it on.
- The virus attacks the nervous system and travels along the peripheral nerves and through the spinal cord to the brain.
- Symptoms can appear within days, but may take months – even years – to manifest. The initial symptoms include fever, with pain or a tingling, prickling, or burning sensation (paraesthesia) at the site of the wound.
- Once symptoms appear, rabies is invariably fatal.
- Rabies is found virtually everywhere. (The highest rates are in South Asia – especially India, Pakistan, and Nepal – but also in much of Southeast Asia, across North America and Europe, and throughout South and Central America, and the Caribbean. Besides Australia, the few countries free of the rabies include New Zealand, Papua New Guinea, the Pacific islands, the UK, and Ireland.)
- Domestic dog bites cause 98% of rabies fatalities. However, many other domestic or wild mammals can also carry rabies, including bats, monkeys, cats, foxes – even raccoons, skunks, and beaver.
- Children are most vulnerable to rabies and, on average, 100 die every day. Of the estimated 55,000 victims worldwide each year, 60-70% are aged 5-15. Kids are at highest risk because they: (a) play outside and are more likely to encounter animals, (b) are more likely to be bitten around the head (which carries a higher risk of infection), and (c) are less likely to tell a parent that they've been bitten.

Aussies lack rabies awareness
Most Australian travellers are simply not aware of rabies. It's this lack of awareness that sees hundreds of them get bitten by animals each year, according to Dr Ed Bajrovic, the medical director of Travelvax Australia.
"Most Australian travellers have no idea that rabies is a serious a problem that they need to actively avoid," Dr Bajrovic said.
"Because they have no experience with rabies back home, they don't give it a second thought when they travel.
"They're just as likely to pat a puppy in a market or feed monkeys at a temple without realising the potential danger. A single bite is enough for them to be infected by a disease that's always fatal once symptoms appear."
Dr Bajrovic said most travellers only become aware of rabies after they've been bitten, and only then if it's mentioned by a local person or a more experienced fellow traveller.
"For a traveller in a foreign country, the challenge then becomes knowing what to do and finding a place that has the medication on hand to provide rapid post-exposure treatment," he said.
"But, it is not always readily available and when it is, it's usually costly.
"For many travellers, a bite from an animal means returning home early from their trip. It's the end of their holiday."

Study revealed delayed, inadequate treatment
A 4-year Queensland study of 136 travellers potentially exposed to rabies overseas between 2008 and 2012 revealed that less than 1-in-3 received post-exposure treatment and many waited weeks to begin. For many, the treatment they received overseas did not follow recommended protocols.
The study, published in the Communicable Diseases Intelligence (CDI) report, showed that:
- Just over a third (38%) of exposures among travellers involved deliberate interaction with animals.
- 28% of the animal attacks were unprovoked.
- Only 3% were accidental.
Only 31% of those exposed received appropriate first aid at the time of the injury and the average time between exposure and starting treatment was 17 days.
The appropriate first aid is to wash the bite site with soap and water and then apply antiseptic. Dress the wound and attend a medical centre as soon as possible. Of the 46% who began treatment overseas, only 4% received HRIG. Just over half (54%) received a full course of post-exposure treatment in Australia.

The rabies 'golden rules'
For Australians travelling overseas, there are 3 golden rules for rabies:
Firstly, don't pat any animals – especially dogs (even puppies) – unless you are 100% certain they've been vaccinated against rabies. (This is easier said than done – an infected animal may simply attack someone passing by.)
Secondly, if bitten, take immediate steps to prevent infection - wash the wound thoroughly with lots of soap and water, and apply alcohol or iodine, but don't bind the wound.
Thirdly, seek expert medical attention urgently. The medical centre should supply human rabies immune globulin (HRIG) and rabies vaccine (known as 'post exposure prophylaxis').
The good news is rabies is 100% preventable, either through effective and complete post-exposure prophylaxis after a bite or scratch (but before the onset of symptoms), or through pre-travel vaccination.
There is a very effective rabies vaccine that provides long term protection. The 3-dose pre-exposure course is given at 0, 7 and 28 days, while an accelerated schedule of 0, 7 and 21 day is also possible.
Generally, travellers who should consider rabies vaccination are those who:
– Are staying in an infected country for longer than a month, or
– Plan to live overseas – especially in a high-risk country – for an extended period.
– Want the peace of mind of knowing they have the protection that immunisation offers.

The advantages of being vaccinated
However, it's important to remember that even if you've been vaccinated, you should receive post-exposure treatment if bitten.
The advantage of having had the pre-exposure vaccine course is that you have more time – let's say a week, rather than 2 days – to get effective treatment. And, you'll need only 2 injections, rather than the 5-6 shots required by unvaccinated travellers.
Travellers immunised before departure also do not require HRIG, the blood-based product that is typically difficult to obtain overseas and often expensive.
Every potential rabies exposure is a medical emergency and requires rapid, expert treatment.
Rabies vaccination is one of the travel health issues best discussed with a doctor experienced in travel medicine. Regions to be visited, length of stay, type of transportation, access to adequate medical attention, and other factors need to be assessed in deciding if a traveller is likely to be at significant risk of exposure to the virus.
NB – Rabies vaccine currently is in short supply in Australia and regular supplies may not resume until December. If you are travelling overseas and had planned to have the rabies vaccine, we suggest you arrange to do so as soon as possible to ensure stock is available to complete the course.

For more advice on rabies and other vaccinations that may be recommended or required for your journey, call Travelvax Australia's obligation free travel health advisory service on 1300 360 164 (toll-free for landlines). You can also make an appointment for a pre-travel medical consultation at a Travelvax clinic to receive vaccines, any medication required, accessories, and personalised advice tailored to your itinerary and your medical history.