By Dr Eddy Bajrovic*
The medical world is buzzing over the rarest of events – someone surviving rabies.
The 16-year-old boy from Gurdaspur, in India’s Punjab State, was bitten by a stray dog in late March this year. He subsequently received 4 doses of anti-rabies vaccine, but did not receive the critical initial dose of human rabies immune globulin (HRIG).
Although the teen recently emerged from a four month-long coma, he has neurological damage and is unable to speak, according to a news report.
The unnamed boy is only one of a handful of people known to have survived rabies infection. Experts attribute their survival to a natural immune response, possibly because they were young and were exposed to a less virulent ‘bat variant’ form of the normally lethal virus.
Risk highest in South Asia
This latest rabies ‘miracle’ comes on the eve of World Rabies Day (Sept 28), the annual global awareness-raising event.
In those countries with rabies (and that’s most of the world), World Rabies Day is about reminding pet owners and the wider community of the dangers of rabies and the steps to take if bitten.
In Australia, the message is mainly a warning for anyone travelling overseas, as well as serving to remind those at home not to handle injured bats, which can carry an equally deadly form of rabies called bat Lyssavirus.
The highest rates of rabies infection are found in South Asia – especially India, Pakistan, and Nepal – but also in parts of Southeast Asia and Africa. Rabies also occurs throughout South and Central America, and the Caribbean, as well as across North America and Europe.
Besides Australia, the few countries free of terrestrial rabies include New Zealand, Papua New Guinea, the Pacific islands, the UK, and Ireland.
Kids are most vulnerable
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.
Aussie travellers oblivious to danger
Most Australians are simply not aware of rabies – or how deadly it is. Because they have no experience with rabies back home, they don’t give it a second thought when they travel overseas to a rabies-infected country.
They’re just as likely to pat a puppy or let monkeys climb over them at a temple without realising that a small nip is enough for them to be infected by a disease that, with the exception of medical miracles, is always fatal.
Hundreds of Aussies return from overseas requiring post-exposure treatment for rabies each year. Experience tells us that getting effective treatment – especially getting HRIG – is often very difficult and very expensive. Ironically, it’s particularly difficult in the developing countries where rabies is most common.
For most Aussies abroad, the only option is to cut short their trip and return home to access free HRIG and begin the long process of post-exposure vaccination.
Weighing up your rabies risk
Rabies is 100% preventable, either through effective post-exposure prophylaxis after a bite or scratch (as long as it is done before the onset of symptoms), or through pre-travel vaccination.
There are very effective rabies vaccines which provide long term protection with the routine 3-dose pre-exposure series. Booster doses are not required except for those who may be at higher risk of regular potential exposure to rabies (e.g. occupational risk in animal handlers. The pre-travel vaccine is given at 0, 7 and 28 days, while an accelerated schedule of 0, 7 and 21 day is also possible.
It’s best to discuss rabies vaccination with a doctor experienced in travel medicine. Factors to be weighed up in determining your potential risk include the region/s to be visited, length of stay, type of local transport, and access to adequate medical attention. Generally speaking, travellers who should consider rabies vaccination are those who:
– Are staying in an infected country for longer than a month, especially children.
– 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.
Rabies’ ‘golden rules’
Obviously, it’s better to avoid bites, but it is equally important to know the steps to take if you think you may have been exposed to rabies.
Here are Travelvax Australia’s 3 golden rules on rabies prevention for travellers:
1 – Don’t pat, feed or touch any animals – especially dogs (even puppies) – unless you are 100% certain they’ve been vaccinated against rabies. (This is easier said than done – infected animals are known to attack people passing by.)
2 – If bitten, take immediate steps to prevent infection - wash the wound thoroughly with lots of soap and water, and apply alcohol or iodine. However, don’t bind the wound.
3 – Seek expert medical attention urgently. The medical centre should be able to administer both HRIG and rabies vaccine. (Those not up to date with tetanus vaccination should also receive a booster tetanus vaccine.)
The advantages of being vaccinated
It’s important to remember that even if you’ve been vaccinated, you should still seek post-exposure treatment if bitten. You can’t take any chances with rabies: Every potential rabies exposure is a medical emergency and requires rapid, expert treatment.
The advantage of having had the vaccine BEFORE travel is that you:
- Have more time – around a week, rather than 2 days – to get effective treatment.
- Need only 2 injections, not the 4-5 shots required if you haven’t been vaccinated.
- Do not require HRIG.
They’re three good reasons to consider vaccination if you are visiting a rabies-infected country soon or in the future. Think of it as a life-long investment in healthy travel.
* Dr Bajrovic is the Medical Director of Travelvax Australia.
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 from 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.