Travelling with kids? Remember rabies

By Tonia Buzzolini*

My kids, Giacomo and Kiara love animals, especially dogs. Here they are with Aramis, our big, boofy Doberman, who they adore.
Which makes it very difficult to convince them that they can’t pat dogs – even cute little puppies – when we holiday overseas. 
Why do I worry about my children around dogs? Rabies.
Rabies occurs just about everywhere and, if left untreated, is virtually always fatal. The vast majority of deaths are caused by dogs, although cats, bats and other mammals are capable to being infected and passing on the deadly virus to people.
When an animal gets rabies the virus is carried in their saliva. When it bites another animal or a person, the virus passes into the wound and travels via nerve fibres to the brain, causing irreversible brain damage. Less commonly, infection can also occur from a scratch if the animal’s paw is contaminated with its saliva, or by licking a wound or the victim’s mucous membranes (i.e. their eyes, nose or mouth).

Why kids are at higher risk

Children aged 5-15 are at highest risk of getting rabies: Indeed, they account for 60-70% of the estimated 55,000 rabies deaths worldwide each year. There are several reasons:
- Kids are drawn to animals and vice versa (it’s probably something to do with kids spending more time outdoors or perhaps because they are closer in size to each other).
- Children’s smaller stature means they are more likely to be bitten on or around the head or neck. Skin in this area has lots of nerve endings, providing more pathways for the virus to reach the brain more rapidly than from elsewhere in the body.
- Having been warned to stay away from animals, kids may be reluctant to admit to being bitten, scratched or licked – probably to avoid getting roused on by mum or dad. (Or they just forget to mention it!) Whatever the reason, rabies is fatal once the symptoms appear.

We are alert to rabies risk

Being a registered nurse working in travel medicine, I’m a believer in the protective power of vaccines. My kids are covered for all the routine childhood immunisations, as well as the basic travel vaccinations.
However, they aren’t vaccinated against rabies.
It’s not a matter of cost: If rabies was going to be a risk, they’d be vaccinated. But, it hasn’t been necessary to this point because we’ve never travelled extensively in a country with a significant risk of rabies, or lived in one.
Which puts the onus squarely on my husband, Patricio and I to be alert to any possible exposures to the disease when we travel.

Take no chances – get expert help

Here are my Rabies Rules for parents heading overseas:
- Discuss rabies vaccinations with the doctor and seriously consider getting your kids covered.
- Don’t allow your kids to pat, feed, or touch any animals – especially dogs – unless you are 100% certain they’ve been vaccinated against rabies. (This is easier said than done. You can be more confident in a developed country with high levels of canine vaccination. But, in developing countries, infected animals could be a household pet or a stray that simply attacks people passing by or wanders into an area where kids are playing.)
- Dog, cat, bat, whatever… be suspicious of all animal bites, licks, or scratches until proven otherwise.
- 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.
- Seek expert medical attention urgently: Every potential rabies exposure should be regarded as a medical emergency requiring rapid, expert treatment. (The medical centre you contact should be able to administer both human rabies immune globulin (HRIG) and rabies vaccine. If not, they should be able to direct you to one that can. A tetanus booster is also advisable, if required.)

South Asia is world’s rabies hotspot

With rabies, there’s no margin of error. It’s virtually 100% fatal if left untreated, yet prompt treatment by a medical professional is 100% effective.
Rabies occurs in North America, Europe, South and Central America, and the Caribbean, the highest rates are found in South Asia – especially India, Pakistan, and Nepal – and parts of Southeast Asia and Africa.
Besides Australia, the few countries free of rabies include New Zealand, Papua New Guinea, the Pacific islands, the UK, and Ireland.
(While we don’t have rabies in Australia, we do have a closely related virus called Lyssavirus, which is mainly found in fruit bats. People who are bitten or scratched while handling infected bats need a precautionary course of rabies vaccinations, although human deaths rare.)

Vaccine offers long-term protection

Hundreds of Aussies return from overseas requiring post-exposure treatment for rabies each year. Getting effective treatment is often both very difficult and expensive, particularly in the developing countries where rabies is most common.
For many Aussies travellers, the only option is to cut short their trip and return home to begin the long process of post-exposure vaccination.
There are very effective rabies vaccines which provide long-term protection with the routine 3-dose pre-exposure series. Pre-travel, the vaccine is given at 0, 7 and 28 days, while an accelerated schedule of 0, 7 and 21 days is also possible. 
According to the WHO, vaccination with cell-culture derived rabies vaccine provides long-term immunity of at least 10 years and booster doses are not required for those travelling to, or living in, an area with high rabies risk if they’ve completed a primary course (either pre- or post-exposure). However, boosters are recommended for those who may be at ongoing occupational risk.

Who should be protected? Ask an expert

Who should get the vaccine? The region/s to be visited, length of stay, type of local transport, and access to adequate medical attention are all factors to be weighed up when considering rabies vaccination.
It’s best to talk to a doctor experienced in travel medicine.
For the most part, vaccination is recommended for those (a) staying in an infected country for longer than a month, or less in the case of children, or (b) planning to live overseas – especially in a high-risk country – for an extended period.
However, travellers of any age who regularly get off the beaten track might simply want the peace of mind the vaccine offers.

Advantages of pre-travel vaccination

It’s important to remember that even if you’ve been vaccinated, you should still seek post-exposure treatment if bitten.
The advantage of having already had the vaccine is that you:
• Need only 2 injections, not the 4-5 shots required if you haven’t been vaccinated.
• Do not require HRIG.
If the circumstances warrant immunisation against the risk of rabies, having the vaccine provides parents with peace of mind. Think of it as a long-term investment in healthy travel for your kids.

* Tonia Buzzolini is the National Operations Manager 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.